The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial. The Effects of Quadriceps Strengthening on Pain, Function, and Patellofemoral Joint Contact Area in Persons with Patellofemoral Pain Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up. The effect of hip and knee exercises on pain, function, and strength in patientswith patellofemoral pain syndrome: a randomized controlled trial. The effect of taping, quadriceps strengthening and stretching prescribed separately or combined on patellofemoral pain. Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial. Comparison of five isometric exercises in the recruitment of the vastus medialis oblique in persons with and without patellofemoral pain syndrome. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomised, single-blind controlled trial Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol The Efficacy of Treatment of Different Intervention Programs for Patellofemoral Pain Syndrome–A Single Blinded Randomized Clinical Trial. Pilot Study Effectiveness of hip abductor strengthening on health status, strength, endurance and six minute walk test in participants with medial compartment symptomatic knee osteoarthritis. A controlled trial of weight-bearing versus non-weight-bearing exercises for patellofemoral pain. Efficacy of live feedback to improve objectively monitored compliance to prescribed, home-based, exercise therapy-dosage in 15 to 19 year old adolescents with patellofemoral pain- a study protocol of a randomized controlled superiority trial (The XRCISE-AS-INSTRUcted-1 trial) Analysis on the activation of the VMO and VLL muscles during semisquat exercises with and without hip adduction in individuals with patellofemoral pain syndrome. Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial.
Objectives : To study the effect of additional strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise rehabilitation programme for patients with the patellofemoral pain syndrome . Design : R and omized controlled pilot trial . Setting : Clinical setting with home programme . Participants : Fourteen patients with patellofemoral pain syndrome . Intervention : The subjects were r and omly assigned to the intervention group ( strengthening of quadriceps plus strengthening of hip abductor and lateral rotator muscles ) or to the control group ( strengthening of quadriceps ) . Both groups participated in a six-week home exercise protocol . Main outcome measures : The perceived pain symptoms , isokinetic eccentric knee extensor , hip abductor and lateral rotator torques and the gluteus medius electromyographic activity were assessed before and after treatment . Parametric and non-parametric tests were used to compare the groups before and after treatment with α=0.05 . Results : Only the intervention group improved perceived pain symptoms during functional activities ( P=0.02—0.04 ) and also increased their gluteus medius electromyographic activity during isometric voluntary contraction ( P=0.03 ) . Eccentric knee extensors torque increased in both groups ( P=0.04 and P=0.02 ) . There was no statistically significant difference in the hip muscles torque in either group . Conclusion : Supplementation of strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise programme provided additional benefits with respect to the perceived pain symptoms during functional activities in patients with patellofemoral pain syndrome after six weeks of treatment STUDY DESIGN R and omized clinical trial . OBJECTIVES To determine if females with patellofemoral pain syndrome ( PFPS ) who perform hip strengthening prior to functional exercises demonstrate greater improvements than females who perform quadriceps strengthening prior to the same functional exercises . BACKGROUND Although PFPS has previously been attributed to quadriceps dysfunction , more recent research has linked this condition to impairment of the hip musculature . Lower extremity strengthening has been deemed an effective intervention . However , research has often examined weight-bearing exercises , making it unclear if increased strength in the hip , quadriceps , or both is beneficial . METHODS Thirty-three females with PFPS performed either initial hip strengthening ( hip group ) or initial quadriceps strengthening ( quad group ) for 4 weeks , prior to 4 weeks of a similar program of functional weight-bearing exercises . Self-reported pain , function , and functional strength were measured . Isometric strength was assessed for hip abductors , external rotators , and knee extensors . A mixed-model analysis of variance was used to determine group differences over time . RESULTS After 4 weeks , there was less mean ± SD pain in the hip group ( 2.4 ± 2.0 ) than in the quad group ( 4.1 ± 2.5 ) ( P = .035 ) . From baseline to 8 weeks , the hip group demonstrated a 21 % increase ( P<.001 ) in hip abductor strength , while that remained unchanged in the quad group . All participants demonstrated improved subjective function ( P<.006 ) , objective function ( P<.001 ) , and hip external rotator strength ( P = .004 ) from baseline to testing at 8 weeks . CONCLUSION Both rehabilitation approaches improved function and