The effectiveness of hip strengthening exercises in the management of patellofemoral pain syndrome (PFPS) in females

Purpose: Patellofemoral pain syndrome (PFPS) is a common and often chronic knee condition with a high prevalence in females of working age. The regular presence of hip weakness in female patients with PFPS, has led to research emerging on hip strengthening exercises. The aim of the systematic review was to examine the effectiveness of hip specific strengthening exercises on the management of patellofemoral pain syndrome (PFPS) specifically in females. Secondly, to evaluate whether hip strengthening exercises should be identified as a primary treatment choice for managing PFPS in females. Methods: A systematic review of randomised control trials (RCTs) was conducted using the PICO framework to define the parameters to be included in the study. The review was conducted following PRISMA guidelines. Medline, EMBASE, PEDro, CINAHL, Web of Science, Scopus and AMED databases were searched between 12th June 2018 and 20th June 2018. Two independent reviewers assessed each RCT for inclusion and methodological quality using the PEDro scoring system focusing on key features such as randomisation, allocation concealment and blinding. The Joanna Briggs Institute data extraction tool was used. Results: 1789 studies were identified through database searching, 33 full text papers were assessed; 26 were excluded leaving seven moderate to high quality RCTs, involving a total of 402 participants to be included in the review. All seven studies demonstrated statistically significant[KB1] improvements in pain levels and functional outcomes pre-post intervention across hip strengthening interventions (p < 0.05). Combined hip and knee exercises were shown to be significantly more effective than knee exercises alone for both function and pain (p < 0.05). However, there were no statistically significant differences reported between hip only/hip focused exercises with no standardised comparison, when compared to knee only exercises. A systematic review of randomised control trials (RCTs) was conducted using the PICO framework to define the parameters to be included in the study. The review was conducted following PRISMA guidelines. Medline, EMBASE, PEDro, CINAHL, Web of Science, Scopus and AMED databases were searched between 12th June 2018 and 20th June 2018. Two independent reviewers assessed each RCT for inclusion and methodological quality using the PEDro scoring system focussing on key features such as randomisation, allocation concealment and blinding. The Joanna Briggs Institute data extraction tool was used. There were insufficient common data points on outcome measures to perform a statistical meta analysis. Conclusion(s): There is consistent moderate to high quality evidence to support the use of hip strengthening exercises in the management of female patients with PFPS. There is also some good quality evidence to suggest that a combined hip and knee approach is more effective in reducing pain than knee exercises alone. However, at present, there is insufficient evidence to suggest that hip strengthening exercises should be introduced as an alternative to knee strengthening exercise regimes. Implications: Further research is therefore needed with established standardisation of the methodology and adequate control group comparison. This should be done before it can be concluded that hip exercises are more effective than traditional knee strengthening regimes