Effects of Functional Stabilization Training on Pain, Function, and Lower Extremity Biomechanics in Women With Patellofemoral Pain: A Randomized Clinical Trial

Abstract

Study Design Randomized clinical trial. Objectives To compare the effects of functional stabilization training (FST) versus standard 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 randomized to either the FST group or standard-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 standard-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. Level of Evidence Therapy, level 2b-. J Orthop Sports Phys Ther 2014;44(4):240–251. Epub 25 February 2014. doi:10.2519/jospt.2014.4940

Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis

“…7,17,21,25 Eleven trials compared hip and knee strengthening with knee strengthening alone, providing data to answer the second study question. 3,10,12,14,16,17,19,20,27,36,38 Additional information on 8 papers was requested from the authors. Quality The mean PEDro score of the trials was 5.8 (range, 3-8) (TABLE 3).…”

The outcome of hip exercise in patellofemoral pain: A systematic review

“…There were greater functional gains with proximal strengthening exercise including instruction on lower limb alignment although both groups reached clinical significance (Baldon et al, 2014).…”

“…One study did not meet the PEDro criteria for randomisation as participants were sequentially allocated (Khayambashi et al, 2012). A further study (Baldon et al, 2014) used block randomisation with groups of four, with no stratification.…”

“…www.casp-uk.net Beneficial effect of hip exercise in PFP Baldon et al, 2014Coppack et al, 2011Ferber et al, 2014Fukuda et al, 2010Fukuda et al, 2012Ismail et al,2013Nakagawa et al, 2008Dolak et al, 2011Khayambashi et al, 2012Avraham et al, 2007Boling et al, 2006Earl & Hoch 2011Ferber et al, 2011Khayambashi et al, 2014Lowry et al, 2008Mascal et al,2003Noehren et al .,2011Razheghi et al, 2010Tyler et al,2006Willy et al, 2012 No benefit of hip exercise in PFP Song et al, 2009 www.cebm.net/ocebm-levels-of-evidence…”

“…Lateral step-down off 6" step standing on airex balance pad with theraband resistance pulling anteriorly 3. Monster walks with theraband resistance around ankles (subjects stand with 30 degrees knee flexion and walk forward with resistance between ankles) Table 8 Exercises known to recruit Gluteal muscles (Reiman et al, 2011 Baldon et al, 2014 Step-up Single leg deadlift…”