J Orthop Sports Phys Ther. 2017 Oct 15:1-35. doi: 10.2519/jospt.2018.7365. [Epub ahead of print]
Hip and Knee Strengthening is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-Analysis.
Nascimento LR1,2, Teixeira-Salmela LF1, Souza RB1, Resende RA1.
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Study Design
Systematic review with meta-analysis. Background The addition of hip strengthening to knee strengthening for persons with patellofemoral pain has the potential to optimize treatment effects. There is a need to systematically review and pool the current evidence in this area.
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.
Methods A systematic review of randomized or controlled trials was performed. Participants in the reviewed studies were individuals with patellofemoral pain and the experimental intervention was hip and/or knee strengthening. Outcome data related to muscle strength, pain, and activity were extracted from the eligible trials and combined using a meta-analysis approach.
Results Fourteen trials involving 673 participants were included. Random effects meta-analyses revealed that hip and knee strengthening decreased pain (MD -3.3, 95% CI -5.6 to -1.1) and improved activity (SMD 1.4, 95% CI 0.03 to 2.8), compared to no training/placebo. In addition, hip and knee strengthening was superior to knee strengthening alone for decreasing pain (MD -1.5, 95% CI -2.3 to -0.8) and improving activity (SMD 0.7, 95% CI 0.2 to 1.3). Results were maintained beyond the intervention period. Meta-analyses showed no significant changes in strength for any of the interventions.
Conclusions Hip and knee strengthening is effective and superior to knee strengthening alone for decreasing pain and improving activity in persons with patellofemoral pain, however these outcomes were achieved without a concurrent change in strength. Level of Evidence Therapy, Level 1a-. J Orthop Sports Phys Ther, Epub 15 Oct 2017. doi:10.2519/jospt.2018.7365.