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Weak hips cause runner’s knee

I’m looking forward to going through the research presented last weekend at this year’s ACSM meeting. For starters, a study presented by researchers from the Indiana University found that hip strengthening exercises reduce or eliminate “patellofemoral pain” (“runner’s knee”) in female runners. This is an idea that has been gaining momentum over the past few years — I first heard about it back in 2007 from Reed Ferber of the University of Calgary’s Running Injury Clinic (and wrote about it here).

The Indiana study is pretty small — just nine runners, with the five who did the hip strengthening exercises lowering their pain score from 7 to 2 or lower (on a scale of 0 to 10) after six weeks of twice-a-week strengthening. The researchers are hoping to try the same program on a larger group of runners. Normally I wouldn’t get too excited about such a small study, but given that the idea is also being developed elsewhere (such as this study about hips strength and knee arthritis that I blogged about last year), it’s starting to look pretty interesting. I suffered through an extremely persistent case of runner’s knee a decade ago that kept me out of competition for almost two years, so I certainly wish I’d known about the possibility that hip exercises might help.

If you want to give them a try, here are Reed Ferber’s suggested hip exercises [pdf, 2 MB].

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  1. William
    June 9th, 2010 at 15:54 | #1

    It’s also worth noting that in the same session at ACSM, a presentation was given by Willson et al. reporting that hip strengthening did very little to change the mechanics that are associated with patellofemoral pain syndrome in females. If the underlying faulty mechanics are not changed, then the runners in the study that you referenced can probably expect a return in their knee pain. Therefore, I would be very interested if any long term follow ups are planned for the PFPS study. Also worth noting that only females were included in the aforementioned studies. So, it’s not known if strengthening a male’s hips will help PFPS-related symptoms in that population. So, even if you strengthened your hips, it is not known if you would have seen much relief.
    Cheers-
    William

  2. alex
    June 9th, 2010 at 23:33 | #2

    @William
    Thanks for pointing that out, William. I don’t mean to fall into the trap of making a big deal out of studies with positive results while ignoring “less exciting” similar studies that fail to confirm the same result. I guess we’ll have to wait until larger studies are completed to get a better sense of whether the hips play a key role.

    (It’s also worth noting that Dierks, the Indiana researcher, acknowledges that PFPS is multifactorial — so even if hip strengthening turns out to be an effective response in some people, it won’t be for everyone.)

    In terms of my own experiences, now that I think about it, the various physio and rehab regimes I tried did include some hip strengthening (though the bigger focus was on the vastus medialis) — so it’s probably retroactive wishful thinking to believe that a few extra hip exercises would have made the difference!

  3. DJ
    November 11th, 2010 at 19:47 | #3

    I’m really glad I stumbled across this article.

    I’ve had several sessions with physiotherapists throughout the years in attempt to deal with a relentless and frustrating case of “PFPS”. The last physio I saw ended up lasting for about a year. Every physio I saw dealt solely with strengthening the quads with concentration on the VMO. All to no avail. It was concluded my last go around that I was in the ‘small percentage of patients that can’t be fixed by physiotherapy’. Small comfort. Meniscal issues were suspected and it was theorized that the physiotherapy would work after such issues were addressed. Wrong. A meniscal tear was confirmed by MRI, dealt with through surgery and still the PFPS issues are not being resolved with the pre and post-surgical stretches and exercises. It’s as if the VMO refuses to strengthen. The weakness prevails, the spasms still occur, and the Baker’s cyst that should have dissolved, hasn’t and keeps pounding into a nerve in the back of my knee and shooting pain up and down the back of my leg and into my foot when I try to go for even a simple walk. In a nutshell: basically everything I’ve done so far has felt like a total colossal waste of time, effort, and expense. I am more than fed up with popping pills and spending my free time laying around doing the ‘RICE’ thing and getting fat when it seems there shouldn’t be any need to live this way. I am more than willing to try anything new before totally giving up the attempt to have some kind of enjoyable life.

    Thank you and I look forward to trying the hip strengthening exercises.

  4. alex
    November 11th, 2010 at 20:11 | #4

    Ouch, sounds like a frustrating experience, DJ. I struggled with PFPS for almost two years about a decade ago, and went through about eight different therapists and rehab regimes before I was finally able to resume running. (But, on the bright side, I haven’t had any problems since.) Interestingly, I also had — and still have, though it has popped a couple of times! — a Baker’s cyst on the back of my knee… Anyway, best of luck with the hip strengthening. I found that my hip adductors, in particular, were abnormally weak.

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