Research Review: Hip and Abdominal Strengthening May Improve Postural Stability in Females with Patellofemoral Pain Syndrome
By Tristan J. Rodik, M.AT, ATC
Edited By Brent Brookbush, DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS
Original Citation: Carry, P. M., Gala, R., Worster, K., Kanai, S., Miller, N. H., James, D., Provance, A. J. and Carollo, J. J. (2017) Postural stability and kinetic change in subjects with patellofemoral pain after a nine-week hip and core strengthening intervention. The International Journal of Sports Medicine, 12(3), 314-323 FULL ARTICLE
Introduction: Patellofemoral Pain Syndrome (PFPS) has been correlated with gluteus maximus and gluteus medius (glute complex ) weakness, and patients often respond favorably to specific exercise for strengthening these muscles (1-14). Human movement professionals and researchers often use the single-leg squat as a functional task to identify movement impairments, including glute complex weakness (15-18). This study by Carry et al. (2017) demonstrated improvements in patient reported pain, foot center of pressure (balance) during a single leg squat, peak knee power and peak knee flexion angles, after a 9 week, progressive hip and abdominal strengthening program. Human movement professionals may consider movement assessment, abdominal strengthening and hip strengthening programs for patients/clients exhibiting signs of PFPS.
Study Summary
Study Design | Cross-sectional intervention study |
Level of Evidence | IIA Evidence from at least one controlled study without randomization |
Participant Characteristics | Demographics: Patellofemoral Pain Syndrome (PFPS) Group
Demographics: Control Group
Inclusion Criteria: PFPS Group
Inclusion Criteria: Control Group
Exclusion Criteria: PFPS Group
Exclusion Criteria: Control Group
|
Methodology | Self-Reported Symptom Severity
Lower-Extremity Function
Physical Therapy Intervention
|
Data Collection and Analysis |
|
Outcome Measures |
|
Results | Demographics
Pre-Intervention (PFPS Group verse Control Group)
Pre- verse Post-Intervention Changes for the PFPS Group
Post-Intervention (PFPS Group verse Control Group) |
Our Conclusions | This study demonstrates that a progressive glute complex and abdominal strengthening program can improve reported pain, balance, peak knee power absorption, and peak knee power generation in individuals with PFPS. This study is congruent with the methodology used by the Brookbush Institute which includes glute complex and abdominals activation for those individuals exhibiting Lower Extremity Dysfunctions (LEDs), such as PFPS. |
Researchers' Conclusions
|
Participants with PFPS noted improvements in CoP range, peak knee power absorption, and peak knee power generation after a 9-week physical therapy intervention. Upon completion of the intervention, self-reported symptoms also significantly improved. CoP measures may be an effective tool for evaluating progression during an intervention in those with PFPS. |
Kneeling Chop
How This Study Contributes to the Body of Research:
This study contributes to a body of research investigating glute complex and core strength and patellofemoral pain syndrome (PFPS) (5, 6, 10, 11, 13, ). A relatively unique combination of outcome measures was evaluated in this study including pain, strength, balance, peak knee power generation, and peak knee power absorption, and the PFPS group was compared to a group of pain-free controls. Although this study did not evaluate electromyographic or kinematic variables (ex. knee valgus, contralateral pelvic drop), it does demonstrate that glute complex , core strength , and the resolution of PFPS symptoms has a significant impact on key performance variables.
How the Findings Apply to Practice:
This study supports the implementation of functional assessment and progressive glute complex and core strengthening for those exhibiting signs of PFPS. The exercises used in this study are similar to exercises commonly seen in practice, and the programs were individualized for volume (reps, sets, tempo, load) (19-22). Human movement professionals should consider integrating functional assessment and progressive glute complex and core strengthening into routines for individuals with PFPS looking to reduce pain and increase performance.
This study had many methodological strengths, including:
- Exercise volume (sets, reps, tempo) was tailored to each participant's needs in accordance with an assessment; similar to the program design commonly used by human movement professionals.
- The single-leg squat assessment was used for functional testing which is widely used and easily implemented by human movement professionals. Further, the use of the single-leg squat assessment in this study aids in validating the use of functional movement assessments in practice.
- The exercises selected used minimal equipment (resistance band) improving replicability for future researchers and applicability for human movement professionals.
Weaknesses that should be noted prior to clinical integration:
- A cohort of 7 participants is extremely small; any changes in practice implied by the study should be carefully assessed and re-assessed.
- The tests selected by the physical therapists in the study were not well described; therefore, it is uncertain the specific tests used for range of motion and manual muscle testing .
- EMG analysis was not included in the study which makes it difficult to compare the results of this study to previous studies.
How this Study Relates to Brookbush Institute Content:
The findings of this study are consistent with the Brookbush Institutes' (BI) predictive models of Lower-Extremity Dysfunction (LED) , Lumbopelvic Hip Complex Dysfunction (LPHCD) and Sacroiliac Joint Dysfunction (SIJD) . These models of movement impairment imply that functional testing , range of motion testing and manual muscle testing for the muscles discussed in this study may be beneficial. Further, glute complex and core strengthening are also implied by the models. BI always recommends an integrated approach to assessment and intervention, and has suggested in prior studies that addressing dysfunction is not only beneficial for rehabilitation but performance as well. The improvements in balance, peak knee power generation, and peak knee power absorption may support this assertion.
Sample Videos Related to the Research Content:
Gluteus Medius Manual Muscle Testing
Gluteus Medius Activation Circuit
Side Stepping for Gluteus Medius Reactive Activation
Recommended Readings:
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