The Hip Solution for Knee Pain

In other pain-related news, clients with patellofemoral pain syndrome (PFPS) may find relief by improving hip strength.

In a study published in the British Journal of Sports Medicine (2013; 47, 207–14), researchers analyzed 10 case-control reviews of gluteal electromyography to explore a potential link between gluteal activity and PFPS.

When descending stairs, subjects with PFPS exhibited delayed-onset and shorter-duration gluteus medius activity compared with those who were syndrome free, the researchers determined. They also found moderate evidence to support delayed-onset and shorter-duration gluteus medius activity in PFPS subjects during stair ascent. The researchers didn’t find much data to support gluteal activity discrepancies during running.

Anthony Carey, MA, CSCS, founder and CEO of San Diego–based Function First and inventor of the Core-Tex™, explains a possible relationship between gluteus dysfunction and PFPS:

“If the hip is not controlled into adduction and internal rotation with the foot on the ground, the foot and shank are externally rotated relative to the femur,” he says. “The patella then can sit lateral to the patellar groove, interfering with optimal articulation between the femoral condyles and the patella.”

So how can you improve this condition?

“From an intervention strategy, our approach is to begin with some floor-based exercises to increase motor unit recruitment,” says Carey. “Examples are supine abduction against a strap or band, and side-lying abduction, like the clam. We never bring the muscle groups to fatigue at this stage. Next we have the client do a single-leg lunge with torso supported parallel to the floor to better recruit the gluteus maximus and decrease the transverse and frontal torques. This also improves the joint centration at the patellofemoral joint while the extremity is loaded.”

For a video demonstration of this movement, follow this URL: www.youtube.com/watch?v=h2f1tvoAAUA.