Do patients with patellofemoral pain have weak hip muscles?

September 17, 2009

November 23, 2009

Michael Callaghan & Janet Fowler, Specialist physiotherapist & Consultant physiotherapist (MRI and Manchester PCT)

In [adults with patellofemoral pain]Do [weak hip muscles]Accompany [patellofemoral pain]

A 27 year female has had PF pain for several months following an atraumatic onset. As well as the standard muscle exercises to the thigh and calf, you wish to instigate some hip muscle exercises, but the patient is surprised that she may have weak hip muscles and she wants to know if this weakness is recognised and has been investigated.

MEDLINE 1950 09/09, CINAHL 1982 –09/09, AMED 1985-09/09, EMBASE 1980-09/09 via the OVID interface and also the Cochrane database.

Medline, CINAHL, EMBASE, AMED,: [{(exp patellofemoral pain syndrome OR exp Arthralgia OR exp Patella OR exp Chondromalacia patellae OR anterior knee pain mp OR ((patellofemoral or patello-femoral) adj (joint)).mp OR ((Patello-femoral or patellofemoral) adj (pain or syndrome or dysfunction)).tw OR ((lateral compression or lateral facet or lateral pressure or odd facet) adj (syndrome)).tw OR ((chondromal$ or chondropath$) adj (knee or patell$ or femoropatell$ or femoro-patell$ or retropatell$ or retro-patell$)).tw)
AND (exp buttocks OR gluteus medius.mp OR gluteus maximus.mp OR gluteus minimus.mp OR hip abduction OR hip internal rotation OR muscle imbalance OR hip strength)}] LIMIT to English language.

The Cochrane database: patellofemoral pain
The PEDro database: patellofemoral pain

There were 26 papers retrieved. Abstracts, case reports, review papers, reliability papers and papers measuring EMG and not muscle strength were excluded, leaving 11 papers.

There seems to be ample evidence using isometric hip testing that there is weakness of the hip muscles in patients with PFPS. The earliest of these studies was 2003. The muscle groups were tested in a variety of positions. The sample sizes were small, and the majority of subjects tested were young females.

Patients with PFPS have weaker hip musculature than healthy controls.

1. Cowan SM, Crossley KM, Bennell KL.. Altered hip and trunk muscle function in individuals with patellofemoral pain.
2. Willson JD, Binder-Macleod S, Davis IS.. Lower extremity jumping mechanics of female athletes with and without patellofemoral pain before and after exertion.
3. Souza RB, Powers CM.. Predictors of hip internal rotation during running: an evaluation of hip strength and femoral structure in women with and without patellofemoral pain.
4. Willson JD, Davis IS. Lower extremity strength and mechanics during jumping in women with patellofemoral pain.
5. Souza RB, Powers CM. Differences in hip kinematics, muscle strength and muscle activation between subjects with and without patellofemoral pain.
6. Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome.
7. Dierks TA, Manal KT, Hamill J, Davis, IS. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run.
8. Cichanowski HR, Schmitt JS, Johnson RJ, Niemuth PE. Hip strength in collegiate female athletes with patellofemoral pain.
9. Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome.
10. Piva SR, Goodnite EA, Childs JD. Stength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome.
11. Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip strength in females with and without patellofemoral pain.