The effect of hip and knee exercises on pain, function, and strength in patientswith patellofemoral pain syndrome: a randomized controlled trial. The Efficacy of Treatment of Different Intervention Programs for Patellofemoral Pain Syndrome–A Single Blinded Randomized Clinical Trial. Pilot Study Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomised, single-blind controlled trial Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study A controlled trial of weight-bearing versus non-weight-bearing exercises for patellofemoral pain. A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? Aerobic walking and strengthening exercises have similar effectiveness for knee osteoarthritis. The Effects of Quadriceps Strengthening on Pain, Function, and Patellofemoral Joint Contact Area in Persons with Patellofemoral Pain A randomized trial of patellofemoral bracing for treatment of patellofemoral osteoarthritis. Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial. The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
BACKGROUND / AIM The role of hip muscles in the rehabilitation of patellofemoral pain syndrome has recently received interest . The aim of this study was to compare the efficiencies of hip exercises alongside knee exercises versus only knee exercises on pain , function , and isokinetic muscle strength in patients with this syndrome . MATERIAL S AND METHODS Fifty-five young female patients ( mean age : 34.1 ± 6.2 years ; mean BMI : 25.9 ± 3.9 kg/m2 ) with patellofemoral pain syndrome were included . The patients were r and omized into groups of hip- and -knee exercises and knee-only exercise programs for 6 weeks with a total of 30 sessions at the clinic . Both groups were evaluated before therapy , after 6 weeks of a supervised exercise program , and after 6 weeks of an at-home exercise program . The outcome measures were muscle strength , pain , and both subjective and objective function . RESULTS The improvements of the patients in the hip- and -knee exercise group were better than in patients of the knee-only exercise group in terms of scores of pain relief ( P < 0.001 ) and functional gain ( P = 0.002 ) after 12 weeks . CONCLUSION We suggest additional hip-strengthening exercises to patients with patellofemoral pain syndrome in order to decrease pain and increase functional status Patello-femoral pain syndrome ( PFPS ) is a common knee joint disability . The integration of hip soft tissue regimens are not always emphasized , although current literature implies that there is a significant relationship between the two and there is a lack of r and omized clinical trials to substantiate this relationship in clinical practice . A r and omized controlled assessor blinded trial was design ed to explore different rehabilitation programs related to PFPS . The study was conducted at RAZIEL institute of physical therapy , Netania , Israel with a total of 30 consecutive patients ( mean age 35y ) , diagnosed with PFPS . All patients were r and omly allocated into 3 groups . Group I conventional knee rehabilitation program . Included quadriceps strengthening and Trans Electric Neuromuscular Stimulation ( TENS ) . Group II hip oriented rehabilitation program . included stretching , Hip external rotators strengthening and TENS . Group III a combination of the two above programs .  Pain and function were documented on initial of the program and again 3 weeks later , on the completion . Pain was assessed by a numeric visual analogue scale ( VAS ) ; function was assessed by Patello-femoral joint evaluation scale ( PFJES ) ( 0 - 100 points ) . At end of trial , all groups showed significant improvements in VAS and PFJES ( p<0.0001 ) ; these improvements did not vary significantly between the 3 groups . The conclusions were that the explored different rehabilitation programs showed a similar beneficial effect OBJECTIVE To determine whether hip abductor and adductor muscle strengthening reduces medial compartment knee load and improves symptoms in people with medial tibiofemoral OA and varus malalignment . METHODS In a r and omised controlled trial , 89 participants were r and omly allocated to a hip strengthening group or to a control group with no intervention . The strengthening group performed a physiotherapist-supervised home exercise program targeting the hip abductor and adductor muscles for 12 weeks . The primary outcome was the peak external knee adduction moment measured using three-dimensional gait analysis by a blinded assessor . Secondary outcomes included a pain numeric rating scale , Western Ontario and McMaster Universities Osteoarthritis Index , step test , stair climb test , maximum isometric strength of hip and quadriceps muscles and participant-perceived rating of overall change . Intention-to-treat analyses were performed using linear regression modelling adjusting for baseline outcomes and other characteristics . RESULTS The trial was completed by 76/89 participants ( 85 % ) . There was no significant between-group difference in change in the knee adduction moment [ mean difference ( 95 % confidence interval ( CI ) ) 0.134 ( -0.069 to 0.337 ) Nm/BW x HT% ] . All pain , physical function and muscle strength measures showed significantly greater improvement in the strengthening group ( all P<0.05 ) . The relative risk ( 95 % CI ) of participant-perceived overall improvement in the strengthening group compared to the control group was 20.02 ( 6.21 - 64.47 ) . CONCLUSIONS Although strengthening the hip muscles improved symptoms and function in this patient group , it did not affect medial knee load as measured by the knee adduction moment . Thus it is unlikely that hip muscle strengthening influences structural disease progression . TRIAL REGISTRATION ACTR12607000001493 CONTEXT Patellofemoral pain ( PFP ) is the most common injury in running and jumping athletes . R and omized controlled trials suggest that incorporating hip and core strengthening ( HIP ) with knee-focused rehabilitation ( KNEE ) improves PFP outcomes . However , no r and omized 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 protocol s 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 R and omized 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 r and omly 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 protocol s ( 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 protocol s produced improvements in PFP , function , and strength over 6 weeks . Although outcomes were similar , the HIP protocol result ed in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol STUDY DESIGN R and omized clinical trial . OBJECTIVES To determine if females with patellofemoral pain syndrome ( PFPS ) who perform hip strengthening prior to functional exercises demonstrate greater improvements than females who perform quadriceps strengthening prior to the same functional exercises . BACKGROUND Although PFPS has previously been attributed to quadriceps dysfunction , more recent research has linked this condition to impairment of the hip musculature . Lower extremity strengthening has been deemed an effective intervention . However , research has often examined weight-bearing exercises , making it unclear if increased strength in the hip , quadriceps , or both is beneficial . METHODS Thirty-three females with PFPS performed 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 was used to determine group differences over time . RESULTS After 4 weeks , there was less mean ± SD pain in the hip group ( 2.4 ± 2.0 ) than in the quad group ( 4.1 ± 2.5 ) ( P = .035 ) . From baseline to 8 weeks , the hip group demonstrated a 21 % increase ( P<.001 ) in hip abductor strength , while that remained unchanged in the quad group . All participants demonstrated improved subjective function ( P<.006 ) , objective function ( P<.001 ) , and hip external rotator strength ( P = .004 ) from baseline to testing at 8 weeks . CONCLUSION Both rehabilitation approaches improved function and reduced pain . For patients with PFPS , initial hip strengthening may allow an earlier dissipation of pain than exercises focused on the quadriceps STUDY DESIGN R and omized controlled trial . OBJECTIVES To determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome ( PFPS ) . BACKGROUND Recent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS . However , there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises . METHODS Fifty-four sedentary women between 20 and 40 years of age , with a diagnosis of unilateral PFPS , were r and omly assigned knee exercise ( KE ) or knee and hip exercise ( KHE ) .  The women in the KE group ( n = 26 ; mean age , 23 years ) performed a 4-week conventional knee-stretching and -strengthening program . The women in the KHE group ( n = 28 ; mean age , 22 years ) performed the same exercises as those in the KE group , as well as strengthening exercises for the hip abductors , lateral rotators , and extensors . An 11-point numeric pain rating scale , the Lower Extremity Functional Scale , the Anterior Knee Pain Scale , and a single-hop test were used as outcome measures at baseline ( pretreatment ) and 3 , 6 , and 12 months posttreatment . RESULTS At baseline , demographic , pain , and functional assessment data were similar between groups . Those in the KHE group had a higher level of function and less pain at 3 , 6 , and 12 months compared to baseline ( P<.05 ) . In contrast , the KE group had reduced pain only at the 3- and 6-month follow-ups ( P<.05 ) , without any changes in Lower Extremity Functional Scale , Anterior Knee Pain Scale , or hop testing ( P>.05 ) through the course of the study . Compared to the KE group , the KHE group had less pain and better function at 3 , 6 , and 12 months posttreatment ( P<.05 ) . For the Lower Extremity Functional Scale , the between-group difference in change scores from baseline at 3 , 6 , and 12 months posttreatment favored the KHE group by 22.0 , 22.0 , and 20.8 points , respectively . CONCLUSION Knee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS Background Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis ( OA ) . Strengthening