P
Study Design: Case report. atellofemoral pain
Objective: To describe an alternative treatment approach for patellofemoral pain. (PFP) is recognized as
Background: Weakness of the hip, pelvis, and trunk musculature has been hypothesized to one of the most com-
influence lower-limb alignment and contribute to patellofemoral pain. Two patients who had a mon lower-extremity
chief complaint of patellofemoral pain and demonstrated lack of control of the hip in the frontal disorders encountered
and transverse planes during functional movements were treated with an exercise program
by orthopaedic physical thera-
targeting the hip, pelvis, and trunk musculature.
pists.28,59 Despite its prevalence,
Methods and Measures: The patients presented in these 2 case reports did not exhibit obvious
however, the etiology of this pain
patellar malalignment or tracking problems; however, on qualitative assessment, both demon-
strated excessive hip adduction, internal rotation, and knee valgus during gait and while
syndrome and specific treatment
performing a step-down maneuver. In addition, both patients exhibited weakness of the hip of this condition remain vague
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
abductors, extensors, and external rotators, as demonstrated by hand-held dynamometry testing. and controversial.
Treatment in both cases occurred over a 14-week period and focused on recruitment and The premise behind most treat-
endurance training of the hip, pelvis, and trunk musculature. Functional status, pain, muscle force ment approaches is that PFP is the
production, as well as subjective and objective assessment of lower-extremity kinematics during result of abnormal patellar track-
gait and a step-down maneuver were assessed preintervention and postintervention. ing and/or malalignment. Given
Results: Both patients experienced a significant reduction in patellofemoral pain, improved as such, interventions are often
lower-extremity kinematics during dynamic testing, and were able to return to their original levels focused locally, and typically in-
of function. Gluteus medius force production improved by 50% in patient A and 90% in patient B, clude quadriceps strengthening,
while gluteus maximus force production improved 55% in patient A and 110% in patient B. patellar taping, patellar bracing,
Journal of Orthopaedic & Sports Physical Therapy®
Objective kinematic improvements in the step-down task also were demonstrated in patient A. stretching, and soft tissue mobiliza-
Conclusion: Assessment and treatment of the hip, pelvis, and trunk musculature should be tion.6,19,46,59 Despite the longevity
considered in the rehabilitation of patients who present with patellofemoral pain and demonstrate of such treatment approaches,
abnormal lower-extremity kinematics. J Orthop Sports Phys Ther 2003;33:642-660. with papers as early as 1922 advo-
CASE REPORT
Key Words: case study, knee pain, lower-extremity rehabilitation, therapeutic cating quadriceps strengthening
exercise exercises,35 intervention outcomes
have been mixed.2,11,29,30 In addi-
tion, the 2001 Philadelphia Panel
systematic review failed to find a
1
Staff Physical Therapist, Kern and Associates Physical Therapy, Santa Monica, CA. At the time these sufficient number of high-quality
cases were managed, Catherine Mascal was a resident in the Orthopaedic Physical Therapy Residency randomized control trials to rec-
Program at the University of Southern California, Los Angeles, CA. ommend any clinically important
2
Associate Professor of Clinical Physical Therapy, Department of Biokinesiology and Physical Therapy,
University of Southern California, Los Angeles, CA.
benefit from exercise, massage,
3
Associate Professor and Director, Musculoskeletal Biomechanics Research Laboratory, Department of heat, or combined therapies for
Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA. patients with PFP.44
Send correspondence to Christopher M. Powers, Department of Biokinesiology and Physical Therapy, One possible reason for the rela-
University of Southern California, 1540 E. Alcazar Street, CHP 155, Los Angeles, CA 90089-9006. E-mail:
powers@usc.edu
tively poor outcomes associated
The methods described in this paper are standard care for patients seen in this clinic. Therefore, with the treatment of PFP may be
Institutional Review Board approval was not necessary for these case reports. related to the assumption that
would appear reasonable to strive for optimal func- view radiographs taken in March 2002 that were
tion of the abdominal, pelvis, and spinal musculature, unremarkable. She described no other ipsilateral or
as it is theorized that this is an important factor when contralateral lower-extremity symptoms.
