Research Review: Altered Hip and Trunk Muscle Function in Those with Patellofemoral Pain Syndrome
By Tristan Rodik, M. AT., ATC
Edited By Brent Brookbush, DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS
Original Citation: Cowan, S. M., Crossley, K. M. and Bennell, K. L. (2009) Altered hip and trunk muscle function in individuals with patellofemoral pain. British Journal of Sports Medicine, 43, 584-588 Abstract
Introduction: Patellofemoral pain syndrome (PFPS) is a common injury that may result from inhibited hip and quadriceps muscle function (1-15). This 2009 study, conducted in Australia, investigated gluteus medius strength and activation, lateral core strength, and hip rotation range of motion in participants with and without PFPS. The findings demonstrate that individuals with PFPS have decreased lateral core strength and delayed activation of the gluteus medius and vastus medialis oblique when performing a step-up test. Human movement professionals may consider adding assessments and techniques to their repretiore, for addressing these impairments.
Knee Pain Referral Pattern
Study Summary
Study Design | Cross-sectional, observational design |
Level of Evidence | III Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies |
Subject Characteristics | Demographics: Patellofemoral Pain Syndrome (PFPS) Group
Demographics: Control Group
Inclusion Criteria (PFPS Group):
Inclusion Criteria: Control Group
Exclusion Criteria (PFPS):
Exclusion (Control Group): |
Methodology | Electromyographic (EMG) Analysis
Self-reported Pain Rating
Stepping Task
Hip Rotation Range of Motion (HRROM)
Hip External Rotation Strength
Hip Abduction Strength
Lateral Core Strength
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Data Collection and Analysis |
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Outcome Measures |
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Results | Descriptive Characteristics
Control Group (Performing the Step-up Task)
PFPS Group (Performing the Step-up Task)
Strength Testing
Hip Rotation Range of Motion (HRROM)
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Our Conclusions | This study identified weakness in lateral core strength and delayed gluteus medius and VMO activity in individuals with PFPS. The findings of this study are congruent with the model and intervention described in Lower-Extremity Dysfunction (LED). |
Researchers' Conclusions
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This study found significantly decreased lateral core strength in the PFPS group compared to the control group. The PFPS group demonstrated delayed gluteus medius and VMO activation during the step-up task. Hip rotation range of motion values did not vary among groups. |
Knee Joint Anterior to Posterior Mobilization
How this Study Contributes to the Body of Research:
This study further contributes to a growing body of research regarding patellofemoral pain syndrome (PFPS) and activity of the gluteus medius , gluteus maximus , vastus lateralis , and vastus medialis (1-15). Relatively unique to this study, recruitment timing was measured in conjunction with electromyographic (EMG) data, revealing delays in the activation of the gluteus medius . Further, this study included EMG analysis of the glute complex , the vastus medialis oblique (VMO) vastus lateralis, lateral core muscle strength, and hip rotation range of motion. The inclusion of peak activity and timing of multiple muscles, along with range of motion aids in aggregating trends noted in other studies, allowing for a more complete understanding of the impairments that develop in this group.
How the Findings Apply to Practice:
This study revealed reduced lateral core strength and delayed gluteus medius and vastus medialis oblique (VMO) activation during a step-up task in individuals with PFPS. It should be noted that the side plank used for lateral core strength assessment could also be affected by gluteus medius strength. Human movement professionals should add assessments and interventions for these impairments to the evaluation and treatment of PFPS.
This study had many methodological strengths, including:
- Researchers were blinded to data and participant group assignment, diminishing the potential for observer bias.
- The step-up task , hip abduction , and lateral strength testing used in the study are easily replicable in practice.
- The rapid decision making that participants were required to make as part of the step-up task helped reduce the possibility that participants prepared for the movement.
Weaknesses that should be noted prior to clinical integration:
- A small cohort of 10 participants made up the PFPS group, reducing the generalizability to a wider population.
- Although range of motion (ROM) was not significantly different between groups, the position used to assess ROM was unusual and has not been established within current literature as reliable nor valid.
- Muscle activation was not represented as a percentage of maximum voluntary isometric contraction, making it difficult to compare findings across other studies focused on the same muscle groups.
How This Study Relates to Brookbush Institute Content:
The study findings are congruent with The Brookbush Institute's (BI) predictive models of Lower-Extremity Dysfunction (LED), Lumbo Pelvic Hip Complex Dysfunction (LPHCD) , and Sacroiliac Joint Dysfunction (SIJD) . An integrated approach is recommended for the assessment and intervention of PFPS. The Brookbush Institute recommends dynamic postural assessment , manual muscle testing , and range of motion assessment similar to those used in the study; however, BI has not recommended specific assessment of lateral core strength. More consideration will be needed to determine practicality, reliability, and effect on intervention selection of this test. Gluteus medius activation and vastus medialis oblique (VMO) activation are commonly recommended for individuals with PFPS.
Sample Videos Related to the Research Study Content:
Gluteus Medius Manual Muscle Testing (MMT) for an Active Population
Isolated Activation of the Gluteus Medius
Vastus Medialis Obliques Activation Progressions:
Side-Stepping Progressions for Gluteus Medius Reactive Activation
Side-Plank Progressions
Recommended Readings:
- Introduction to activation exercises .
- Gluteus medius activation during common rehabilitation and injury prevention exercises .
Bibliography:
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2018 Brent Brookbush©
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