reduced pain . For patients with PFPS , initial hip strengthening may allow an earlier dissipation of pain than exercises focused on the quadriceps STUDY DESIGN R and omized clinical trial . OBJECTIVES To compare the effects of functional stabilization training ( FST ) versus st and ard training on knee pain and function , lower-limb and trunk kinematics , trunk muscle endurance , and eccentric hip and knee muscle strength in women with patellofemoral pain . BACKGROUND A combination of hip- and knee-strengthening exercise may be more beneficial than quadriceps strengthening alone to improve pain and function in individuals with patellofemoral pain . However , there is limited evidence of the effectiveness of these exercise programs on the biomechanics of the lower extremity . METHODS Thirty-one women were r and omized to either the FST group or st and ard-training group .  Patients attended a baseline assessment session , followed by an 8-week intervention , and were reassessed at the end of the intervention and at 3 months after the intervention . Assessment measures were a 10-cm visual analog scale for pain , the Lower Extremity Functional Scale , and the single-leg triple-hop test . A global rating of change scale was used to measure perceived improvement . Kinematics were assessed during the single-leg squat . Outcome measures also included trunk endurance and eccentric hip and knee muscle strength assessment . RESULTS The patients in the FST group had less pain at the 3-month follow-up and greater global improvement and physical function at the end of the intervention compared to those in the st and ard-training group . Lesser ipsilateral trunk inclination , pelvis contralateral depression , hip adduction , and knee abduction , along with greater pelvis anteversion and hip flexion movement excursions during the single-leg squat , were only observed in the FST group after the intervention . Only those in the FST group had greater eccentric hip abductor and knee flexor strength , as well as greater endurance of the anterior , posterior , and lateral trunk muscles , after training . CONCLUSION An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain , physical function , kinematics , and muscle strength compared to a program of quadriceps-strengthening exercises alone STUDY DESIGN R and omized clinical trial . OBJECTIVE To investigate the influence of strengthening the hip abductor and lateral rotator musculature on pain and function of females with patellofemoral pain syndrome ( PFPS ) . BACKGROUND Hip muscle weakness in women athletes has been the focus of many recent studies and is suggested as an important impairment to address in the conservative treatment of women with PFPS . However , it is still not well established if strengthening these muscles is associated with clinical improvement in pain and function in sedentary females with PFPS . METHODS Seventy females ( average±SD age , 25±07 years ) , with a diagnosis of unilateral PFPS , were distributed r and omly into 3 groups : 22 females in the knee exercise group , who received a conventional treatment that emphasized stretching and strengthening of the knee musculature ; 23 females in the knee and hip exercise group , who performed exercises to strengthen the hip abductors and external rotators in addition to the same exercises performed by those in the knee exercise group ; and of the 25 females who did not receive any treatment . The females of the nontreatment group ( control ) were instructed to maintain their normal daily activities . An 11-point numerical pain rating scale ( NPRS ) was used to assess pain during stair ascent and descent . The lower extremity functional scale ( LEFS ) and the anterior knee pain scale ( AKPS ) were used to assess function . The single-limb single hop test was also used as a functional outcome to measure preintervention and 4-week postintervention function . RESULTS The 3 groups were homogeneous prior to treatment in respect to demographic , pain , and functional scales data . Both the knee exercise and the knee and hip exercise groups showed significant improvement in the LEFS , the AKPS , and the NPRS , when compared to the control group ( P<.05 and P<.001 , respectively ) . But , when we considered minimal clinical ly important differences , only the knee and hip exercise group demonstrated mean improvements in AKPS and pain scores that were large enough to be clinical ly meaningful . For the single-limb single hop test , both groups receiving an intervention showed greater improvement than the control group , but there was no difference between the 2 interventions ( P>.05 ) . CONCLUSION Rehabilitation programs focusing on knee strengthening exercises and knee strengthening exercises supplemented by hip strengthening exercises were both effective in improving function and reducing pain in sedentary women with PFPS .  