Comparing Rehabilitation Programs for Patellofemoral Pain Syndrome

Comparison of Early Hip Strengthening to Early Quadriceps Strengthening in the Treatment of Females With Patellofemoral Pain

Patellofemoral pain syndrome (PFPS) is a common knee disorder affecting physically active people. Despite the growing base of support for the early introduction of hip strengthening exercises into the rehabilitation of PFPS, there have been few randomized clinical trials comparing isolated hip to isolated quadriceps strengthening. The purpose of this study is to determine how different exercises affect pain, strength, muscle activity, and function in female subjects with patellofemoral pain. The researchers hypothesize that females diagnosed with PFPS who initially participate in a hip strengthening program will report a greater perceived level of function, greater strength, less pain, and improved neuromuscular activity than those who participate in a progressive quadriceps strengthening intervention.

Study Overview

• Status: Completed
• Conditions: Patellofemoral Pain Syndrome
• Intervention / Treatment: Other: Hip Progressive Resistive Exercise; Other: Quad Progressive Resistive Exercises

Detailed Description

Methods: Thirty-three females with PFPS will perform either initial hip strengthening (hip group) or initial quadriceps strengthening (quad group) for 4 weeks, prior to 4 weeks of a similar program of functional weight-bearing exercises. Self-reported pain, function, and functional strength were measured. Isometric strength was assessed for hip abductors, external rotators, and knee extensors. A mixed-model analysis of variance will be used to determine group differences over time.

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Kentucky
    • Lexington, Kentucky, United States, 40506
      • University of Kentucky

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 35 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• anterior or retropatellar knee pain reported during at least 2 of the following activities: ascending and descending stairs, hopping and running, squatting, kneeling, and prolonged sitting
• insidious onset of symptoms not related to trauma
• pain with compression of the patella
• pain on palpation of the patellar facets

Exclusion Criteria:

• symptoms present for less than one month
• clinical evidence of other knee pathology
• history of recent knee surgery within past one year
• history of patellar dislocations or subluxations
• current significant injury affecting other lower extremity joints

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hip Progressive Resistive Exercises; Exercises targeting hip musculature such as hip abduction and hip external rotation that was progressed by increased resistance following typical progressive resistive exercise approach.	Other: Hip Progressive Resistive Exercise; Hip Progressive Resistance Exercise program will be carried out by subjects under supervision once a week and then performed at home 2 additional times at home without supervision. Exercises focus on strengthening hip abduction ad external rotation musculature.
Active Comparator: Quad Progressive Resistive Exercises; Exercises targeting quadriceps musculature such as quadriceps isometric setting, terminal knee extensions, and straight leg raises that was progressed by increased resistance following typical progressive resistive exercise approach..	Other: Quad Progressive Resistive Exercises; Quad Progressive Resistive Exercise program will be carried out by subjects under supervision once a week and then performed at home 2 additional times at home without supervision. Exercises focus on strengthening quadriceps musculature with straight leg raises and quadriceps isometrics.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Pain Scale (Describing Worst Pain Felt During the Past Week)	0 to 10 cm line with 0 representing no pain and 10 representing severe pain	weekly
Subjective Function by Lower Extremity Functional Scale Report Form		Baseline, Mid-Intervention, and Post-Intervention
Visual Analog Pain Scale	Visual analog pain scale at end of intervention. 0 to 10 cm line with 0 representing no pain and 10 representing severe pain	8 week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Strength by Isometric Dynamometer		Baseline, Mid, and Post-Intervention
Neuromuscular Activity by Surface Electromyographical Amplitude During Stair Descent		Baseline, Mid and Post-Intervention
Objective Function by Step-down Task for 30 Seconds		Baseline, Mid, and Post-Intervention
Hip Abduction Strength	Side lying Hip Abduction maximal muscular contraction with a hand held dynamometer	8 week

Collaborators and Investigators

• Sponsor: Timothy Uhl
• Investigators: Study Chair: Timothy Uhl, PhD, ATC, PT, University of Kentucky

Publications and helpful links

General Publications

• Dolak KL, Silkman C, Medina McKeon J, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2011 Aug;41(8):560-70. doi: 10.2519/jospt.2011.3499. Epub 2011 Jun 7. Erratum In: J Orthop Sports Phys Ther. 2011 Sep;41(9):700.

Study record dates

Study Major Dates

• Study Start: January 1, 2008
• Primary Completion (Actual): January 1, 2010
• Study Completion (Actual): January 1, 2010

Study Registration Dates

• First Submitted: March 6, 2007
• First Submitted That Met QC Criteria: March 7, 2007
• First Posted (Estimate): March 8, 2007

Study Record Updates

• Last Update Posted (Actual): March 28, 2017
• Last Update Submitted That Met QC Criteria: February 25, 2017
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Keywords: Rehabilitation; Knee pain
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Joint Diseases; Musculoskeletal Diseases; Syndrome; Patellofemoral Pain Syndrome
• Other Study ID Numbers: 07-0138-F2L

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: willing to share strength and patient reported outcome data at pre, mid, and post testing time points.