Persons with patellofemoral pain exhibit altered hip abductor muscle recruitment while performing hip abductor exercises

ABSTRACT

Introduction

Strengthening of the hip abductors has been advocated for persons with patellofemoral pain (PFP). It is not clear if these individuals activate the hip abductor muscles appropriately to achieve the desired therapeutic effects.

Objective

To compare activation of the hip abductor muscles between persons with and without PFP during the performance of hip abductor exercises.

Methods

Thirty-two individuals participated (12 with PFP and 20 without PFP). The average age (± standard deviation) was 29.7 ± 5.9 years for the PFP group and 28.1 ± 6.9 for the control group. Electromyographic (EMG) signals from the gluteus medius (GMED), superior gluteus maximus (SUP-GMAX), and tensor fascia lata (TFL) were obtained using fine-wire electrodes while participants performed 11 different exercises. Normalized EMG activity of each muscle was compared between groups across all exercises.

Results

When averaged across all exercises, persons with PFP exhibited significantly greater EMG activity of TFL (mean = 25.3% MVIC; 95% CI = 19.2, 31.3) compared to those without PFP (mean = 17.6% MVIC; 95% CI = 12.8, 22.4) and significantly lower EMG activity of SUP-GMAX (mean = 16.4% MVIC; 95% CI = 11.0, 22.0) compared to those without PFP (mean = 25.4% MVIC; 95% CI = 21.0, 29.8). Persons with PFP exhibited lower EMG activity of GMED, but only for 3 out of the 11 exercises evaluated (hip abduction, hip hike, step-up).

Conclusion

Compared to persons without PFP, those with PFP exhibited activation differences during the performance of exercises used to target the hip abductors. Our results highlight the need for activation training prior to the initiation of strengthening exercises to achieve desired therapeutic effects.

KEYWORDS:

• Patellofemoral pain syndrome
• electromyography
• gluteal muscles
• tensor fascia lata
• exercise therapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported in part by a Western University of Health Sciences Intramural Grant to Dr. Selkowitz. We thank Dr. Lucinda Baker PT, PhD, for her consultation on EMG analysis. We also thank the following individuals for their assistance with data management: Michelle Bui PT, DPT; Sarah Daly, PT, DPT; George Dechello, PT, DPT; Matthew Devine, PT, DPT; Susan Garzon, PT, DPT; Jessica Hildebrandt, PT, DPT; Tamsin Kennedy, PT, DPT; Maria Kulikova, PT, DPT; Prajakta Mithbavkar, PT, MS, DPT; Lea Noonan, PT, DPT; Michael Petty, PT, DPT; Carrie Robinson, PT, DPT; Lan Tran, PT, DPT; Qui Trinh, PT, DPT; Brandon Woo, PT, DPT.