Hip and Knee Strengthening Most Effective For Patients With Knee Pain


Patellofemoral Pain Syndrome (pain on the front the knee and around knee cap) is the most common source of knee pain among active individuals.  Patients often complain of pain with running, stair climbing, squatting, and during prolonged sitting.  The natural history of this diagnosis is not as short as once thought with 90% of patients reporting symptoms up to 4 years after the onset of their symptoms.  Thankfully this condition is successfully treated by Physical Therapists who utilize manual therapy and exercise to reduce pain and facilitate a return to prior levels of activity for this patient population.  

In previous decades, Physical Therapists utilized quadriceps strength training exercises attempting to improve the stability of the knee cap.  More recent research on this diagnosis indicates hip muscles play a larger role in the development and progression of the pain process because of their greater control of the knee joint.  Smaller studies have supported the use of hip or hip and knee strengthening over knee strengthening alone for the treatment of patellofemoral pain syndrome.

A recent review of the available literature was conducted in the Journal of Orthopedic and Sports Physical Therapy.  Nascimento and colleagues studies 14 individual studies of 673 patients with knee pain (JOSPT 2017).  The authors noted a combined hip and knee program was superior to knee strengthening alone for reducing pain and improving activity and function.  Interestingly, some of the these positive changes did not correlate to a significant improvement in strength for some of the patients indicating a motor learning or coordination effect may be at work.