Improvements of pain and function were greater for the group that performed the hip strengthening exercises , but the difference was significant only for pain rating while descending stairs . LEVEL OF EVIDENCE Therapy , level 1b- Objective Patellar malalignment is a major cause of patellofemoral pain syndrome ( PFPS ) , but the relationship between clinical symptoms and changes in patellar position and knee muscle strength has not been confirmed . This study examined the effect of weight training on hip and knee muscle strength , patellofemoral joint contact area , and patellar tilt on subjects with and without PFPS , hoping to develop an optimal rehabilitation protocol for subjects with PFPS . Design The study uses a prospect i ve independent group comparison . Fifteen subjects with and without PFPS were assessed for knee strength , patellofemoral joint contact area , and patellar tilt angle using magnetic resonance imaging . The subjects with PFPS were also examined and given a numeric pain rating score and a Kujala patellofemoral score . The subjects performed lower-limb weight training 3 times/wk for 8 wks , and the outcomes were assessed both before and after training . Results Subjects with PFPS have increased their patellofemoral joint contact area after weight training ( P < 0.001 ) . No statistical significant change was found on the patellar tilt angle . The isometric and isokinetic knee strength in subjects with and without PFPS have increased after weight training ( P value increased from 0.007 to 0.05 ) . Both numeric pain rating and Kujala patellofemoral score in the PFPS group improved after training ( P < 0.001 ) . Conclusions Weight-training exercise increased knee muscle strength and the patellofemoral joint contact area , which could reduce mechanical stress in the joint , improving pain and function in subjects with PFPS STUDY DESIGN R and omized controlled trial . OBJECTIVES To determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome ( PFPS ) . BACKGROUND Recent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS . However , there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises . METHODS Fifty-four sedentary women between 20 and 40 years of age , with a diagnosis of unilateral PFPS , were r and omly assigned knee exercise ( KE ) or knee and hip exercise ( KHE ) .  The women in the KE group ( n = 26 ; mean age , 23 years ) performed a 4-week conventional knee-stretching and -strengthening program . The women in the KHE group ( n = 28 ; mean age , 22 years ) performed the same exercises as those in the KE group , as well as strengthening exercises for the hip abductors , lateral rotators , and extensors . An 11-point numeric pain rating scale , the Lower Extremity Functional Scale , the Anterior Knee Pain Scale , and a single-hop test were used as outcome measures at baseline ( pretreatment ) and 3 , 6 , and 12 months posttreatment . RESULTS At baseline , demographic , pain , and functional assessment data were similar between groups . Those in the KHE group had a higher level of function and less pain at 3 , 6 , and 12 months compared to baseline ( P<.05 ) . In contrast , the KE group had reduced pain only at the 3- and 6-month follow-ups ( P<.05 ) , without any changes in Lower Extremity Functional Scale , Anterior Knee Pain Scale , or hop testing ( P>.05 ) through the course of the study . Compared to the KE group , the KHE group had less pain and better function at 3 , 6 , and 12 months posttreatment ( P<.05 ) . For the Lower Extremity Functional Scale , the between-group difference in change scores from baseline at 3 , 6 , and 12 months posttreatment favored the KHE group by 22.0 , 22.0 , and 20.8 points , respectively . CONCLUSION Knee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS BACKGROUND / AIM The role of hip muscles in the rehabilitation of patellofemoral pain syndrome has recently received interest . The aim of this study was to compare the efficiencies of hip exercises alongside knee exercises versus only knee exercises on pain , function , and isokinetic muscle strength in patients with this syndrome . MATERIAL S AND METHODS Fifty-five young female patients ( mean age : 34.1 ± 6.2 years ; mean BMI : 25.9 ± 3.9 kg/m2 ) with patellofemoral pain syndrome were included . The patients were r and omized into groups of hip- and -knee exercises and knee-only exercise programs for 6 weeks with a total of 30 sessions at the clinic . Both groups were evaluated before therapy , after 6 weeks of a supervised exercise program , and after 6 weeks of an at-home exercise program . The outcome measures were muscle strength , pain , and both subjective and objective function . RESULTS The improvements of the patients in the hip- and -knee exercise group were better than in patients of the knee-only exercise group in terms of scores of pain relief ( P < 0.001 ) and functional gain ( P = 0.002 ) after 12 weeks . CONCLUSION We suggest additional hip-strengthening exercises to patients with patellofemoral pain syndrome in order to decrease pain and increase functional status BACKGROUND AND PURPOSE Quadriceps strengthening , quadriceps stretching and patellar taping are commonly prescribed together for patellofemoral pain patients . This study aim ed to examine the effectiveness of each of these techniques in isolation for one week and in combination for one week . METHODS A prospect i ve double-blind r and omized control study was design ed involving 41 subjects