Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jul 29;9(7):23259671211017503.
doi: 10.1177/23259671211017503. eCollection 2021 Jul.

Is Isolated Hip Strengthening or Traditional Knee-Based Strengthening More Effective in Patients With Patellofemoral Pain Syndrome? A Systematic Review With Meta-analysis

Yuyan Na  1 , Changxu Han  1 , Yuting Shi  2 , Yong Zhu  3 , Yizhong Ren  1 , Wanlin Liu  4
Affiliations
Review

Is Isolated Hip Strengthening or Traditional Knee-Based Strengthening More Effective in Patients With Patellofemoral Pain Syndrome? A Systematic Review With Meta-analysis

Yuyan Na et al. Orthop J Sports Med. .

Abstract

Background: Focus on the importance of hip muscle strength in patients with patellofemoral pain syndrome (PFPS) has recently increased. It is unknown whether patients with PFPS will benefit more from hip strengthening compared with traditional knee-based strengthening.

Purpose: To compare the efficiency of isolated hip strengthening versus traditional knee-based strengthening for patients with PFPS.

Study design: Systematic review; Level of evidence, 2.

Methods: We conducted a search for studies comparing isolated hip strengthening and knee-based strengthening by using the MEDLINE, Embase, and Cochrane Library electronic databases. The methodological quality of included studies was assessed using the PEDro scale. Predetermined variables from each study were extracted and analyzed.

Results: A total of 5 comparative studies were included in this review; all studies were of moderate to high quality and reflected good internal and external validity. Pain (visual analog scale [VAS]) and function (Anterior Knee Pain Scale) scores improved in both the hip and knee groups after strengthening intervention, although no statistically significant differences were seen between groups in the pooled analysis. In 2 studies, VAS pain scores were reduced earlier for patients in the hip group than for those in the knee group (P < .05). In 1 study, improvement in Western Ontario and McMaster Universities Osteoarthritis Index function scores in the hip group was statistically superior compared with those in the knee group after intervention and at 6-month follow-up (P < .05). In 2 studies, patients in the hip group exhibited statistically greater hip abductor and extensor strength than did those in the knee group after intervention (P < .05).

Conclusion: The best-available evidence suggests that overall, isolated hip strengthening and knee strengthening were equivalent for treatment of PFPS.

Keywords: PFPS; hip; knee; muscle strengthening; rehabilitation.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the Natural Science Foundation of Inner Mongolia (No. 2016MS0366, 2020MS08119). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flow diagram of study selection using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). PFPS, patellofemoral pain syndrome.
Figure 2.
Figure 2.
Hip-strengthening exercises compared with knee-based exercises for visual analog scale pain score. IV, inverse variance.
Figure 3.
Figure 3.
Hip-strengthening exercises compared with knee-based exercises for function score on the Anterior Knee Pain Scale. IV, inverse variance.
See this image and copyright information in PMC

References

    1. Baldon Rde M, Serrão FV, Scattone Silva R, Piva SR. Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44(4):240–251, A1-A8. - PubMed
    1. Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The “best practice guide to conservative management of patellofemoral pain”: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015;49(14):923–934. - PubMed
    1. Bolgla LA, Boling MC. An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther. 2011;6(2):112–125. - PMC - PubMed
    1. Bolgla LA, Earl-Boehm J, Emery C, Hamstra-Wright K, Ferber R. Pain, function, and strength outcomes for males and females with patellofemoral pain who participate in either a hip/core- or knee-based rehabilitation program. Int J Sports Phys Ther. 2016;11(6):926–935. - PMC - PubMed
    1. Collins NJ, Barton CJ, van Middelkoop M, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018;52(18):1170–1178. - PubMed

LinkOut - more resources