Patellofemoral pain with and without hip strength
Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in the knee joint, more specifically the patellofemoral joint (underneath the knee cap). Weakness within the Gluteal muscles of the hip has been identified as one of the possible causative factors within PFPS. One study has compared the strength of the hip’s abductors (Gluteus Medius) and external rotators (Gluteus Maximus) relative to pain and/or dysfunction of distal structures in a young athletic female population (1). Their results indicate that young women with PFPS are more likely to demonstrate weakness in hip abduction and external rotation than age-matched women who are non-symptomatic. This study adds to the growing evidence that hip abductor and external rotator strength correlates with knee pathology and pain.
Why is Glute med strength important?
The main role of the Gluteus Medius muscle is to stabilise the hip whilst walking and running, and to abduct the hip. So if we have weakness in this muscle when running, we will adopt a shorter stride length and our running gait will turn into more of a shuffling type of pattern. This in turn reduces the ground reaction force at heel strike and therefore, reduces the amount of muscle control required for maintaining pelvic posture, which can lead to compensation patterns and other joints having to help distribute the load throughout the lower limb and trunk. Many athletes with running-related overuse injuries to the lower limb and trunk region will usually present with poor glute med and glute max function, so it is key to ensure you are firing up these muscles correctly prior to exercise. Otherwise, weakness within these muscles could lead to:
Lumbar pathology and sacral torsions,
Hypertonic QL muscles on the opposing side,
Excessive adduction and internal rotation of the femur,
Misfiring or weakness within the posterior oblique sling,
Knee valgus or possible knee varus positions, leading to mal-tracking of the patella and possible PFPS,
Internal rotation of the tibia (shin bone) relative to the position of the foot,
And even excessive pronation of the foot and ankle to name a few.
Therefore, if someone is experiencing PFPS and weakness has been identified within the abductors and external rotators of the hip, including activation exercises pre training and incorporating strengthening exercises within a training routine may be beneficial in order to aid in the individuals knee pain.
To make it easier for you guys, I have incorporated a hip abductor and external rotator activation routine below that should be easy to follow, to aid in strengthening these muscles and improving stability of the lower extremity by activating the muscles pre training/exercise.
One thing I’d like to note here is that weak abductors and external rotators may not be the only underlying cause for knee pain. There are a number of other contributing factors that may play a part in an individual’s knee pain. And as a therapist, it’s vital to look at the individual as a whole, not just focusing on one specific area you think could be the problem, as that alone might not be the underlying cause of pain.
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Citation
Ireland, ML., Wilson, JD., Ballantyne, BT., Davis, IM. (2003). Hip Strength in Females With and Without Patellofemoral Pain. J Orthop Sports Phys Ther 2003. 33: 671-676