addressing lower-extremity muscle strength train-
ing.10,18,47,50 To date, no patient outcomes have been Presenting Complaints
described for an intervention focusing on control of
hip and pelvis motion in individuals with PFP. Patient A’s symptoms were described as an inter-
The purpose of these 2 case reports was to illus- mittent sharp pain in the right retropatellar region.
trate that an exercise program focusing primarily on She stated that walking for 2 hours, or descending 2
the hip, pelvis, and trunk musculature could have a flights of stairs exacerbated her pain. Alleviating
positive effect on PFP, functional status, and lower- factors included ice, rest, and a neoprene knee
limb positioning during gait and a step-down task. As support. Her activity level included 3 days a week at
one of the hallmark signs of PFP is an exacerbation
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ing no pain and 10 representing the worst pain patellofemoral dysfunction also were performed.29
imaginable. This method of evaluation has been These included the patellar compression test54 and
shown to be both reliable and valid for measuring the apprehension (Fairbanks) test.14 Passive patellar
pain.13,48,53 The initial VAS score for patient A was mobility was examined and compared to the unaf-
5/10 after walking for 2 hours, and 4/10 after fected side. Symptom reproduction was evaluated
climbing 2 flights of stairs. The initial VAS score for during resisted knee extension at various knee flex-
patient B ranged from 7/10 while descending a ion angles and palpation was performed for
single step to 10/10 on descending an entire flight. A retinaculum tenderness. Patient A presented with a
VAS score of 8/10 was reported for walking 2 miles. positive compression and apprehension test, and pain
with resisted knee extension from 10° to 0° of knee
Differential Diagnostic Screening flexion. She had normal passive patellar mobility.
Patient B had slight pain on patellar compression and
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Active, passive, and accessory mobility of the moderate tenderness with palpation of the right
rearfoot, tibiofemoral joint, hip joint, and lumbar medial retinaculum. She had pain on resisted knee
spine were assessed. Clinical tests as described in extension from 20° to 0° knee flexion, and had
Magee36 were carried out to eliminate these struc- normal passive patellar mobility with slight pain at
tures as potential sources of the subjects’ symptoms. end range medial and lateral translation.
This screening examination revealed no abnormali- Quadriceps strength was assessed using a Microfet2
ties and both patients demonstrated a full pain-free hand-held dynamometer (Hoggan Health Industries,
range of knee motion. Negative test results were also Inc., Draper, UT). This method of measuring muscle
found for the following conditions: ligamentous insta- strength has been validated and the intertester reli-
ability has been shown to be good to excellent.3-5
Journal of Orthopaedic & Sports Physical Therapy®
TABLE. Hand-held dynamometry, preintervention and postintervention results. Values given are the average of 3 trials. Numbers in pa-
rentheses are subjective muscle strength ratings based on an isometric break test where 5/5 is maximal strength (ie, unable to ‘‘break’’
the muscle’s isometric hold).38
Patient A Patient B
Pretest Posttest Increase Pretest Posttest Increase
Force (N) Force (N) (%) Force (N) Force (N) (%)
Quadriceps 155.8 (3+/5) 186.9 (3+/5) 20 267.0 (4/5) 293.7 (4/5) 10
Gluteus maximus 129.0 (4⫺/5) 200.0 (4/5) 55 89.0 (3+/5) 186.9 (4/5) 110
Gluteus medius 53.4 (3+/5) 80.1 (4⫺/5) 50 44.5 (3+/5) 84.6 (4/5) 90
Hip lateral rotator group 26.7 (3+/5) 111.3 (4/5) 317 120.1 (4⫺/5) 138.0 (4⫺/5) 15
Hip medial rotator group 84.6 (4⫺/5) 120.1 (4/5) 42 62.3 (4⫺/5) 106.8 (4/5) 71
was assessed bilaterally in the supine position and was drop and observing the lateral translation of the
found to be equal when measured to the nearest 0.5 pelvis; (2) maintenance of a static bridge position
cm. against a manual rotational displacement force ap-
plied to the pelvis in the transverse plane; (3)
Dynamic Assessment evaluation of the patients’ ability to prevent pelvic