the hip abductor and adductor muscles may influence joint loading and /or OA-related symptoms , but no study has evaluated these hypotheses directly . The aim of this r and omised , single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA . Methods / Design 88 participants with painful , radiographically confirmed medial compartment knee OA and varus alignment will be recruited from the community and r and omly allocated to a hip strengthening or control group using concealed allocation stratified by disease severity . The hip strengthening group will perform 6 exercises to strengthen the hip abductor and adductor muscles at home 5 times per week for 12 weeks . They will consult with a physiotherapist on 7 occasions to be taught the exercises and progress exercise resistance . The control group will be requested to continue with their usual care . Blinded follow up assessment will be conducted at 12 weeks after r and omisation . The primary outcome measure is the change in the peak external knee adduction moment measured during walking . Question naires will assess changes in pain and physical function as well as overall perceived rating of change . An intention-to-treat analysis will be performed using linear regression modelling and adjusting for baseline outcome values and other demographic characteristics . Discussion Results from this trial will contribute to the evidence regarding the effect of hip strengthening on knee loads and symptoms in people with medial compartment knee OA . If shown to reduce the knee adduction moment , hip strengthening has the potential to slow disease progression . Trial Registration Australia New Zeal and Clinical Trials Registry STUDY DESIGN R and omized clinical trial . OBJECTIVES To compare the effects of functional stabilization training ( FST ) versus st and ard training on knee pain and function , lower-limb and trunk kinematics , trunk muscle endurance , and eccentric hip and knee muscle strength in women with patellofemoral pain . BACKGROUND A combination of hip- and knee-strengthening exercise may be more beneficial than quadriceps strengthening alone to improve pain and function in individuals with patellofemoral pain . However , there is limited evidence of the effectiveness of these exercise programs on the biomechanics of the lower extremity . METHODS Thirty-one women were r and omized to either the FST group or st and ard-training group .  Patients attended a baseline assessment session , followed by an 8-week intervention , and were reassessed at the end of the intervention and at 3 months after the intervention . Assessment measures were a 10-cm visual analog scale for pain , the Lower Extremity Functional Scale , and the single-leg triple-hop test . A global rating of change scale was used to measure perceived improvement . Kinematics were assessed during the single-leg squat . Outcome measures also included trunk endurance and eccentric hip and knee muscle strength assessment . RESULTS The patients in the FST group had less pain at the 3-month follow-up and greater global improvement and physical function at the end of the intervention compared to those in the st and ard-training group . Lesser ipsilateral trunk inclination , pelvis contralateral depression , hip adduction , and knee abduction , along with greater pelvis anteversion and hip flexion movement excursions during the single-leg squat , were only observed in the FST group after the intervention . Only those in the FST group had greater eccentric hip abductor and knee flexor strength , as well as greater endurance of the anterior , posterior , and lateral trunk muscles , after training . CONCLUSION An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain , physical function , kinematics , and muscle strength compared to a program of quadriceps-strengthening exercises alone STUDY DESIGN R and omized clinical trial . OBJECTIVE To investigate the influence of strengthening the hip abductor and lateral rotator musculature on pain and function of females with patellofemoral pain syndrome ( PFPS ) . BACKGROUND Hip muscle weakness in women athletes has been the focus of many recent studies and is suggested as an important impairment to address in the conservative treatment of women with PFPS . However , it is still not well established if strengthening these muscles is associated with clinical improvement in pain and function in sedentary females with PFPS . METHODS Seventy females ( average±SD age , 25±07 years ) , with a diagnosis of unilateral PFPS , were distributed r and omly into 3 groups : 22 females in the knee exercise group , who received a conventional treatment that emphasized stretching and strengthening of the knee musculature ; 23 females in the knee and hip exercise group , who performed exercises to strengthen the hip abductors and external rotators in addition to the same exercises performed by those in the knee exercise group ; and of the 25 females who did not receive any treatment . The females of the nontreatment group ( control ) were instructed to