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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hip Progressive Resistive Exercises | Experimental | Exercises targeting hip musculature such as hip abduction and hip external rotation that was progressed by increased resistance following typical progressive resistive exercise approach. |
|
| Quad Progressive Resistive Exercises | Active Comparator | 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.. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hip Progressive Resistive Exercise | Other | 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. |
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Timothy Uhl, PhD, ATC, PT | University of Kentucky | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Kentucky | Lexington | Kentucky | 40506 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21654093 | Derived | 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. |
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willing to share strength and patient reported outcome data at pre, mid, and post testing time points.
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Subjects were evaluated for PFPS using the following:(1)anterior knee pain reported during at least 2 activities: stair climbing, running, squatting, kneeling, and prolonged sitting;(2)insidious onset of symptoms ;(3)pain with compression of the patella; and(4)pain on palpation of patellar facets. Only three patients were excluded during study.
33 females with anterior knee pain (PFPS) volunteered to participate in this study. Enrollment began August 2007 and last subject was enrolled in August 2009.
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| ID | Title | Description |
|---|---|---|
| FG000 | Hip Strengthening Then Combined Exercises | Performed hip strengthening exercises for 4 weeks prior to crossing over to a combined hip and quadricep rehabilitation program |
| FG001 | Quadricep Group Then Combined Exercises | Performed quadricep strengthening exercises for 4 weeks prior to crossing over to a combined hip and quadricep rehabilitation program |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Specific Exercises |
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| Combined Exercises |
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| ID | Title | Description |
|---|---|---|
| BG000 | Hip Strengthening Then Combined Exercises | Performed hip strengthening exercises for 4 weeks prior to crossing over to a combined hip and quadricep rehabilitation program |
| BG001 | Quadricep Group Then Combined Exercises |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | 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 | Posted | Mean | Standard Deviation | centimeter | weekly |
|
During the study and for 6 months following the study
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Hip Strengthening Then Combined Exercises | Performed hip strengthening exercises for 4 weeks prior to crossing over to a combined hip and quadricep rehabilitation program |
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Early termination leading to small number of subjects analyzed. Intention to treat analysis, last score carried forward, was used to analyze all outcome data.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Tim L. Uhl Principal Investigator | University of Kentucky | 859-323-1100 | 80858 | tluhl2@uky.edu |
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| ID | Term |
|---|---|
| D046788 | Patellofemoral Pain Syndrome |
| ID | Term |
|---|---|
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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|
| Quad Progressive Resistive Exercises | Other | 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. |
|
| 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 |
| NOT COMPLETED |
|
Performed quadricep strengthening exercises for 4 weeks prior to crossing over to a combined hip and quadricep rehabilitation program
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Units | Counts |
|---|---|
| Participants |
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| Primary | Subjective Function by Lower Extremity Functional Scale Report Form | Not Posted | Baseline, Mid-Intervention, and Post-Intervention | Participants |
| Secondary | Strength by Isometric Dynamometer | Not Posted | Baseline, Mid, and Post-Intervention | Participants |
| Secondary | Neuromuscular Activity by Surface Electromyographical Amplitude During Stair Descent | Not Posted | Baseline, Mid and Post-Intervention | Participants |
| Secondary | Objective Function by Step-down Task for 30 Seconds | Not Posted | Baseline, Mid, and Post-Intervention | Participants |
| Secondary | Hip Abduction Strength | Side lying Hip Abduction maximal muscular contraction with a hand held dynamometer | Posted | Mean | Standard Deviation | (Newton*meters)/(Weight*Height) | 8 week |
|
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| Primary | 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 | Posted | Mean | Standard Deviation | centimeters | 8 week |
|
|
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| 0 |
| 17 |
| 0 |
| 17 |
| EG001 | Quadricep Group Then Combined Exercises | Performed quadricep strengthening exercises for 4 weeks prior to crossing over to a combined hip and quadricep rehabilitation program | 0 | 16 | 0 | 16 |
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