tilting in the frontal plane during a single-hip abduc-
Gait Observational gait analysis was performed as tion motion in a sidelying position; and (4) preven-
the patients walked at a self-selected pace along a tion of pelvic motion in the transverse plane during
10-m walkway. Both patients demonstrated normal an abduction/external rotation movement of the hip
sagittal plane motion of the ankle, knee, and hip
joints. Abnormalities were noted, however, in the
frontal and transverse planes. During stance phase on
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
2
ASSESSMENT
0
Given the subjective and objective information
0 20 40 60 80 100
obtained in the examination, it was our impression
that neither patient demonstrated significant abnor- Stance (%)
malities specific to the patellofemoral joint that could
account for subjective complaints of PFP. Both pa- C
tients, however, demonstrated significant weakness of Pretreatment
the hip and abdominal musculature, and a reduced 3 Posttreatment
Journal of Orthopaedic & Sports Physical Therapy®
Foundations for Treatment FIGURE 2. Kinematic plots demonstrating patient A’s lower-
extremity motion (preintervention and postintervention) during the
Both patients were scheduled to attend physical step-down task. (A) Hip internal rotation. (B) Hip adduction. (C)
therapy once or twice a week over a 3-month period. Frontal plane pelvic motion of the contralateral pelvis.
with alternate legs, and the progression criteria were included isometric and dynamic exercises in single-
achieved for isometric gluteus maximus and medius limb stance. At this time the patients were introduced
contractions, the patients were progressed to dynamic to the concept of neutral lower-extremity alignment
exercises. This occurred at week 3 for patient A, and as described by McConnell.38 This involved alignment
week 4 for patient B. The subsequent program of of the lower extremity such that the ASIS and knee
dynamic hip-strengthening exercises for the lateral remained positioned over the second toe, with the
rotators and the abductors of the hip predominately hip positioned in approximately 10° of external
targeted the gluteus medius and maximus. rotation.
Gluteus medius exercises were done in sidelying, The patients were then instructed to stand next to
with hips and knees flexed, performing hip abduc- a wall with the stance limb furthest from the wall.
tion with external rotation, while maintaining a They were asked to contract their transversus
neutral spinal position by coactivating the transversus abdominus and gluteal muscles and then to assume a
abdominus (Figure 3B). The patients were instructed single-limb stance position by flexing the contralateral
to keep both feet together and lift the uppermost knee with the hip in a neutral position (Figure 4A).
knee as high as possible, while concurrently palpating Patients then performed isometric external rotation
These were undertaken using the Clinical Reformer formed in knee flexion ranges less than 45°.57 The
Pilates exercise equipment (Current Concepts Corp., exercise was then progressed by securing Theraband
Sacramento, CA). This device consists of a horizon- around the distal aspect of the thighs to encourage
tally moving carriage on which the patient can lie, activation of the external hip rotator/abductor mus-
kneel, sit, or stand. Resistance is provided using culature throughout the range of hip flexion/
springs, with fewer springs increasing the demand on extension movement, and to provide proprioceptive
A B C D
Journal of Orthopaedic & Sports Physical Therapy®
FIGURE 4. Weight-bearing exercises (weeks 6-10). (A) Isometric hip abduction performed in weight bearing against a wall. (B)
Upper-extremity activities performed in a single-leg stance. (C) Bilateral standing hip abduction performed on the Clinical Reformer. The
patient’s right leg is on a platform that moves to the right against spring resistance as she concurrently pushes both legs apart against
resistance, while maintaining a stable pelvic position. (D) Holding Theraband and rotating the body medially while maintaining a static
lower extremity produces relative external rotation at the hip.
