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Vol. 22. Num. 2.01 March 2018
Pages 95-174
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Vol. 22. Num. 2.01 March 2018
Pages 95-174
Masterclass
DOI: 10.1016/j.bjpt.2017.10.002
Do hip muscle weakness and dynamic knee valgus matter for the clinical evaluation and decision-making process in patients with patellofemoral pain?
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Nayra Deise dos Anjos Rabelo, Paulo Roberto Garcia Lucareli
Corresponding author
plucareli@hotmail.com
paulolucareli@uni9.pro.br

Corresponding author at: UNINOVE, Rua Vergueiro, 235, São Paulo, SP, Brazil.
Human Motion Analysis Laboratory, Reabilitation Sciences Departament, Universidade Nove de Julho – UNINOVE, São Paulo, SP, Brazil
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Highlights

  • Hip muscle weakness in PFP patients may be consequence and not the cause of pain.

  • Pain and disability may not be associated with kinematics after treatment.

  • Hip muscle weakness may have no causal relationship with dynamic knee valgus.

  • The mechanical factors that may impair the management of PFP are likely to be overestimated.

  • PFP patients should be treated on a biopsychosocial approach.

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Abstract
Background

Patellofemoral pain is a very common musculoskeletal condition. In the last years, evidence regarding this disease increased exponentially. Although widely investigated, this problem still frustrates patients and clinicians for having an unfavorable prognosis. Some gaps still exist in the understanding and managing of patellofemoral pain. Numerous cross-sectional association studies show an association between gluteus muscular strength and dynamic knee valgus in patients with patellofemoral pain. In spite of this biological plausibility, many evidences challenge the direct relationship between these factors. Recent studies have concluded that women with patellofemoral pain show muscular weakness of the hip based on the cross-sectional studies, however prospective studies indicate that hip weakness cannot be considered a risk for development of patellofemoral pain. In addition, some clinical trials have demonstrated that strength training of the gluteal muscles promotes significant improvement in symptoms but not alter the kinematics of the patients with patellofemoral pain. These findings cast doubt on whether the cause of this condition is really being treated, whether all individuals suffering from patellofemoral pain present dynamic knee valgus or if this is a disturbance present in only a subgroup of patients and whether the strengthening of the hip musculature is an option to consider for prevention of patellofemoral pain.

Conclusion

Certainly, more studies should be conducted to clarify the influence of mechanical patterns on this condition, but with the existing evidence so far, the importance given to these issues in the evaluation and clinical decision on treatment of these patients seems questionable. Therefore, this masterclass explores the understanding about patellofemoral pain, highlighting mainly the importance of muscular strength and dynamic knee valgus, as well as other possible factors that must be consider during the evaluation and the decision making in these patients.

Keywords:
Patellofemoral pain
Muscle strength
Kinematics
Biomechanics
Physical therapy

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