maintain their normal daily activities . An 11-point numerical pain rating scale ( NPRS ) was used to assess pain during stair ascent and descent . The lower extremity functional scale ( LEFS ) and the anterior knee pain scale ( AKPS ) were used to assess function . The single-limb single hop test was also used as a functional outcome to measure preintervention and 4-week postintervention function . RESULTS The 3 groups were homogeneous prior to treatment in respect to demographic , pain , and functional scales data . Both the knee exercise and the knee and hip exercise groups showed significant improvement in the LEFS , the AKPS , and the NPRS , when compared to the control group ( P<.05 and P<.001 , respectively ) . But , when we considered minimal clinical ly important differences , only the knee and hip exercise group demonstrated mean improvements in AKPS and pain scores that were large enough to be clinical ly meaningful . For the single-limb single hop test , both groups receiving an intervention showed greater improvement than the control group , but there was no difference between the 2 interventions ( P>.05 ) . CONCLUSION Rehabilitation programs focusing on knee strengthening exercises and knee strengthening exercises supplemented by hip strengthening exercises were both effective in improving function and reducing pain in sedentary women with PFPS .  Improvements of pain and function were greater for the group that performed the hip strengthening exercises , but the difference was significant only for pain rating while descending stairs . LEVEL OF EVIDENCE Therapy , level 1b- Objectives : To study the effect of additional strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise rehabilitation programme for patients with the patellofemoral pain syndrome . Design : R and omized controlled pilot trial . Setting : Clinical setting with home programme . Participants : Fourteen patients with patellofemoral pain syndrome . Intervention : The subjects were r and omly assigned to the intervention group ( strengthening of quadriceps plus strengthening of hip abductor and lateral rotator muscles ) or to the control group ( strengthening of quadriceps ) . Both groups participated in a six-week home exercise protocol . Main outcome measures : The perceived pain symptoms , isokinetic eccentric knee extensor , hip abductor and lateral rotator torques and the gluteus medius electromyographic activity were assessed before and after treatment . Parametric and non-parametric tests were used to compare the groups before and after treatment with α=0.05 . Results : Only the intervention group improved perceived pain symptoms during functional activities ( P=0.02—0.04 ) and also increased their gluteus medius electromyographic activity during isometric voluntary contraction ( P=0.03 ) . Eccentric knee extensors torque increased in both groups ( P=0.04 and P=0.02 ) . There was no statistically significant difference in the hip muscles torque in either group . Conclusion : Supplementation of strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise programme provided additional benefits with respect to the perceived pain symptoms during functional activities in patients with patellofemoral pain syndrome after six weeks of treatment STUDY DESIGN R and omized controlled trial , pretest-posttest design . OBJECTIVES To compare the efficacy of non-weight-bearing single-joint quadriceps exercise ( SJNWBE ) versus weight-bearing multiple-joint quadriceps exercise ( MJWBE ) for individuals with patellofemoral pain syndrome ( PFPS ) . BACKGROUND PFPS is a common ailment of the knee . Both weight-bearing and non-weight-bearing exercises are considered appropriate for strengthening the quadriceps , a key element in the treatment of this condition . METHODS AND MEASURES Forty-five male subjects with PFPS between 18 and 35 years of age were r and omized into 1 of 3 groups . Group 1 ( SJNWBE ) performed knee extension exercises , group 2 ( MJWBE ) performed seated leg press exercises , and group 3 ( control group ) received no treatment .  Subjective symptoms , knee extensor muscle strength , and functional performance were evaluated at the time of the initial examination and at the end of the 6-week treatment period . RESULTS Individuals in both exercise groups demonstrated a statistically significant decrease in pain and an increase in muscle strength and functional performance , as compared to the control group ( P<.05 ) . All measures showed no significant differences in outcome between the 2 exercise groups ( P>.05 ) . CONCLUSION This study demonstrates that both weight-bearing and non-weight-bearing quadriceps exercises can significantly improve subjective and clinical outcomes in patients with PFPS Purpose There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome . However , what is unclear are the parameters underpinning this intervention . This has led to uncertainty when operationalizing exercises for patients with patellofemoral pain syndrome in clinical practice . The aim of this review was