So I’ve been having difficulty with treating people with patellofemoral pain.  A lot of the patients that I work with will see improvements but will have flare ups when they increase their physical activity and recreational activity intensities.  I found this research article that I have been using with my patients.  The rehab protocol incorporates hip and trunk stabilization to reduce abnormal accessory motions at the knee(s).  This article has not helped to eliminate that pain in all of my patients but their frequency and intensity of flare ups have reduced.  Here is a short summary of the article and if you want the protocol (with pictures of the exercises) just let me know and I will send it your way.

Baldon RM, Serrao FV, Silva RS, Piva SR. Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014; 44(4):240-251.(Click on the link for access to the article)

Purpose: To compare a treatment focused on hip muscle strengthening and lower limb and trunk movement control (functional stabilization training) to a treatment focused primarily on quadriceps strengthening (standard training) by their effects on knee pain and function, lower limb and trunk kinematics, trunk muscle endurance, and eccentric hip and knee strength.

Protocol: The loads for the exercises were progressed when the patients could perform the whole exercise without exacerbation of knee pain, excessive fatigue, and local muscle pain local muscle pain 48 hours after the previous training session.

8 Week Protocol

Weeks 1-2: enhance motor control of trunk and hip muscles

  • Transverse abdominis and multifidus muscle training in quadruped and prone (2 sets of 15 reps with 10 second isometric cocontractions)
  • Sitting on the Swiss ball with single leg knee extension, TA contraction, and multifidus contractions (5 reps with 20 second isometric cocontractions)
  • Isometric hip abduction/lateral rotation in standing (2 sets of 20 reps with 5 second isometric contraction
  • Swiss ball
    Isometric hip abduction/lateral rotation in standing (2 sets of 20 reps with 5 second isometric contraction
  • Isometric hipHip abduction/lateral rotation/extension in sidelying (2 sets of 20 reps with 5 second isometric contractions with an ankle weight consisting of 20% of 1 rep max)
  • Hip Extension/lateral rotation in prone (2 sets of 20 reps with 5 second isometric contractions with an ankle weight consisting of 20% of 1 rep max)
  • Side-lying clams (2 sets of 20 reps with 5 second isometric contractions with an elastic band or theraband)
  • Prone knee flexion (2 sets of 20 reps using 50% of 1 rep max)
  • Seated knee extension (2 sets of 20 reps using 50% of 1 rep max and staying in the 90-45 degree knee flexion range)
  • Single leg standing on an unstable platform with emphasis on hip flexion and forward trunk lean and contraction of TA and multifidus (3 sets of 30 seconds)

Weeks 3-5: increase strength of trunk and hip muscles and improve motor control in WB positions

  • Lateral planks and normal planks all on knees (5 sets of 30 second holds)
  • Trunk extension  on a Swiss Ball performed with arms crossed on thorax (3 sets of 12 reps)
  • SB trunk extension
    Hip abduction/lateral rotation/extension in sidelying (3 sets of 12 reps with 5 second isometric contractions with an ankle weight consisting of 75% of 1 rep max)
  • Hip Extension/lateral rotation in prone (3 sets of 12 reps with 5 second isometric contractions with an ankle weight consisting of 75% of 1 rep max)
  • Side-lying clams (3 sets of 12 reps with 5 second isometric contractions with an increased elastic band or theraband difficulty)
  • Pelvic drop in standing (3 sets of 12 reps with an ankle weight consisting of 75% of 1 rep max)
  • Hip Hikes
    Hip lateral rotation in closed kinetic chain (3 sets of 12 reps with an elastic band)
  • SLS rotation
    Single Leg Dead Lift (3 sets of 12 reps with an elastic band)
  • single leg deal lift
    Prone knee flexion (3 sets of 12 reps using 75% of 1 rep max)
  • Seated knee extension (3 sets of 12 reps using 75% of 1 rep max and staying in the 90-45 degree knee flexion range)
  • Single leg standing on an unstable platform with emphasis on hip flexion and forward trunk lean and contraction of TA and multifidus (3 sets of 30 seconds with external perturbation from a medicine ball)

Weeks 6-8: increase difficulty of WB activities with hips at neutral frontal alignment and avoid quadriceps dominance by leaning the trunk forward.

  • Lateral planks and normal planks performed on toes (5 sets of 45 to 60 seconds)
  • Trunk extension  on a Swiss Ball performed with hands behind neck (3 sets of 12 reps)
  • Hip abduction/lateral rotation/extension in sidelying (3 sets of 12 reps with 5 second isometric contractions with an ankle weight consisting of 75% of 1 rep max)
  • Hip Extension/lateral rotation in prone (3 sets of 12 reps with 5 second isometric contractions with an ankle weight consisting of 75% of 1 rep max)
  • Side-lying clams (3 sets of 12 reps with 5 second isometric contractions with an increased elastic band or theraband difficulty)
  • Pelvic drop in standing (3 sets of 12 reps with an ankle weight consisting of 75% of 1 rep max)
  • Hip lateral rotation in closed kinetic chain (3 sets of 12 reps with an elastic band)
  • Single Leg Dead Lift (3 sets of 12 reps with an elastic band)
  • Single Leg Squat with elastic band around the knee of the support limb to encourage hip abduction and lateral rotation and hip flexion and forward lean emphasized (3 sets of 12 reps)
  • Single leg squat
    Forward Lunge with elastic band around the anterior knee to encourage hip abduction and lateral rotation with an emphasis on hip flexion and forward trunk lean
  • Forward lunge
    Prone knee flexion (3 sets of 12 reps using 75% of 1 rep max)
  • Seated knee extension (3 sets of 12 reps using 75% of 1 rep max and staying in the 90-45 degree knee flexion range)
  • Single leg standing on an unstable platform with emphasis on hip flexion and forward trunk lean and contraction of TA and multifidus (3 sets of 30 seconds with external perturbation from a medicine ball)

Results:  The patients in the functional stabilization group had significantly less pain at the 3 month follow-up.  They had significantly less ipsilateral trunk movement, less contralateral pelvic drop, less hip adduction, and less knee abduction during a single leg squat.  They also presented with greater pelvic anteversion and hip flexion movement also during a single leg squat.  The functional stabilization group had significantly greater eccentric hip abductor and knee flexor strength and greater trunk muscle endurance.

Thoughts: Any other ideas on what has helped with patients suffering from patellofemoral pain?

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