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Vol. 22. Issue 5.
Pages 408-416 (01 September 2018)
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Vol. 22. Issue 5.
Pages 408-416 (01 September 2018)
Original Research
DOI: 10.1016/j.bjpt.2018.03.009
Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises
Marcelo Camargo Saada,b,
Corresponding author

Corresponding author at: Prédio da Fisioterapia e Terapia Ocupacional da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Avenida Bandeirantes, 3900, Bairro Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
, Rodrigo Antunes de Vasconcelosc, Letícia Villani de Oliveira Mancinellid, Matheus Soares de Barros Munnod, Rogério Ferreira Liporacib, Débora Bevilaqua Grossia
a Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
b Programa de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
c Núcleo de Estudos Instituto Wilson Mello, Campinas, SP, Brazil
d Curso de Fisioterapia,Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil

  • It is commonly believed that hip dysfunctions have been responsible for PFP onset.

  • Several forms of treatment (HE, QE and SE) can be effective in decreasing PFPS pain.

  • Only interventions with strengthening exercises were able to change movement patterns.

  • More effective rehabilitation programs should focus on the deficits presented by individuals in their initial evaluations.

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Figures (1)
Tables (4)
Table 1. Female patient demographics for muscle strengthening & stretching in PFP patients at baseline.
Table 2. Pain (VAS) pre and post treatment. Anterior Knee Pain Score (AKPS) pre and post treatment for female PFP patients. Final criteria for clinical relevance on pain results based on MCID to the treatment groups and final results comparison between treatment group.
Table 3. Pre and post treatment effects on muscle strength (Kgf) for female PFP patients.
Table 4. Pre and post treatment effects on lower limb kinematics for female PFP patients.
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Additional material (1)

To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics.


A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention.


All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities.


Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (

Anterior knee pain
Step up and down kinematics
Quadriceps and hip muscles.


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