Effectiveness Of Combined Hamstring-Quadriceps Strengthening With Tibial Rotation Control In Reducing Pain And Enhancing Function In Patellofemoral Pain Syndrome
Keywords:
patellofemoral pain, tibial rotation, hamstring, quadriceps, rehabilitation, randomized trialAbstract
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
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