with 60 knees diagnosed with patellofemoral pain . The knees were r and omized in onto one of four groups ( n = 15 ) : infrapatellar taping , quadriceps strengthening , quadriceps stretching and control . The taping was worn continually for the week ; the strengthening group followed a programme of non-weight-bearing terminal range quadriceps exercises , the stretching group performed rectus femoris stretches . The control group did not receive treatment . All subjects received advice . Seven pre- and post-treatment measures included isokinetic quadriceps strength , quadriceps length , pain measured during four activities and maximum eccentric , posturally controlled , pain-free knee flexion angle during a step-down . Results showed significant changes over time ( p < 0.01 ) in two out of seven measures for the taping group , in five out of seven for the strengthening group and five out of seven for the stretching group and none in the control group . When the three modalities were combined for one week , ( n = 60 ) all seven measures improved significantly ( p < 0.01 ) . CONCLUSION In isolation , quadriceps stretching and quadriceps strengthening result ed in more improvements than taping . Combining these treatments is recommended as the initial approach to treating patellofemoral pain but further individualized more functional , global treatment is essential OBJECTIVE To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain ( PFP ) . DESIGN Comparative control trial . SETTING Rehabilitation facility . PARTICIPANTS Persons with a diagnosis of PFP ( N=36 ; 18 men , 18 women ) . INTERVENTIONS Patients were alternately assigned to a posterolateral hip muscle strengthening group ( 9 men and 9 women ) or a quadriceps strengthening group ( 9 men and 9 women ) . The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises , whereas the quadriceps strengthening group performed quadriceps strengthening exercises ( 3 times a week for 8wk ) . MAIN OUTCOME MEASURES Pain ( visual analog scale [ VAS ] ) and health status ( Western Ontario McMaster Universities Osteoarthritis Index [ WOMAC ] ) were assessed at baseline , postintervention , and 6-month follow-up . RESULTS Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up ( P<.001 ) . Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up ( P<.05 ) . CONCLUSIONS Although both intervention programs result ed in decreased pain and improved function in persons with PFP , outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group . The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention CONTEXT Patellofemoral pain ( PFP ) is the most common injury in running and jumping athletes . R and omized controlled trials suggest that incorporating hip and core strengthening ( HIP ) with knee-focused rehabilitation ( KNEE ) improves PFP outcomes . However , no r and omized controlled trials have , to our knowledge , directly compared HIP and KNEE programs . OBJECTIVE To compare PFP pain , function , hip- and knee-muscle strength , and core endurance between KNEE and HIP protocol s after 6 weeks of rehabilitation . We hypothesized greater improvements in ( 1 ) pain and function , ( 2 ) hip strength and core endurance for patients with PFP involved in the HIP protocol , and ( 3 ) knee strength for patients involved in the KNEE protocol . DESIGN R and omized controlled clinical trial . SETTING Four clinical research laboratories in Calgary , Alberta ; Chicago , Illinois ; Milwaukee , Wisconsin ; and Augusta , Georgia . PATIENTS OR OTHER PARTICIPANTS Of 721 patients with PFP screened , 199 ( 27.6 % ) met the inclusion criteria ( 66 men [ 31.2 % ] , 133 women [ 66.8 % ] , age = 29.0 ± 7.1 years , height = 170.4 ± 9.4 cm , weight = 67.6 ± 13.5 kg ) . INTERVENTION(S ) Patients with PFP were r and omly assigned to a 6-week KNEE or HIP protocol . MAIN OUTCOME MEASURE(S ) Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures , which were conducted weekly . Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks . RESULTS Compared with baseline , both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocol s ( P < .001 ) , but the visual analog scale scores for those in the HIP protocol were reduced 1 week earlier than in the KNEE group . Both groups increased in strength ( P < .001 ) , but those in the HIP protocol gained more in hip-abductor ( P = .01 ) and -extensor ( P = .01 ) strength and posterior core endurance ( P = .05 ) compared with the KNEE group . CONCLUSIONS Both the HIP and KNEE rehabilitation protocol s produced improvements in PFP , function , and strength over 6 weeks . Although outcomes were similar , the HIP protocol result ed in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol STUDY DESIGN R and omized controlled trial . OBJECTIVES To examine the effectiveness of isolated hip abductor and external rotator strengthening on pain , health status , and hip strength in females with patellofemoral pain ( PFP ) . BACKGROUND Altered hip kinematics result ing from hip muscle weakness has been proposed as a contributing factor in the development of PFP . To date , no study has examined clinical outcomes associated with isolated hip muscle strengthening in those