Comparing Rehabilitation Programs for Patellofemoral Pain Syndrome

Study Overview
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Brief Summary
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Patellofemoral pain syndrome (PFPS) is a common knee disorder affecting physically active people. Despite the growing base of support for the early introduction of hip strengthening exercises into the rehabilitation of PFPS, there have been few randomized clinical trials comparing isolated hip to isolated quadriceps strengthening. The purpose of this study is to determine how different exercises affect pain, strength, muscle activity, and function in female subjects with patellofemoral pain. The researchers hypothesize that females diagnosed with PFPS who initially participate in a hip strengthening program will report a greater perceived level of function, greater strength, less pain, and improved neuromuscular activity than those who participate in a progressive quadriceps strengthening intervention.

Detailed Description
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Methods: Thirty-three females with PFPS will perform 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 will be used to determine group differences over time.

Official Title
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Comparison of Early Hip Strengthening to Early Quadriceps Strengthening in the Treatment of Females With Patellofemoral Pain

Conditions
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Patellofemoral Pain Syndrome

Intervention / Treatment
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* Other: Hip Progressive Resistive Exercise
* Other: Quad Progressive Resistive Exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: anterior or retropatellar knee pain reported during at least 2 of the following activities: ascending and descending stairs, hopping and running, squatting, kneeling, and prolonged sitting insidious onset of symptoms not related to trauma pain with compression of the patella pain on palpation of the patellar facets Exclusion Criteria: symptoms present for less than one month clinical evidence of other knee pathology history of recent knee surgery within past one year history of patellar dislocations or subluxations current significant injury affecting other lower extremity joints

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hip Progressive Resistive Exercises<br>Exercises targeting hip musculature such as hip abduction and hip external rotation that was progressed by increased resistance following typical progressive resistive exercise approach. | Other: Hip Progressive Resistive Exercise<br>* Hip Progressive Resistance Exercise program will be carried out by subjects under supervision once a week and then performed at home 2 additional times at home without supervision. Exercises focus on strengthening hip abduction ad external rotation musculature.<br>|
| Active Comparator: Quad Progressive Resistive Exercises<br>Exercises targeting quadriceps musculature such as quadriceps isometric setting, terminal knee extensions, and straight leg raises that was progressed by increased resistance following typical progressive resistive exercise approach.. | Other: Quad Progressive Resistive Exercises<br>* Quad Progressive Resistive Exercise program will be carried out by subjects under supervision once a week and then performed at home 2 additional times at home without supervision. Exercises focus on strengthening quadriceps musculature with straight leg raises and quadriceps isometrics.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Pain Scale (Describing Worst Pain Felt During the Past Week) | 0 to 10 cm line with 0 representing no pain and 10 representing severe pain | weekly | 
| Subjective Function by Lower Extremity Functional Scale Report Form |  | Baseline, Mid-Intervention, and Post-Intervention | 
| Visual Analog Pain Scale | Visual analog pain scale at end of intervention. 0 to 10 cm line with 0 representing no pain and 10 representing severe pain | 8 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Strength by Isometric Dynamometer |  | Baseline, Mid, and Post-Intervention | 
| Neuromuscular Activity by Surface Electromyographical Amplitude During Stair Descent |  | Baseline, Mid and Post-Intervention | 
| Objective Function by Step-down Task for 30 Seconds |  | Baseline, Mid, and Post-Intervention | 
| Hip Abduction Strength | Side lying Hip Abduction maximal muscular contraction with a hand held dynamometer | 8 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Knee pain, Rehabilitation