Effectiveness Of Combined Hamstring-Quadriceps Strengthening With Tibial Rotation Control In Reducing Pain And Enhancing Function In Patellofemoral Pain Syndrome

Authors

  • Divyank Shrimali
  • Renuka Pal
  • Jafar Khan
  • KM. Annamalai
  • Deepak Lohar
  • Farukh Mohammad Pinjara
  • Richa Hirendra Rai

Keywords:

patellofemoral pain, tibial rotation, hamstring, quadriceps, rehabilitation, randomized trial

Abstract

Background: Muscular imbalance and aberrant tibial rotation are recognized contributors to patellofemoral pain syndrome (PFPS). Although quadriceps-dominant strengthening is the conventional approach, the additional value of hamstring work and active tibial-rotation control remains unclear.

Objective: To determine whether integrating tibial-rotation control into a balanced hamstring–quadriceps strengthening programme yields superior pain relief and functional gains compared with conventional strengthening alone.

Methods: Thirty adults with chronic PFPS (18–60 y) were randomised to (A) combined hamstring–quadriceps strengthening with tibial-rotation exercises or (B) the same protocol without tibial-rotation work. Both groups trained 30 min∙session⁻¹, five days week⁻¹ for six weeks. Primary outcomes were pain (10-cm visual-analogue scale, VAS) and function (Kujala Anterior Knee Pain Scale). Statistical significance was set at p < 0.05.

Results: Group A showed a larger VAS reduction (-4.13 ± 1.29 vs -2.00 ± 1.22) and greater Kujala gain (+25.27 ± 5.12 vs +13.87 ± 4.55) than Group B (both p < 0.005). Post-intervention mean VAS was 2.47 ± 0.83 in Group A versus 4.47 ± 0.83 in Group B; mean Kujala scores were 85.47 ± 3.14 and 78.93 ± 3.55, respectively. No adverse events occurred.

Conclusion: Adding tibial-rotation control to balanced lower-extremity strengthening produced clinically and statistically superior pain relief and functional recovery compared with conventional strengthening alone. Rehabilitation programmes for PFPS should address rotational mechanics in addition to muscle strength

Downloads

Download data is not yet available.

References

Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med. 2002;30:447-56.

Witvrouw E, Callaghan MJ, Stefanik JJ, et al. Patellofemoral pain: consensus statement. Br J Sports Med. 2014;48:411-14.

Noehren B, Hamill J, Davis I. Prospective evidence for a hip aetiology in PFPS. Med Sci Sports Exerc. 2013;45:1120-24.

Lee TQ, Morris G, Csintalan RP. Influence of tibial rotation on patellofemoral contact. J Orthop Sports Phys Ther. 2003;33:686-93.

Fukuda TY, Rossetto FM, Magalhães E, et al. Hip abductor strengthening in PFPS. J Orthop Sports Phys Ther. 2010;40:736-42.

Draper CE, Besier TF, Fredericson M, et al. Patellofemoral kinematics differences. Am J Sports Med. 2011;39:1050-58.

Earl JE, Hoch AZ. Proximal strengthening improves PFPS. Am J Sports Med. 2011;39:154-63.

Salsich GB, Perman WH. Tibiofemoral rotation in females with PFPS. J Orthop Sports Phys Ther. 2007;37:755-63.

Hall R, Barber Foss K, Hewett TE, Myer GD. Sport specialisation and anterior knee pain. J Sport Rehabil. 2015;24:31-35.

Powers CM. Altered lower-extremity kinematics in PFPS. J Orthop Sports Phys Ther. 2003;33:639-46.

Besier TF, Gold GE, Beaupré GS, Delp SL. Modelling patellofemoral cartilage stress. Med Sci Sports Exerc. 2005;37:1924-30.

Petersen W, Ellermann A, Gösele-Koppenburg A, et al. PFPS overview. Knee Surg Sports Traumatol Arthrosc. 2014;22:2264-74.

Ferber R, Bolgla L, Earl-Boehm J, et al. Hip-core vs knee strengthening in PFPS. J Athl Train. 2015;50:866-78..

Downloads

Published

2025-08-02

How to Cite

1.
Shrimali D, Pal R, Khan J, Annamalai K, Lohar D, Pinjara FM, Rai RH. Effectiveness Of Combined Hamstring-Quadriceps Strengthening With Tibial Rotation Control In Reducing Pain And Enhancing Function In Patellofemoral Pain Syndrome. J Neonatal Surg [Internet]. 2025Aug.2 [cited 2025Oct.12];14(21S):1636-9. Available from: https://mail.jneonatalsurg.com/index.php/jns/article/view/8688

Most read articles by the same author(s)

1 2 3 4 5 6 > >>