with PFP . METHODS Twenty-eight females with PFP were sequentially assigned to an exercise ( n = 14 ) or a no-exercise control group ( n = 14 ) . The exercise group completed bilateral hip abductor and external rotator strengthening 3 times per week for 8 weeks . Pain ( visual analog scale ) , health status ( WOMAC ) , and hip strength ( h and held dynamometer ) were assessed at baseline and postintervention . Pain and health status were also evaluated at 6 months postintervention in the exercise group . Two-factor mixed-model analyses of variance were used to determine the effects of the intervention on each outcome variable . RESULTS Significant group-by-time interactions were observed for each variable of interest . Post hoc testing revealed that pain , health status , and bilateral hip strength improved in the exercise group following the 8-week intervention but did not change in the control group . Improvements in pain and health status were sustained at 6-month follow-up in the exercise group . CONCLUSION A program of isolated hip abductor and external rotator strengthening was effective in improving pain and health status in females with PFP compared to a no-exercise control group . The incorporation of hip-strengthening exercises should be considered when design ing a rehabilitation program for females with PFP . LEVEL OF EVIDENCE Therapy , level 2b Strengthening of the vastus medialis oblique ( VMO ) has been advocated as a treatment for patellofemoral pain syndrome ( PFPS ) , as weakness of this component of the quadriceps is postulated to contribute to malalignment of the patella . This study investigated the  surface electromyographic activity ( EMG ) of the VMO relative to the vastus lateralis ( VL ) during five isometric exercises in eight PFPS female subjects and 19 controls . The area under the EMG curve of each muscle was normalized to the EMG area acquired while subjects performed a submaximal isometric contraction ( 50 % of maximum voluntary contraction ) , and the " normalized " outcome measure was expressed as a proportion ( VMO : VL ) . A two-factor repeated measures analysis of variance indicated no differences in the VMO : VL proportion between the control group and PFPS participants across the five exercises ( p > .05 ) . The VMO : VL proportions  for medial tibial rotation and knee extension combined and knee extension alone were significantly greater than for the other three exercises ( p < 0.005 ) . Hip adduction or the combination of hip adduction and knee extension did not result in greater recruitment of the VMO compared with the VL Background Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis ( OA ) . Strengthening the hip abductor and adductor muscles may influence joint loading and /or OA-related symptoms , but no study has evaluated these hypotheses directly . The aim of this r and omised , single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA . Methods / Design 88 participants with painful , radiographically confirmed medial compartment knee OA and varus alignment will be recruited from the community and r and omly allocated to a hip strengthening or control group using concealed allocation stratified by disease severity . The hip strengthening group will perform 6 exercises to strengthen the hip abductor and adductor muscles at home 5 times per week for 12 weeks . They will consult with a physiotherapist on 7 occasions to be taught the exercises and progress exercise resistance . The control group will be requested to continue with their usual care . Blinded follow up assessment will be conducted at 12 weeks after r and omisation . The primary outcome measure is the change in the peak external knee adduction moment measured during walking . Question naires will assess changes in pain and physical function as well as overall perceived rating of change . An intention-to-treat analysis will be performed using linear regression modelling and adjusting for baseline outcome values and other demographic characteristics . Discussion Results from this trial will contribute to the evidence regarding the effect of hip strengthening on knee loads and symptoms in people with medial compartment knee OA . If shown to reduce the knee adduction moment , hip strengthening has the potential to slow disease progression . Trial Registration Australia New Zeal and Clinical Trials Registry OBJECTIVE To determine whether hip abductor and adductor muscle strengthening reduces medial compartment knee load and improves symptoms in people with medial tibiofemoral OA and varus malalignment . METHODS In a r and omised controlled trial , 89 participants were r and omly allocated to a hip strengthening group or to a control group with no intervention . The strengthening group performed a physiotherapist-supervised home exercise program targeting the hip abductor and adductor muscles for 12 weeks . The primary outcome was the peak external knee adduction moment measured using three-dimensional gait analysis by a blinded assessor . Secondary outcomes included a pain numeric rating scale , Western Ontario and McMaster Universities Osteoarthritis Index , step test , stair climb test , maximum