to evaluate the parameters of exercise programs reported in primary research , to provide clinicians with evidence -based recommendations for exercise prescription for patellofemoral pain . Methods A systematic review of r and omized controlled trials was undertaken . Only trials that identified exercise to be effective in treating patellofemoral pain were included . Appropriate data bases and reference lists were search ed using established keywords . Data relating to common exercise parameters such as the type of exercise , length , and frequency of intervention , intensity , repetitions , sets , and specific technique were extracted , along with details of co- interventions that may have been used . Results A total of ten r and omized controlled trials were included in this review and from these trials 14 interventions arms were evaluated . All 14 interventions focused on active exercises , all but two of which also included a passive stretching component . The current body of evidence demonstrates positive results with exercise interventions such as  knee extension , squats , stationary cycling , static quadriceps , active straight leg raise , leg press , and step-up and down exercises  for patients with patellofemoral pain syndrome . A progressive regime of daily exercises of two to four sets of ten or more repetitions over an intervention period of 6 weeks or more , combined with exercises to address flexibility of the lower limb musculature was commonly used . Conclusion Currently , the primary research on this topic supports the use of closed kinetic chain , strengthening exercises for musculature of the lower limb , combined with flexibility options . The current evidence base supports a prescription of daily exercises of two – four sets of ten or more repetitions over a period of 6 weeks or more Question To compare the efficacy of aerobic walking and home based quadriceps strengthening exercises in reducing  pain and disability in knee osteoarthritis . Design Systematic review of r and omised controlled trials . Setting / population People with knee osteoarthritis . Interventions Comparison of aerobic walking or home based quadriceps strengthening exercise with a non-exercise control group . Strengthening exercise was considered to be ‘ home based ' where it was undertaken exclusively in the subject 's home environment or , where exercise was partly supervised , the regimen was intended to be continued at home unsupervised . Outcomes Pain and disability . Results 13 studies were included . One study provided a direct comparison between aerobic walking and home based strengthening exercises and control . Nine RCTs evaluated quadriceps strengthening exercises , and in three studies the exercise intervention was predominantly aerobic walking . Control interventions included education and lifestyle advice , support by telephone calls , and no intervention . When comparing aerobic walking with no exercise interventions , the pooled effect sizes for pain and disability were 0.52 ( 95 % CI 0.34 to 0.70 ) and 0.46 ( 95 % CI 0.25 to 0.67 ) respectively . Corresponding effect size for quadriceps strengthening was 0.32 ( 95 % CI 0.23 to 0.42 ) for both pain and disability . Conclusion Both aerobic walking and home based quadriceps strengthening exercises are effective at reducing pain and disability in subjects with knee osteoarthritis . No advantage of one form of exercise over the other was found on indirect comparison Objective Patellar malalignment is a major cause of patellofemoral pain syndrome ( PFPS ) , but the relationship between clinical symptoms and changes in patellar position and knee muscle strength has not been confirmed . This study examined the effect of weight training on hip and knee muscle strength , patellofemoral joint contact area , and patellar tilt on subjects with and without PFPS , hoping to develop an optimal rehabilitation protocol for subjects with PFPS . Design The study uses a prospect i ve independent group comparison . Fifteen subjects with and without PFPS were assessed for knee strength , patellofemoral joint contact area , and patellar tilt angle using magnetic resonance imaging . The subjects with PFPS were also examined and given a numeric pain rating score and a Kujala patellofemoral score . The subjects performed lower-limb weight training 3 times/wk for 8 wks , and the outcomes were assessed both before and after training . Results Subjects with PFPS have increased their patellofemoral joint contact area after weight training ( P < 0.001 ) . No statistical significant change was found on the patellar tilt angle . The isometric and isokinetic knee strength in subjects with and without PFPS have increased after weight training ( P value increased from 0.007 to 0.05 ) . Both numeric pain rating and Kujala patellofemoral score in the PFPS group improved after training ( P < 0.001 ) . Conclusions Weight-training exercise increased knee muscle strength and the patellofemoral joint contact area , which could reduce mechanical stress in the joint , improving pain and function in subjects with PFPS PURPOSE The number of effective knee osteoarthritis ( OA ) interventions , especially those tailored to specific compartmental involvement , are small . The objective of this study was to determine the efficacy of a realigning patellofemoral ( PF ) brace in improving pain and function among persons with symptomatic lateral PF OA . METHOD We conducted a double blind , r and omized crossover trial of a realigning PF brace for persons with lateral PF OA . Participants had lateral PF OA with anterior knee symptoms on most days of the month , lateral PF joint space narrowing , and radiographic evidence of a definite osteophyte in the PF joint . We compared two treatments : ( 1 ) Control treatment consisting of a BioSkin Q Brace with patellar realigning strap removed ; and ( 2 ) Active treatment consisting of a realigning BioSkin Q Brace with the strap applied . For each participant , the trial lasted 18 weeks , including 6 weeks each of active and control treatment period separated by a 6-week washout period . The order of treatments was r and omized . The primary outcome was change in knee pain on the visual analog scale ( VAS ) . Secondary outcomes included WOMAC pain , function , and stiffness . An unstructured correlation matrix for observations within participants was used in generalized estimating equation fitting to derive a linear regression model that expressed the relation between the intervention and change in VAS pain . RESULTS 80 participants ( 63 F ) with a mean age and body mass index of 61 years and 28 kg/m(2 ) , respectively , were r and omized by order of treatment . A model examining the main effects for change in VAS knee pain ( 0 - 100 ) demonstrated no significant treatment effect ( -0.68 VAS units , 95 % CI : -6.2 , 4.8 units , P=0.81 ) and no differential carryover effect . There was also no significant difference between active and control treatments for WOMAC pain , function , or stiffness outcomes . CONCLUSION The effects of a specific realigning PF brace are not of clinical or statistical significance OBJECTIVE To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain ( PFP ) . DESIGN Comparative control trial . SETTING Rehabilitation facility . PARTICIPANTS Persons with a diagnosis of PFP ( N=36 ; 18 men , 18 women ) . INTERVENTIONS Patients were alternately assigned to a posterolateral hip muscle strengthening group ( 9 men and 9 women ) or a quadriceps strengthening group ( 9 men and 9 women ) . The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises , whereas the quadriceps strengthening group performed quadriceps strengthening exercises ( 3 times a week for 8wk ) . MAIN OUTCOME MEASURES Pain ( visual analog scale [ VAS ] ) and health status ( Western Ontario McMaster Universities Osteoarthritis Index [ WOMAC ] ) were assessed at baseline , postintervention , and 6-month follow-up . RESULTS Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up ( P<.001 ) . Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up ( P<.05 ) . CONCLUSIONS Although both intervention programs result ed in decreased pain and improved function in persons with PFP , outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group . The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention OBJECTIVE The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip , thigh , and knee . METHODS We conducted a systematic review and search ed MEDLINE , EMBASE , PsycINFO , the Cochrane Central Register of Controlled Trials , and CINAHL Plus with Full Text from January 1 , 1990 , to April 8 , 2015 , for r and omized controlled trials ( RCTs ) , cohort studies , and case-control studies evaluating the effect of exercise on pain intensity , self-rated recovery , functional recovery , health-related quality of life , psychological outcomes , and adverse events . R and om pairs of independent review ers screened titles and abstract s and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria . Best evidence synthesis methodology was used . RESULTS We screened 9494 citations . Eight RCTs were critically appraised , and 3 had low risk of bias and were included in our synthesis . One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a " wait and see " approach for patellofemoral pain syndrome . A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome . One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain . CONCLUSION We found limited high- quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity . The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain . Further high- quality research is needed
Meta‐analyses showed no significant changes in strength for any of the interventions . •
BACKGROUND : The addition of hip strengthening to knee strengthening for persons with patellofemoral pain has the potential to optimize treatment effects .
OBJECTIVE : To examine the efficacy of hip strengthening , associated or not with knee strengthening , to increase strength , reduce pain , and improve activity in individuals with patellofemoral pain .