Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis

Rathleff, Michael Skovdal; Rathleff, Camilla Rams; Crossley, Kay M; Barton, Christian J

doi:10.1136/bjsports-2013-093305

Cited by 181 publications

(120 citation statements)

References 64 publications

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“…Although there is evidence for hip abductor and external rotator weakness in PFP, hip strength deficits are not exclusive to these muscle groups (Rathleff et al, 2014). It is possible that the focus on hip abductor and external rotator exercise is too simplistic.…”

Section: Hip Strengthening Exercisementioning

confidence: 99%

“…However, this was based on one study investigating one isometric exercise. There may be an argument for incorporating adductor strengthening as there is evidence to show a deficit in isometric adduction strength in PFP (Rathleff et al, 2014). Additionally, the adductors contribute to the eccentric control of hip internal rotation, are considered to be important flexors and extensors of the hip, have a bidirectional sagittal plane torque which is useful for powering cyclic activities including sprinting and raising and descending a deep squat,and contribute to pelvis stability (Charnock et al, 2009;Gottschall et al, 2012;Leighton, 2006;Neumann, 2010).…”

Section: Hip Strengthening Exercisementioning

confidence: 99%

“…Additionally, it has been shown that there are gender specific differences in hip abduction strength (Brent et al,2013;Ramskov et al, 2014), gluteal activation (Nakagawa et al, 2012) and trunk and lower limb kinematics (Nakagawa et al, 2012, Willy et al, 2012a in both the normal and PFP population. There have been shown to be differences in hip strength deficits in males and females in PFP (Rathleff et al, 2014) suggesting that rehabilitation and future research trials should be gender specific.…”

Section: Hip Strengthening Exercisementioning

confidence: 99%

“…It has been proposed that that there are hip strength deficits in adults with PFP (Rathleff et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in clinical practice. Current evidence shows that there are hip strength deficits, delayed onset and shorter activation of gluteus medius in people with PFP. The aim of this review was to systematically review the literature to investigate the outcome of hip exercise in people with PFP.Method AMED, CINAHL, Cochrane, EMBASE, PEDro, Pubmed, Science direct and SPORTDiscus databases were searched from inception to November 2014 for RCTs, non-randomised studies and case studies. Two independent reviewers assessed each paper for inclusion and quality. ResultsTwenty one papers were identified;eighteen investigating strengthening exercise, two investigating the effect of neuromuscular exercise and one study investigated the effect of hip exercise for the prevention of PFP.Hip and knee strengthening programmes were shown to be equally effective. Limited evidence indicates that the addition of hip exercise to an exercise programme is beneficial. Limited evidence demonstrates that motor skill retraining in a participant group who displayed abnormal hip alignment in running improves pain. ConclusionThe evidence consistently demonstrated that both hip strengthening and neuromuscular exercise has a beneficial effect on pain and function in people with PFP. Strengthening exercise predominantly addressed abductor and external rotator muscle groups. 2 A consensus from PFP researchers for standardisation of methodology is recommended to enable meaningful comparison between trials.

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Section: Hip Strengthening Exercisementioning

confidence: 99%

Section: Hip Strengthening Exercisementioning

confidence: 99%

Section: Hip Strengthening Exercisementioning

confidence: 99%

“…It has been proposed that that there are hip strength deficits in adults with PFP (Rathleff et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Hip-and trunk-muscle weaknesses have also been cited retrospectively as contributors to PFP; however, recent prospective studies [18][19][20] and a systematic review 21 have failed to demonstrate that hip weakness is a cause of this injury. One group 18 proposed that hip weakness is the result of chronic pain, possibly due to the effects of muscle inhibition.…”

mentioning

confidence: 99%

Acute Responses of Strength and Running Mechanics to Increasing and Decreasing Pain in Patients With Patellofemoral Pain

Bazett-Jones

Huddleston

Cobb

et al. 2017

Journal of Athletic Training

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; †University of Wisconsin-MilwaukeeContext: Patellofemoral pain (PFP) is typically exacerbated by repetitive activities that load the patellofemoral joint, such as running. Understanding the mediating effects of changes in pain in individuals with PFP might inform injury progression, rehabilitation, or both.Objective: To investigate the effects of changing pain on muscular strength and running biomechanics in those with PFP.Design: Crossover study. Setting: University research laboratory.Patients or Other Participants: Seventeen participants (10 men, 7 women) with PFP.Intervention(s): Each participant completed knee painreducing and pain-inducing protocols in random order. The pain-reducing protocol consisted of 15 minutes of transcutaneous electric nerve stimulation (TENS) around the patella. The pain-inducing protocol was sets of 20 repeated single-legged squats (RSLS). Participants completed RSLS sets until either their pain was within at least 1 cm of their pain during an exhaustive run or they reached 10 sets.Main Outcome Measure(s): Pain, isometric hip and trunk strength, and running mechanics were assessed before and after the protocols. Dependent variables were pain, normalized strength (abduction, extension, external rotation, lateral trunk flexion), and peak lower extremity kinematics and kinetics in all planes. Pain scores were analyzed using a Friedman test. Strength and mechanical variables were analyzed using repeated-measures analyses of variance. The a level was set at P , .05.Results: Pain was decreased after the TENS (pretest: 3.10 6 1.95, posttest: 1.89 6 2.33) and increased after the RSLS (baseline: 3.10 6 1.95, posttest: 4.38 6 2.40) protocols (each P , .05). The RSLS protocol resulted in a decrease in hipextension strength (baseline: 0.355 6 0.08 kg/kg, posttest: 0.309 6 0.09 kg/kg; P , .001). Peak plantar-flexion angle was decreased after RSLS (baseline: À13.978 6 6.418, posttest: À12.848 6 6.458; P ¼ .003). Peak hip-extension (pretest: À2.31 6 0.46) and hip-abduction (pretest: À2.02 6 0.35) moments decreased after both the TENS (extension: À2.15 6 0.48 Nm/ kg, P ¼ .015; abduction: À1.91 6 0.33 Nm/kg, P ¼ .015) and RSLS (extension: À2.18 6 0.52 Nm/kg, P ¼ .003; abduction: À1.87 6 0.36 Nm/kg, P ¼ .039) protocols.Conclusions: This study presents a novel and effective method of increasing pain in persons with PFP. Functionally increased pain after RSLS coincides with reduced hip-extensor muscle strength and decreased plantar-flexion angle during running. The TENS treatment decreased pain during running in those with PFP but failed to influence strength. Hip moments were reduced by both protocols, which may demonstrate that acute increases or decreases in pain cause runners to change their mechanics.

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