By: Aaron Adler, PT, DPT and Clinic Manager at ApexNetwork Physical Therapy in Monett, MO

 Coming out of school about 5 years ago many clinical instructors and professors would teach the practice of knee stability with strengthening the quadricep musculature and most importantly the VMO. Many continue to practice this form of knee stability strengthening associated with issues with patella disorders. New research has enlightened this practice with focus on hip stability versus knee stability.

The start of the research began back in 2003 when Ireland, Wilson, et al. wrote an article Hip Strength in Females With and Without Patellofemoral Pain (1). This article displayed a large difference in hip strength in young adults with and without pain. In most cases, the displayed a 10% lack of strength on involved LE with PFP. With this knowledge, biomechanically, there is also more factors that can cause VMO insufficiency, decreased hamstring, quadriceps, or IT band flexibility, patella alta, and femoral anteversion (1). With continual research throughout the years, many articles have displayed benefits, but one pointed out that it would help reduce symptoms but not the load in people with medial knee osteoarthritis. Bennell, Hunt, et al. concluded that very thing with 89 participants with diagnosed knee arthritis back in 2010 (2). For physical therapy benefits, hip strengthening can be a new set of activity for knee derangements. In 2015, Berry, Lee, et al. tested the best practice for hip strengthening. They concluded that during resisted sidestepping, “the hip abductors on the stance limb ar more active than the hip abductors on the moving limb. In the squat posture, the activity of the gluteal muscles are increased, whereas the activity of the TFL is reduced compared to the upright position” (3).
Utilizing this new research will greatly help with better outcomes for knee patients that will affect more long term issues associated with PFP.

  1. Ireland ML, Wilsson JD, Ballantyne BT, Davis IM. Hip Strength in Females With and Without Patellofemoral Pain. JOSPT 2003; 33:11.
  2. Bennell KL, Hunt MA, Wrigley TV, et al. Hip Strengtheing Reduces Symptoms But Not Knee Lead In People With Medial Knee Osteoarthritis and Varus Malalignment: a randomized controlled trial. Osteoarthritis Research Society International 2010 18(5):621-8.
  3. Berry JW, Theresa SL, Foley HD, Lewis CL. Resisted Side Stepping: The Effect of Posture on Hip Abductor Muscle Activation. JOSTP 2015; 45:9.