RESULTS
Both patients were re-evaluated at week 14, 3
CASE REPORT
Functional Status
The postintervention functional assessment scores
increased from 76 to 85 and from 70 to 84 for
patients A and B, respectively.
joint demonstrated a negative apprehension test, but These case reports describe 2 patients with chief
mild pain with patellar compression. She demon- complaints of PFP who responded favorably to a
strated pain-free isometric resisted knee extension in strengthening program targeting the trunk, pelvis,
non-weight-bearing; however, some tightness was ex- and hip musculature. Clinically relevant results were
perienced at 20° of flexion. Patient B still demon- achieved without treatment strategies commonly em-
strated a mild positive patellar compression test with ployed for the patellofemoral joint (ie, taping, vastus
slight pain elicited and mild medial retinacular ten- medialis oblique strengthening, or stretching re-
derness, but no pain on isometric resisted knee gimes). This suggests that the underlying cause of
extension at 20° to 0°. She had full pain-free passive PFP in certain individuals may not be restricted to
the patellofemoral joint.
range of patella mobility.
Carson and James9,25 discussed the relevance of
considering lower-extremity kinetic chain factors
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Muscle Strength Assessment when evaluating and treating patients with a chief
complaint of knee pain. In addition, research by
Re-evaluation of muscle strength using the hand- Beckman and Buchanan,1 Bullock-Saxton,8 and
held dynamometer revealed significant improvements Jaramillo et al26 has demonstrated that weakness
in both patients (Table). Patient A demonstrated proximal to the symptomatic area is often present
strength gains in all muscle groups, most notably the with distal lower-extremity pathologies. This weakness,
ipsilateral lateral rotators of the hip (317%), gluteus however, may be a precursor to the pathology or the
maximus (55%), gluteus medius (50%), and result of subsequent motor control changes.27 Never-
quadriceps (20%). Similarly, patient B demonstrated theless, by addressing the identified weak proximal
Journal of Orthopaedic & Sports Physical Therapy®
strength gains in the gluteus maximus (110%), musculature in the patients in these cases, improve-
gluteus medius (90%), the hip lateral rotator group ments were noted in both subjective and objective
(15%), and quadriceps (10%). parameters.
It should be noted that during the exercise pro-
gram, patients were continuously encouraged to
Dynamic Assessment monitor their performance of each motion. Such
training would facilitate motor learning of correct
Gait Based on observational assessment, both pa- movement patterns, which may be distinct from
tients demonstrated improved gait kinematics at the control of motion due to muscle strength alone.49 It
hip in the frontal and transverse planes. In general, is, therefore, possible that the observed improve-
there was less hip adduction during weight accep- ments in lower-extremity kinematics could have been
tance, and a decrease in both hip internal rotation the result of a combination of muscle strength and
and contralateral pelvic drop during midstance. improved motor control of motion.
Step-Down Task Both patients demonstrated signifi- Both patients initially had a chief complaint of pain
cant improvements during the step-down maneuver. during stair ascent/descent and prolonged walking,
Both had a reduction in adduction/internal rotation and demonstrated poor control of the lumbopelvic/
of the stance limb, less knee valgus, and a smoother hip region during these activities. McFadyen39 and
motion into hip flexion. Neither patient experienced Soderberg56 concluded that the gluteus medius plays
pain during, or after, the step-down maneuver. an important role in hip and pelvic stability during
CASE REPORT
FIGURE 6. Computer-generated skeletal representation of patient A’s lower-extremity kinematics. (A) Prior to intervention. (B) Postinterven-
tion. Reduced hip adduction and internal rotation of the hip can be observed in B.
stair descent, especially during the last 85% of the that this difference was clinically meaningful. For
stance phase. In the preintervention test, patient A example, hip adduction would move the patella
demonstrated excessive hip adduction during the last medially with respect to the ASIS, thereby increasing
80% of stance phase, suggesting inadequate strength the dynamic Q angle.45 Theoretically, any decrease in
of the gluteus medius. As can be seen by the the hip adduction angle could result in a decrease in
postintervention data (Figure 2B), hip adduction was the dynamic Q angle, thereby reducing the lateral
reduced, especially during the last 80% of the step- force acting on the patella.45
down cycle, suggesting an improved control of this The gluteus maximus muscle has been shown to be
motion. a powerful external rotator of the hip,12 and the
Although the measured changes in hip adduction function of its upper fibers have been found by Lyons
during the step-down maneuver were relatively small et al34 to be similar to that of gluteus medius during
(6.4° averaged across the stance phase), we believe gait and stair ascent. The substantial changes found
The patients studied in these 2 case reports were Ther. 1994;74:17-28; discussion 28-31.
selected based on their clinical presentation of sus- 9. Carson WG, Jr., James SL, Larson RL, Singer KM,
pected proximal weakness, as suggested by observa- Winternitz WW. Patellofemoral disorders: physical and
tional tests of gait and stair descent, and the lack of radiographic evaluation. Part I: Physical examination.
