Patellofemoral Pain Syndrome

Mentoring Minutes: Patellofemoral Pain Syndrome



J Orthop Sports Phys Ther. 2009 Jan;39(1):12-9. doi: 10.2519/jospt.2009.2885.

Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain.

Souza RB1, Powers CM.

            - Twenty-one females with PFP and 20 pain-free controls

-Hip kinematics and activity level of hip musculature were obtained during running, a drop jump, and a step-down maneuver. Isometric hip muscle torque production was quantified using a multimodal dynamometer.

- Runners with PFPS, best predictor of hip IR: isotonic hip extension endurance


J Orthop Sports Phys Ther. 2012 Jun;42(6):491-501. doi: 10.2519/jospt.2012.3987. Epub 2012 Mar 8.

Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome.

Nakagawa TH1, Moriya ETMaciel CDSerrão FV.

 - 4 groups: females with PFPS, female controls, males with PFPS and male controls

- Outcomes: trunk, pelvis, hip, and knee kinematics; gluteal muscle activation during SL squat; hip abd+ER eccentric strength

- During SL squat PFPS patients had significantly greater ipsilateral trunk lean, contralateral pelvic drop, hip adduction, and knee abduction with SL squat

- Pts with PFPS had 18% less hip abd and 17% less hip ER strength

- females with PFPS had more hip IR and less glut med activation during SL squat


J Orthop Sports Phys Ther. 2009 Jul;39(7):532-40. doi: 10.2519/jospt.2009.2796.

Gluteal muscle activation during common therapeutic exercises.

Distefano LJ1, Blackburn JTMarshall SWPadua DA.

- Which exercise is best for patients with PFPS for glut med and max strengthening

            - Glut med: Side lying hip abd (81% MVIC), Single limb squat: 64%

            - Glut max: Single limb squat and Single limb deadlift (both 59%)


J Orthop Sports Phys Ther. 2013 Feb;43(2):54-64. doi: 10.2519/jospt.2013.4116. Epub 2012 Nov 16.

Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes.

Selkowitz DM1, Beneck GJPowers CM.

- Best exercises for activating glut max – bilateral bridging, clam, quadruped hip ext with knee extended, quadruped hip extension with knee flexed, side step, squat, and unilateral bridges

All of these exercises produces 50% higher normalized EMG amplitudes for both gluteal muscles compared to TFL

Clamshells with band– highest glut max normalized EMG amplitude; unilateral bridges – second highest normalized EMG amplitude

Hip abduction in sidelying and hip hike – highest glut med normalized EMG amplitude compared to TFL and glut max


J Orthop Sports Phys Ther. 2012 Jan;42(1):22-9. doi: 10.2519/jospt.2012.3704. Epub 2011 Oct 25.

The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial.

Khayambashi K1, Mohammadkhani ZGhaznavi KLyle MAPowers CM.

- Isolated hip abductore and ER strength with PFPS. RCT

- 28 females with PFPS split into 2 groups; 1 group did hip abduction and ER strengthening 3x a week for 8 weeks;

measured pain, womac, strength,

- performed standing abduction and seated Er both with resistance. Starting 3 sets of 20, increasing reps and resistance from TB.. Pain and health status both sustained at 6 month follow up.

- pain, health status, and bilateral hip strength improved in the exercise group following the 8-week intervention but did not change in the control group.

- Improvements in pain and health status were sustained at 6-month follow-up in the exercise group.


J Orthop Sports Phys Ther. 2011 Sep;41(9):625-32. doi: 10.2519/jospt.2011.3470. Epub 2011 Jul 12.

The effect of a hip-strengthening program on mechanics during running and during a single-leg squat.

Willy RWDavis IS.

- evaluate a simple gait retraining technique, using a full-length mirror, in female runners with patellofemoral pain and abnormal hip mechanics.

- Had them just practice running in front of a mirror with verbal cues… slowly deceasing the feedback Transfer of the new motor skill to the untrained tasks of single leg squat and step descent was also evaluated.

- significant changes in only 2 weeks, (8 sessions)  with improved mechanics and decrease in pain, with feedback decreasing after 4, also recheck at 1 month and 3 months after.  Were shown their video of running to see faults- that transferred over to other tasks (SL squat) and was sustained up to 3 months later

-Subjects reduced peaks of hip adduction, contralateral pelvic drop, and hip abduction moment during running

- Skill transfer to single leg squatting and step descent was noted, and maintained through 3 months post retraining.

Solving Patellofemoral Pain - It's All In The Hips

Patellofemoral Pain.jpeg

When we see patients with this common diagnosis, are we giving them a clear understanding of what could be leading to their knee pain?  

Many of my patients breathe a sigh of relief when they hear that there's nothing "wrong" with their knee that's causing it to hurt - and that strengthening their hip muscles can improve their mechanics, taking pressure off the knee.  

Our patients need to be educated to fully buy in to their treatment and, ultimately, to improve.  

Be their educator, their guide, and their encouragement...

continue reading...