isometric strength of hip and quadriceps muscles and participant-perceived rating of overall change . Intention-to-treat analyses were performed using linear regression modelling adjusting for baseline outcomes and other characteristics . RESULTS The trial was completed by 76/89 participants ( 85 % ) . There was no significant between-group difference in change in the knee adduction moment [ mean difference ( 95 % confidence interval ( CI ) ) 0.134 ( -0.069 to 0.337 ) Nm/BW x HT% ] . All pain , physical function and muscle strength measures showed significantly greater improvement in the strengthening group ( all P<0.05 ) . The relative risk ( 95 % CI ) of participant-perceived overall improvement in the strengthening group compared to the control group was 20.02 ( 6.21 - 64.47 ) . CONCLUSIONS Although strengthening the hip muscles improved symptoms and function in this patient group , it did not affect medial knee load as measured by the knee adduction moment . Thus it is unlikely that hip muscle strengthening influences structural disease progression . TRIAL REGISTRATION ACTR12607000001493 Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference : Patello-femoral pain syndrome ( PFPS ) is a common knee joint disability . The integration of hip soft tissue regimens are not always emphasized , although current literature implies that there is a significant relationship between the two and there is a lack of r and omized clinical trials to substantiate this relationship in clinical practice . A r and omized controlled assessor blinded trial was design ed to explore different rehabilitation programs related to PFPS . The study was conducted at RAZIEL institute of physical therapy , Netania , Israel with a total of 30 consecutive patients ( mean age 35y ) , diagnosed with PFPS . All patients were r and omly allocated into 3 groups . Group I conventional knee rehabilitation program . Included quadriceps strengthening and Trans Electric Neuromuscular Stimulation ( TENS ) . Group II hip oriented rehabilitation program . included stretching , Hip external rotators strengthening and TENS . Group III a combination of the two above programs .  Pain and function were documented on initial of the program and again 3 weeks later , on the completion . Pain was assessed by a numeric visual analogue scale ( VAS ) ; function was assessed by Patello-femoral joint evaluation scale ( PFJES ) ( 0 - 100 points ) . At end of trial , all groups showed significant improvements in VAS and PFJES ( p<0.0001 ) ; these improvements did not vary significantly between the 3 groups . The conclusions were that the explored different rehabilitation programs showed a similar beneficial effect BACKGROUND AND OBJECTIVES Decreased activity of hip abductor musculature has been suggested as a contributing factor for the disease progression in participants with symptomatic knee osteoarthritis ( OA ) . In this study , the effectiveness of 6 weeks isolated hip abductor strengthening on WOMAC , 6 minute walk test and hip strength and endurance in participants with symptomatic medial compartment knee OA were studied . MATERIAL AND METHOD Thirty persons with medial compartment knee OA were r and omized to hip abductor strengthening group ( n = 15 )  and conventional group ( n = 15 ) . Both the groups received intervention for 5 times per week for 6 weeks . 6 minute walk test , health status ( WOMAC ) , hip strength ( by modified syphgmomanometer ) and hip endurance ( number of repetitions ) were assessed at baseline and post intervention . The dependent variables were analyzed using 2 × 2 ANOVA , with repeated measurement as second factor to determine the effects of the intervention on each outcome variable . RESULTS Significant group-by-time interactions were observed for each variable of interest . Post hoc testing revealed that all the outcome measures improved significantly in the hip abductor strengthening group following the 6-week intervention than the control group . CONCLUSION The incorporation of hip-strengthening exercises may be considered along with conventional exercises when design ing a rehabilitation program for persons with knee OA STUDY DESIGN R and omized controlled trial , pretest-posttest design . OBJECTIVES To compare the efficacy of non-weight-bearing single-joint quadriceps exercise ( SJNWBE ) versus weight-bearing multiple-joint quadriceps exercise ( MJWBE ) for individuals with patellofemoral pain syndrome ( PFPS ) . BACKGROUND PFPS is a common ailment of the knee . Both weight-bearing and non-weight-bearing exercises are considered appropriate for strengthening the quadriceps , a key element in the treatment of this condition . METHODS AND MEASURES Forty-five male subjects with PFPS between 18 and 35 years of age were r and omized into 1 of 3 groups . Group 1 ( SJNWBE ) performed knee extension exercises , group 2 ( MJWBE ) performed seated leg press exercises , and group 3 ( control group ) received no treatment .  