Onset significantly earlier during descent compared with
  • There were greater functional gains with proximal strengthening exercise including instruction on lower limb alignment although both groups reached clinical significance (Baldon et al., 2014).
    3.6. Effect of hip strengthening exercise on kinematics
    Evidence for improvement in kinematics was conflicting (Table 9). One study demonstrated no change; two showed an improvement, but both included instruction on lower limb alignment with the strengthening exercise.
    3.7. Effect of hip strengthening exercises for the prevention of PFP
    The incidence of PFP after hip strengthening exercise was reduced (Table 9).
    3.8. Neuromuscular exercise
    Two case series including 20 female runners with both unilateral and bilateral PFP, aged 18–45 years investigated neuromuscular exercise (Table 10 and Table 11). One paper analysed the Torin 1 leg in subjects with bilateral symptoms, the other the limb with more marked hip adduction when running.
      Study characteristics of neuromuscular control exercise.
      StudyStudy designPopulationSample sizeSample size calculationAgeGenderInclusionUnilateral/bilateral PFP
      If bilateral PFP leg with greater hip adduction used for analysis
      Willy et al., 2012bCase seriesRunners10Yes18–40 yearsfemaleVAS >3/10 when runningUnilateral/bilateral If bilateral most dominant limb used for analysis
      Willy and Davis 2013Case study of 2 runners from paper above, additional dataRunners2N/A18–40 yearsfemaleOne unilateral, one bilateral – most painful knee assessed
      PFP – patellofemoral pain; VAS – visual analogue scale.
      Table options
      Exercise protocols: Neuromuscular exercise.
      StudyExerciseProgressionTime frame for exerciseFrequency of exerciseFollow up period
      Noehren et al., 2011Real time kinematic visual feedback of hip adduction during stance phase in 30 min runIncrease in running time from 15 to 30 min.
      Reduction in visual feedback from continual over last 4 sessions2 weeks4× week1 month
      Willy et al., 2012bReal time mirror visual feedback of hip adduction and internal rotation during stance phase in 30 min runIncrease in running time, fromimg src="http://www.gdc0068.com/image/1-s2.0-S2078152015300298-gr1.jpg#" /> 15 to 24 min session 1–4, 30 min run final session.
      Reduction in visual feedback over last 4 sessions from full running time to 3 min2 weeks4× week3 months
      Willy and Davis 2013Real time mirror visual feedback of hip adduction and internal rotation during stance phase in 30 min runIncrease in running time, 15 min–24 min in sessions 1–4, 30 min run final session.
      Reduction in visual feedback over last 4 sessions, last visit 3 min feedback.2 weeks4× week3 months
      Table options
    Hip neuromuscular training was effective for reducing pain, improving function and improving hip kinematics (Table 12). Pain reduced considerably, being in the region of 90% reduction in img src="http://farm4.static.flickr.com/3666/33543714635_b7e1438f3f.jpg" align="left" width="297" style="padding:10px;"/> both studies, which was maintained at follow-up despite a trend for the hip mechanics to revert toward baseline.

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