Clin Orthop. 1984;165-177.
localized patellofemoral joint static positional faults
10. Clark MA. Core stabilization training in rehabilitation.
and dynamic tracking problems. As always, careful In: Prentice WE, Voight ML, eds. Techniques in
selection of the appropriate patient for a particular Musculoskeletal Rehabilitation. New York, NY:
intervention is important in achieving successful out- McGraw-Hill; 2001:259-278.
comes. With this in mind, we feel that the described 11. Dehaven KE, Dolan WA, Mayer PJ. Chondromalacia
patellae in athletes. Clinical presentation and conserva-
treatment approach should be considered in the
tive management. Am J Sports Med. 1979;7:5-11.
management of patients with PFP who present with 12. Delp SL, Hess WE, Hungerford DS, Jones LC. Variation
similar clinical findings. This may be especially true of rotation moment arms with hip flexion. J Biomech.
of those patients in whom a traditional course of 1999;32:493-501.
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
treatment has not produced satisfactory results. 13. Downie WW, Leatham PA, Rhind VM, Wright V,
Branco JA, Anderson JA. Studies with pain rating scales.
Ann Rheum Dis. 1978;37:378-381.
CONCLUSION 14. Fairbank HAT. Derangement of the knee in children and
adolescents. Proc Roy Soc Med. 1937;30:427-432.
These case reports present 2 patients with PFP who 15. Farrell JP, Koury M, Caroline DT. Therapeutic exercise
for back pain. In: Twomey LT, Taylor JR, eds. Physical
demonstrated abnormal kinematics at the hip and Therapy of the Low Back. New York, NY: Churchill
who responded favorably to an exercise program Livingstone; 2000:327-350.
specifically targeting the hip, pelvis, and trunk muscu- 16. Franklin BA, Whaley MH, Howley ET. ACSM’s Guide-
lature. Further research is indicated to better define lines for Exercise Testing and Prescription. Philadelphia,
Journal of Orthopaedic & Sports Physical Therapy®
the relationship between proximal hip muscle weak- PA: Lippincott Williams and Wilkins; 2000.
17. Fitzgerald GK, McClure PW. Reliability of measure-
ness and PFP, and to identify patients who will best ments obtained with four tests for patellofemoral align-
respond to this treatment approach. ment. Phys Ther. 1995;75:84-90; discussion 90-82.
18. Grelsamer RP, McConnell J. The Patella: A Team
Approach. Gathersburg, MD: Aspen Publishers; 1998.
ACKNOWLEDGMENTS 19. Henry JH. Conservative treatment of patellofemoral
subluxation. Clin Sports Med. 1989;8:261-278.
The authors wish to thank Yu-Jen Chen, PT, MS, 20. Hodges PW, Richardson CA. Contraction of the ab-
for assisting in the collection and processing of the dominal muscles associated with movement of the
kinematic data, and the staff at USC Physical Therapy lower limb. Phys Ther. 1997;77:132-142; discussion
142-134.
Associates, where these patients received their care.
21. Huberti HH, Hayes WC. Patellofemoral contact pres-
sures. The influence of q-angle and tendofemoral con-
tact. J Bone Joint Surg Am. 1984;66:715-724.
22. Hvid I, Andersen LI. The quadriceps angle and its
REFERENCES relation to femoral torsion. Acta Orthop Scand.
1982;53:577-579.
