The effect of different hip exercise programs on pain, function and muscle strength in females with patellofemoral pain syndrome: a systematic review

Details

Supervisors

Van Cant-Joachim

Faculty

Faculté des sciences de la motricité

Degree label

Master [120] en sciences de la motricité, orientation générale, à finalité spécialisée: kinésithérapie musculo-squelettique

Abstract

Objective: To compare the effect of different hip muscles training programs on pain, function and strength in females with PFP. Data sources: A systematic search strategy was performed up to December 2020 in order to identify relevant studies in the following databases: PubMed, EMBASE and PEDro. The following key words were combined: “patellofemoral pain”, “anterior knee pain”, “patellofemoral syndrome”, “retropatellar pain”, “peripatellar pain”, “patellofemoral joint pain”, “parapatellar pain”, “PFP”, “chondromalacia patellae”, “proximal”, “gluteal”, “strength”, “training”, “program”, “exercise”, “rehab”. Study selection: The included studies were only randomized controlled trials that compared different training hip muscle programs on pain, function and strength in females with PFP. Data extraction: Two independent investigators extracted the data from the included studies. They included: the date and author’s name, individual characteristics, inclusion and exclusion of the studies criteria, exercise/interventional characteristics, outcome measures assessed at baseline and within 7 days after the final training session and the main results of the study. Results: In the short-term, the strength training program indicated a superiority in the hip group alone regarding pain, function and strength when compared with stretching program or no treatment. A moderate and limited evidence did not find any difference between the hip group alone or with the addition of knee and core exercises and knee group regarding pain and function but greater improvements were indicated regarding strength of the hip muscles. In addition, a moderate evidence indicated a greater reduction regarding pain and greater improvements regarding function with the addition of core exercises to hip exercises when compared to knee exercises. A moderate evidence indicated a contradictory results regarding pain and a limited evidence indicated another contradictory results regarding function between the knee group and hip and knee group. In the medium-term, a limited and a very limited evidence indicated a greater reduction regarding pain and greater improvement regarding function when hip and core group and hip, core and knee group were compared to knee exercises. A moderate evidence indicated a contradictory results when hip group alone are compared to knee group. In the long term, a limited evidence indicated greater improvements regarding function in both hip group alone or with the addition of both core and knee exercises at the same time when compared to knee exercises. However, no difference was found regarding pain when hip, core and knee exercises were compared to knee exercises in the long term. The strength and neuromuscular training program demonstrated in a very limited evidence a greater reduction in the hip and core group regarding pain and no difference between groups regarding function in the short-term and no difference between groups regarding pain and function in the medium-term. The endurance training program demonstrated in a very limited evidence greater improvements in the hip group regarding pain, function and hip muscles strength in the short-term. The strength and endurance training program demonstrated in a limited evidence greater improvements in the hip, knee and core group regarding pain and hip muscles strength in the short-term. The strength and power training program demonstrated in a limited evidence greater improvements in the hip and knee group regarding pain, function and hip external rotators muscles strength in the short- and medium-term without any difference between groups regarding hip abductor muscles strength in the medium-term only. Conclusion: Different hip training programs show positive outcome on pain, function and strength in females with PFP when compared to stretching, ice and/or heat and no treatment in the short-term. However, a superiority over knee training program regarding pain, function and muscle strength in short- medium-term was only found in the strength training program towards the hip and core group and in the strength and power training program towards the hip and knee group.