Subjective symptoms , knee extensor muscle strength , and functional performance were evaluated at the time of the initial examination and at the end of the 6-week treatment period . RESULTS Individuals in both exercise groups demonstrated a statistically significant decrease in pain and an increase in muscle strength and functional performance , as compared to the control group ( P<.05 ) . All measures showed no significant differences in outcome between the 2 exercise groups ( P>.05 ) . CONCLUSION This study demonstrates that both weight-bearing and non-weight-bearing quadriceps exercises can significantly improve subjective and clinical outcomes in patients with PFPS Background Patellofemoral pain is one of the most frequent knee conditions among adolescents with a prevalence of 7 % . Evidence -based treatment consists of patient education combined with hip and quadriceps strengthening . Recent evidence suggests that a large proportion of adolescents does not follow their exercise prescription , performing too few repetitions or too fast below the prescribed time under tension . Live feedback , such as a metronome or exercise games , has previously shown promising results in improving the quality of exercises . The aim of this study is to investigate if live feedback from a sensor ( B and Cizer ™ ) and an iPad will improve the ability of adolescents with PFP to perform exercises as prescribed . Methods This study is a r and omized , controlled , participant-blinded , superiority trial with a 2-group parallel design . Forty 15 to 19 year old adolescents with patellofemoral pain will be r and omized to receive either live visual and auditory feedback on time under tension or no feedback on time under tension during a 6-week intervention period . Adolescents will be instructed to perform three elastic b and exercises . Feedback will be provided by B and Cizer ™ and an iPad . The adolescents perform the exercises twice a week unsupervised and once a week during a supervised group training session . The primary outcome will be the mean deviation of the prescribed time under tension per repetition in seconds during the course of the intervention . Discussion Low compliance is a major problem among adolescents with patellofemoral pain . Providing the adolescents with real time feedback on time under tension from a sensor and an iPad could potentially help the adolescents perform the exercises as prescribed . This may increase the total exercise dosage they receive during treatment which may help improve patient outcomes .Trial registration Registered at Clinical Trials.gov ( identifier : NCT02674841 ) on February 4th 2016 OBJECTIVE The purpose of this study was to investigate the effect of hip adduction on the activity of the Vastus Medialis Obliquus ( VMO ) and Vastus Lateralis Longus ( VLL ) muscles during semisquat exercises . METHODS Twenty female subjects , divided into two groups comprising healthy and patellofemoral pain syndrome ( PFPS ) subjects ( ten volunteers for each group ) , performed three double-leg semisquat exercise trials with maximum hip adduction isometric contraction ( DLSS-HA ) and three double-leg semisquat exercise trials without hip adduction ( DLSS ) . The normalized electromyographic muscle data were analysed using Repeated Measure ANOVA ( p < or=0.05 ) . RESULTS The electrical activity of both VMO and VLL muscles was significantly greater during DLSS-HA exercise than during DLSS ( p=0.0002 ) for both groups . Additionally , an independent Repeated Measure ANOVA revealed that the electric activity of the VLL muscle was significantly greater ( p=0.0149 ) than that of the VMO muscle during DLSS exercises only for the PFPS group . However , no differences were found during DLSS-HA exercises . CONCLUSIONS Although there was no preferential VMO muscle activation , the association of hip adduction with squat exercise promoted a greater balance between the medial and lateral portions of the quadriceps femoris muscle and could be indicated for the conservatory treatment of PFPS patients . The association of isometric hip adduction with isometric semisquat exercises produced a more overall quadriceps activity and could be indicated for clinical rehabilitation or muscle strengthening programs OBJECTIVE To determine the effects of a weight-bearing rehabilitation program on quadriceps and gluteus medius electromyographic activity , pain , and function in subjects diagnosed with patellofemoral pain syndrome ( PFPS ) . DESIGN Pretest and posttest 6-week intervention study . SETTING Musculoskeletal research laboratory . PARTICIPANTS Fourteen subjects diagnosed with PFPS and 14 healthy control subjects volunteered to participate in this study . No subjects withdrew from the study because of adverse effects . INTERVENTION Subjects diagnosed with PFPS participated in a 6-week rehabilitation program . The rehabilitation program consisted of weight-bearing exercises that focused on strengthening the quadriceps and hip abductor musculature . MAIN OUTCOME MEASURES Electromyographic onsets of the vastus medialis oblique ( VMO ) and vastus lateralis and onset and duration of the gluteus medius were collected during a stair-stepping task that was performed during the pretest and posttest . A visual analog scale ( VAS ) and Functional Index Question naire ( FIQ ) were administered at pretest and posttest and each