Individuals with patellofemoral pain have less hip flexibility than controls regardless of treatment outcome

Objective: To examine differences in hip flexibility before and after a 6-week muscle strengthening program between those with patellofemoral pain (PFP) and healthy controls. Design: Single-blind, multicentered, randomized controlled trial. Setting: Four clinical research laboratories. Subjects: Physically active individuals (199 PFP and 38 controls). Interventions: Patellofemoral pain and control subjects were randomized into either a hip-focused or a knee-focused muscle strengthening treatment program. Main Outcome Measures: Pain - visual analog scale (centimeter), function - Anterior Knee Pain Scale (points), flexibility - passive goniometry (degrees): Hip adduction (HADD), hip external rotation (HER), hip internal rotation (HIR), total hip rotation (HROT), hip extension (HEXT) were measured before and after the muscle strengthening treatment program. Results: Subjects with patellofemoral pain who successfully completed the treatment program (n = 153) had 65%, 25%, 18%, and 12% less HADD, HER, HROT, and HIR ranges of motion (ROMs), respectively, than controls (P < 0.05). Patellofemoral pain subjects who did not successfully complete the program (n = 41) had 134%, 31%, 22%, and 13% less HADD, HER, HROT, and HIR ROMs, respectively, than controls (P < 0.05). All subjects increased their HIR, HROT, and HEXT ROMs pretest to posttest (P < 0.05), but by less than 2 degree. Conclusions: Individuals with PFP had less hip flexibility than controls regardless of treatment outcome or time. After the 6-week muscle strengthening program, and regardless of treatment success, PFP and control subjects experienced a small but clinically insignificant improvement in hip flexibility. Clinical Relevance: Hip ROM should be considered as a targeted area of focus in a rehabilitation program for physically active individuals with PFP.