Comparing the Effects of Strengthening Exercises of Knee and Hip Muscles in Reducing Pain in Patients with Patellofemoral Pain Syndrome: A Randomized Clinical Trial

Abstract

Background: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition characterized by anterior knee pain, frequently affecting sedentary females and leading to functional limitations. Biomechanical deficits, particularly involving the hip abductors and external rotators, have been implicated in the etiology and persistence of PFPS symptoms. While knee-focused rehabilitation has traditionally been employed, the potential added benefit of incorporating hip strengthening exercises remains underexplored in short-term protocols. Objective: To compare the short-term effects of isolated knee muscle strengthening versus combined knee and hip muscle strengthening on pain reduction in sedentary females with PFPS. Methods: In this single-blinded randomized clinical trial, 40 sedentary females aged 21–50 years with clinically diagnosed unilateral PFPS were randomly assigned to two groups. Group A received quadriceps and hamstring strengthening exercises, while Group B received the same knee exercises along with hip abductor and external rotator strengthening. Interventions were administered over four sessions across two weeks. Pain intensity was assessed at five time points using the Numeric Pain Rating Scale (NPRS). Data were analyzed using repeated measures ANOVA and independent samples t-tests. Results: Both groups showed significant pain reduction over time (p < 0.001). However, Group B demonstrated significantly greater pain reduction at Day 11 (mean difference = 0.90, 95% CI: 0.54–1.26, p < 0.001). Conclusion: The addition of hip muscle strengthening to knee-focused rehabilitation results in superior short-term pain reduction in sedentary females with PFPS, supporting a more integrated therapeutic approach.