Adding hip strengthening exercises to knee strengthening exercises
leads to the greatest benefits for patients with knee pain

Earlier research on the topic has not led to any clear conclusions
Patellofemoral pain syndrome (PFPS) - also known as runner’s knee - is a painful condition that’s very prevalent in physically active individuals, especially runners. Patients with PFPS typically experience a dull ache behind or around the kneecap that’s particularly bad when running or ascending/descending stairs. Symptoms can often prevent these individuals from staying physically active and even getting around in everyday life. Physical therapy is commonly recommended for PFPS patients, and treatment will often include a variety of strengthening exercises. While exercises that strengthen muscles that support the injured knee are most common, some physical therapists also recommend exercises to strengthen muscles surrounding the hip. It’s believed that many patients with PFPS have weak hip muscles, and these strengthening exercises may address this weakness and improve PFPS symptoms. Despite their usage, though, previous studies investigating these exercises have not led to any clear conclusions, and additional research has been needed. For this reason, researchers conducted a powerful pair of studies called a systematic review and meta-analysis comparing hip strengthening and knee strengthening exercises to knee strengthening exercises alone for PFPS patients.

Five medical databases searched for relevant studies
To conduct these studies, investigators performed a thorough search of five major medical databases for trials that evaluated the use of knee strengthening exercises alone or knee and hip strengthening exercises for PFPS. This search led to 14 studies being included in the systematic review and meta-analysis, which together included data on 673 PFPS patients. Once identified, the investigators analyzed the findings of each of these studies and compared them to one another to determine the true value of hip strengthening exercises. They also assessed the quality of each included study to gauge the reliability of the information they contained.

Combined strengthening exercises leads to greater improvements in pain and activity
After performing this review and analysis, investigators found evidence that both hip and knee strengthening exercises were in fact effective for reducing pain and improving activity in patients with PFPS. In addition, the studies revealed that combining hip and knee strengthening exercises resulted in a greater decrease in pain and improvement in activity compared to knee strengthening alone. These improvements were significant, and they lasted well beyond the period of time in which treatment was received. Finally, the meta-analysis showed that the average treatment program consisted of three treatment sessions per week for six weeks, and that this amount of treatment could be expected to bring about improvements in people with moderate-to-high levels of PFPS. With these findings in mind, it appears that combining hip and knee strengthening exercises is most beneficial for PFPS patients, and individuals currently dealing with this condition are urged to seek out these treatments from a physical therapist. Doing so will lead to a reduction in symptoms and a successful recovery in the most efficient manner possible.

-Summarized by Greg Gargiulo

-As reported in the October '17 issue of JOSPT