week of the intervention . RESULTS Vastus lateralis and VMO onset timing differences ( vastus lateralis electromyographic onset minus VMO electromyographic onset ) and VAS and FIQ scores significantly improved for patients diagnosed with PFPS . Vastus lateralis and VMO onset timing in the PFPS group were significantly different from those in the control group at baseline and were not significantly different from the control group after the intervention . We did not find differences in gluteus medius onsets or duration of activity . CONCLUSIONS Subjects diagnosed with PFPS responded favorably and quickly to a therapeutic exercise program that incorporated quadriceps and hip musculature strengthening . The efficacy of the therapeutic exercise program used in this study should be further investigated in a larger subject population This study was a prospect i ve single blind r and omised controlled trial to compare the effects of rehabilitation with emphasis on retraining the vastus medialis ( VMO ) component of the quadriceps femoris muscle and rehabilitation with emphasis on general strengthening of the quadriceps femoris muscles on pain , function and Quality of Life in patients with patellofemoral pain syndrome ( PFPS ) . Patients with PFPS ( n=69 ) were recruited from a hospital orthopaedic clinic and r and omised into three groups : ( 1 ) physiotherapy with emphasis on selectively retraining the VMO ( Selective ) ; ( 2 ) physiotherapy with emphasis on general strengthening of the quadriceps femoris muscles ( General ) ; and ( 3 ) a no-treatment control group ( Control ) . The three groups were then compared before and after an eight-week rehabilitation period . The Selective and General groups demonstrated statistically significant and ' moderate ' to ' large ' effect size reductions in pain when compared to the Control group . Both the Selective and General groups displayed statistically significant and ' moderate ' and ' large ' effect size improvements in subjective function and Quality of Life compared to the Control group . Knee flexion excursion during the stance phase of gait , demonstrated that there were no statistical significant differences and only ' trivial ' to ' small ' effect size differences between the Selective or General groups and the Control group . A large number of PFPS patients can experience significant improvements in pain , function and Quality of Life , at least in the short term , with quadriceps femoris rehabilitation , with or without emphasis on selective activation of the VMO component . Both approaches would seem acceptable for rehabilitating patients with PFPS . It may be appropriate to undertake exercises involving selective activation of the vastus medialis early in the rehabilitation process , however , clinicians should not overly focus on selective activation before progressing rehabilitation , especially in more chronic cases with significant participation restrictions OBJECTIVE To examine whether the effects of 12 weeks of quadriceps strengthening on the knee adduction moment , pain , and function in people with medial knee osteoarthritis ( OA ) differ in those with and without varus malalignment . METHODS A single-blind , r and omized controlled trial of 107 community volunteers with medial knee OA was conducted . Participants were stratified according to knee malalignment ( more varus or more neutral ) and then r and omized into either a 12-week supervised home-based quadriceps strengthening group or a control group with no intervention . The primary outcome was the knee adduction moment , measured using 3-dimensional gait analysis . Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index scores ( measuring pain and physical function ) , step test score , stair climb test score , and maximum quadriceps isometric strength . Analyses of covariance were carried out based on intent-to-treat principles . RESULTS Quadriceps strengthening did not significantly alter the knee adduction moment in either the more malaligned or the more neutral group ( unadjusted knee adduction moment 0.12 and 0.05 % Nm/BWxHT , respectively ) . Function did not improve significantly following quadriceps strengthening in either alignment group , but there was a significant improvement in knee pain in the more neutrally aligned group ( P < 0.001 ) . CONCLUSION Quadriceps strengthening did not have any significant effect on the knee adduction moment in participants with either more varus or more neutral alignment . The benefits of quadriceps strengthening on pain were more evident in those with more neutral alignment . Knee alignment thus represents a local mechanical factor that can mediate symptomatic outcome from exercise interventions in knee OA
Meta‐analyses showed no significant changes in strength for any of the interventions . •
BACKGROUND : The addition of hip strengthening to knee strengthening for persons with patellofemoral pain has the potential to optimize treatment effects .
OBJECTIVE : To examine the efficacy of hip strengthening , associated or not with knee strengthening , to increase strength , reduce pain , and improve activity in individuals with patellofemoral pain .