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Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial.

Abstract

CONTEXT

Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized 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 protocols 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

Randomized 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 randomly 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 protocols (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 protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol.

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  • Authors+Show Affiliations

    ,

    Faculty of Kinesiology, University of Calgary, AB, Canada.

    , , ,

    Source

    Journal of athletic training 50:4 2015 Apr pg 366-77

    MeSH

    Adult
    Athletic Injuries
    Chronic Pain
    Female
    Hip
    Humans
    Knee Joint
    Male
    Muscle Strength
    Muscle, Skeletal
    Musculoskeletal Pain
    Pain Measurement
    Patellofemoral Pain Syndrome
    Resistance Training
    Running
    Self Report
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25365133

    Citation

    Ferber, Reed, et al. "Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: a Multicenter Randomized Controlled Trial." Journal of Athletic Training, vol. 50, no. 4, 2015, pp. 366-77.
    Ferber R, Bolgla L, Earl-Boehm JE, et al. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. J Athl Train. 2015;50(4):366-77.
    Ferber, R., Bolgla, L., Earl-Boehm, J. E., Emery, C., & Hamstra-Wright, K. (2015). Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. Journal of Athletic Training, 50(4), pp. 366-77. doi:10.4085/1062-6050-49.3.70.
    Ferber R, et al. Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: a Multicenter Randomized Controlled Trial. J Athl Train. 2015;50(4):366-77. PubMed PMID: 25365133.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. AU - Ferber,Reed, AU - Bolgla,Lori, AU - Earl-Boehm,Jennifer E, AU - Emery,Carolyn, AU - Hamstra-Wright,Karrie, Y1 - 2014/11/03/ PY - 2014/11/4/entrez PY - 2014/11/5/pubmed PY - 2015/10/20/medline KW - anterior knee pain KW - clinical trial KW - knee rehabilitation KW - outcomes assessment KW - patella SP - 366 EP - 77 JF - Journal of athletic training JO - J Athl Train VL - 50 IS - 4 N2 - CONTEXT: Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized 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 protocols 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: Randomized 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 randomly 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 protocols (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 protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol. SN - 1938-162X UR - https://www.unboundmedicine.com/medline/citation/25365133/Strengthening_of_the_hip_and_core_versus_knee_muscles_for_the_treatment_of_patellofemoral_pain:_a_multicenter_randomized_controlled_trial_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25365133/ DB - PRIME DP - Unbound Medicine ER -