The Role of Hip Muscle Function in the Treatment of Patellofemoral Pain Syndrome

  • Tyler T
  • Nicholas S
  • Mullaney M
 et al. 
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630 Patellofemoral pain syndrome (PFPS) is one of the most common disabilities of the knee joint in sports medicine. 9,21 Many nonoperative approaches have been developed to treat this pain syndrome, but no single intervention has been demonstrated to be the most effective. 3 For many years, the nonoperative treatment approach has been to address abnormal patellar tracking and/or malalignment; this method typically includes quadriceps strengthening, patellar bracing and taping, soft tissue mobilization, and stretching. Unfortunately, the results of this treatment approach have been mixed. 3,11,25 As early as 1976, Nicholas et al 22 recognized the importance of hip strength in this injury condition. Patients with patellofemoral pain demonstrated significant weakness in their hip flexors during seated hip flexion strength testing. Such findings suggest a possible inability of the hip muscu-lature to control femoral rotation during activities resulting in PFPS. Hip flexor weakness may not adequately provide a stable pelvis during gait to prevent the pelvis from going into an anterior pelvic tilt and concomitant femoral internal rotation. In addition, the iliopsoas muscle is a secondary femoral external rotator, and weakness may allow the femur to be positioned in relative internal rotation, misaligning the trochlear groove with the patella. It has recently been suggested that patellar subluxation during weightbearing activities may be the result of the femur rotating under-neath the patella in the transverse plane. 27,30 The purpose of this study was to objectively evaluate if a nonoperative treatment program emphasizing open and closed kinetic chain hip strength and flexibility exercises resulted in decreased patellofemoral pain. Specifically, the study sought to identify if changes in hip strength and flexibility were related to treatment outcome. Background: Previous literature has associated hip weakness with patellofemoral pain syndrome.

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  • Timothy F Tyler

  • Stephen J Nicholas

  • Michael J Mullaney

  • Malachy P McHugh

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