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Individuals With Patellofemoral Pain Have Less Hip Flexibility Than Controls Regardless of Treatment Outcome

Hamstra-Wright, Karrie L. PhD, ATC; Earl-Boehm, Jennifer PhD, ATC; Bolgla, Lori PhD, PT, ATC; Emery, Carolyn PhD, BScPT; Ferber, Reed PhD, ATC

Clinical Journal of Sport Medicine: March 2017 - Volume 27 - Issue 2 - p 97–103
doi: 10.1097/JSM.0000000000000307
Original Research

Objective: To examine differences in hip flexibility before and after a 6-week muscle strengthening program between those with patellofemoral pain (PFP) and healthy controls.

Design: Single-blind, multicentered, randomized controlled trial.

Setting: Four clinical research laboratories.

Subjects: Physically active individuals (199 PFP and 38 controls).

Interventions: Patellofemoral pain and control subjects were randomized into either a hip-focused or a knee-focused muscle strengthening treatment program.

Main Outcome Measures: Pain—visual analog scale (centimeter), function—Anterior Knee Pain Scale (points), flexibility—passive goniometry (degrees): hip adduction (HADD), hip external rotation (HER), hip internal rotation (HIR), total hip rotation (HROT), hip extension (HEXT) were measured before and after the muscle strengthening treatment program.

Results: Subjects with patellofemoral pain who successfully completed the treatment program (n = 153) had 65%, 25%, 18%, and 12% less HADD, HER, HROT, and HIR ranges of motion (ROMs), respectively, than controls (P < 0.05). Patellofemoral pain subjects who did not successfully complete the program (n = 41) had 134%, 31%, 22%, and 13% less HADD, HER, HROT, and HIR ROMs, respectively, than controls (P < 0.05). All subjects increased their HIR, HROT, and HEXT ROMs pretest to posttest (P < 0.05), but by less than 2 degree.

Conclusions: Individuals with PFP had less hip flexibility than controls regardless of treatment outcome or time. After the 6-week muscle strengthening program, and regardless of treatment success, PFP and control subjects experienced a small but clinically insignificant improvement in hip flexibility.

Clinical Relevance: Hip ROM should be considered as a targeted area of focus in a rehabilitation program for physically active individuals with PFP.

*Department of Kinesiology & Nutrition, University of Illinois at Chicago, Chicago, Illinois;

Department of Kinesiology: Integrated Health Care and Performance Unit, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin;

Department of Physical Therapy, Georgia Regents University, Augusta, Georgia;

§Faculty of Kinesiology, University of Calgary, Calgary, Canada; and

Faculties of Kinesiology and Nursing, University of Calgary, Calgary, Canada.

Corresponding Author: Karrie L. Hamstra-Wright, PhD, ATC, Department of Kinesiology & Nutrition, University of Illinois at Chicago, 901 W. Roosevelt Rd., PEB 337, MC 194, Chicago, IL 60608 (

Supported by the National Athletic Trainers' Association Research and Education Foundation through the Outcomes Grant Program (808OUT003R) and Alberta Innovates: Health Solutions (funded by the Alberta Heritage Foundation for Medical Research endowment fund).

The authors report no conflicts of interest.

Received July 22, 2015

Accepted January 02, 2016

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