• Thiago Yukio Fukuda, William Pagotti Melo, Bruno Marcos Zaffalon, Flavio Marcondes Rossetto, Eduardo Magalhães, Flavio Fernandes Bryk, and Robroy L Martin.
• Department of Physical Therapy, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), Centro Universitário SãoCamilo (CUSC), São Paulo-SP, Brazil. tfukuda10@yahoo.com.br
• J Orthop Sports Phys Ther. 2012 Oct 1; 42 (10): 823-30.

Study DesignRandomized controlled trial.ObjectivesTo determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome (PFPS).BackgroundRecent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS. However, there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises.MethodsFifty-four sedentary women between 20 and 40 years of age, with a diagnosis of unilateral PFPS, were randomly assigned knee exercise (KE) or knee and hip exercise (KHE). The women in the KE group (n = 26; mean age, 23 years) performed a 4-week conventional knee-stretching and -strengthening program. The women in the KHE group (n = 28; mean age, 22 years) performed the same exercises as those in the KE group, as well as strengthening exercises for the hip abductors, lateral rotators, and extensors. An 11-point numeric pain rating scale, the Lower Extremity Functional Scale, the Anterior Knee Pain Scale, and a single-hop test were used as outcome measures at baseline (pretreatment) and 3, 6, and 12 months posttreatment.ResultsAt baseline, demographic, pain, and functional assessment data were similar between groups. Those in the KHE group had a higher level of function and less pain at 3, 6, and 12 months compared to baseline (P<.05). In contrast, the KE group had reduced pain only at the 3- and 6-month follow-ups (P<.05), without any changes in Lower Extremity Functional Scale, Anterior Knee Pain Scale, or hop testing (P>.05) through the course of the study. Compared to the KE group, the KHE group had less pain and better function at 3, 6, and 12 months posttreatment (P<.05). For the Lower Extremity Functional Scale, the between-group difference in change scores from baseline at 3, 6, and 12 months posttreatment favored the KHE group by 22.0, 22.0, and 20.8 points, respectively.ConclusionKnee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS.

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