• 
• 

Three Part Question

In [adults with chronic patellofemoral pain]
Does [strengthening the hip muscles]
Improve [their pain]

Clinical Scenario

A 27 year female has an atraumatic onset of PF pain for several months. As well as the standard exercises and physiotherapy, you wish to instigate some hip muscle exercises, but the patient is surprised that she may have weak hip muscles and how treating this may alleviate her PF pain. You want to show her evidence that treating hip muscles will alleviate PF pain.

Search Strategy

Medline 1950 01/09, CINAHL 1982 –01/09, AMED 1985-01/09, EMBASE 1980-01/09 via the OVID interface and also the Cochrane database.
Medline, CINAHL, EMBASE, AMED,: [{(exp patellofemoral pain syndrome OR exp arthralgia OR exp Patella OR exp Chondromalacia patellae OR anterior knee pain mp OR ((patellofemoral or patello-femoral) adj (joint)).mp OR ((Patello-femoral or patellofemoral) adj (pain or syndrome or dysfunction)).tw OR ((lateral compression or lateral facet or lateral pressure or odd facet) adj (syndrome)).tw OR ((chondromal$ or chondropath$) adj (knee or patell$ or femoropatell$ or femoro-patell$ or retropatell$ or retro-patell$)).tw) AND (exp buttocks OR gluteus medius.mp OR gluteus maximus.mp OR gluteus minimus.mp OR hip abduction OR hip internal rotation OR muscle imbalance OR )}] LIMIT to English language.

The Cochrane database: patellofemoral pain
The PEDro database: patellofemoral pain

Search Outcome

There were 22 papers retrieved including 3 abstracts. Only 2 papers concerned a rehabilitation programme for hip strengthening in PF pain patients; only one was RCT.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Nakagawa et al. 2008 Brazil	PF pain n = 14	RCT level 1a	1.VAS	No between groups analysis performed	Small sample size leading to type II statistical error. No ‘treatment’ control group. No long-term follow up.
			2. EMG	No between groups analysis performed
			3.Hip peak torque	No between groups analysis performed

Comment(s)

Despite a number of papers published on the subject of hip strength in PF pain there has never been a robust RCT to lend evidence to the theory that PF pain can be improved with the addition of hip strengthening exercises to a physiotherapy treatment programme.

Clinical Bottom Line

There is no good evidence yet that PF pain can be alleviated by adding hip strengthening exercises to a treatment programme.

References

1. Nakagawa TH, Muniz TB, Baldon RdM, as Maciel C, de Menezes Reiff RB, Serrao FV. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clin Rehab. 2008: 22(12): 1051-1060