1. Beckman SM, Buchanan TS. Ankle inversion injury and 23. Inman VT. Functional aspects of the abductor muscles
hypermobility: effect on hip and ankle muscle of the hip. J Bone Joint Surg Am. 1947;53:577-579.
electromyography onset latency. Arch Phys Med 24. Insall J. Current Concepts Review: patellar pain. J Bone
Rehabil. 1995;76:1138-1143. Joint Surg Am. 1982;64:147-152.
31. Kendall FP, McCreary EK, Provance P. Muscles, Posture, effects of patellar taping on knee kinetics, kinematics,
and Pain. Baltimore, MD: Williams and Wilkins; 1993. and vastus lateralis muscle activity during stair ambula-
32. Kisner C, Colby LA. Therapeutic Exercise: Foundations tion in individuals with patellofemoral pain. J Orthop
and Techniques. Philadelphia, PA: F. A. Davis; 1996. Sports Phys Ther. 2002;32:3-10.
33. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, 52. Salsich GB, Brechter JH, Powers CM. Lower extremity
Hurme M, Nelimarkka O. Scoring of patellofemoral kinetics during stair ambulation in patients with and
disorders. Arthroscopy. 1993;9:159-163. without patellofemoral pain. Clin Biomech (Bristol,
34. Lyons K, Perry J, Gronley JK, Barnes L, Antonelli D. Avon). 2001;16:906-912.
Timing and relative intensity of hip extensor and
53. Scott J, Huskisson EC. Graphic representation of pain.
abductor muscle action during level and stair ambula-
Pain. 1976;2:175-184.
tion. An EMG study. Phys Ther. 1983;63:1597-1605.
35. Macausland WR, Sargent AF. Recurrent dislocation of 54. Scuderi GR. Surgical treatment for patellar instability.
the patella. Surg Gynecol Obstet. 1922;35:35-41. Orthop Clin North Am. 1992;23:619-630.
36. Magee DJ. Orthopedic Physical Assessment. Philadel- 55. Siler B. The Pilates Body. New York, NY: Broadway;
phia, PA: W. B. Saunders; 1997. 2000.
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
37. Maquet PGJ. Biomechanics of the Knee: With Applica- 56. Soderberg GL, Dostal WF. Electromyographic study of
tion to the Pathogenesis and the Surgical Treatment of three parts of the gluteus medius muscle during func-
Osteoarthritis. New York, NY: Springer-Verlag; 1984. tional activities. Phys Ther. 1978;58:691-696.
38. McConnell J. Patellofemoral joint complications and 57. Steinkamp LA, Dillingham MF, Markel MD, Hill JA,
considerations. In: Ellenbecker TS, ed. Knee Ligament Kaufman KR. Biomechanical considerations in patel-
Rehabilitation. New York, NY: Churchill Livingstone; lofemoral joint rehabilitation. Am J Sports Med.
2000:202-224. 1993;21:438-444.
39. McFadyen BJ, Winter DA. An integrated biomechanical 58. Taylor JR, O’Sullivan P. Lumbar segmental instability:
analysis of normal stair ascent and descent. J Biomech. pathology, diagnosis, and conservative management. In:
1988;21:733-744. Physical Therapy of the Low Back. New York, NY:
40. Messier SP, Davis SE, Curl WW, Lowery RB, Pack RJ. Churchill Livingstone; 2000:201-247.
Journal of Orthopaedic & Sports Physical Therapy®
Etiologic factors associated with patellofemoral pain in 59. Thomee R, Augustsson J, Karlsson J. Patellofemoral pain
runners. Med Sci Sports Exerc. 1991;23:1008-1015. syndrome: a review of current issues. Sports Med.
41. Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, 1999;28:245-262.
Prybicien M, Deprince M. Hip muscle imbalance and
60. Ward SR, Powers CM, Fredericson M, Guillet M,
low back pain in athletes: influence of core strengthen-
CASE REPORT
(b) Slight pain when descending (8) (c) Occasionally in daily activities (4)
(c) Pain both when descending and (d) At least 1 documented dislocation (2)
ascending (5) (e) More than 2 dislocations (0)
(d) Unable (0)
12. Atrophy of thigh
5. Squatting
(a) None (5)
(a) No difficulty (5)
(b) Slight (3)
(b) Repeated squatting painful (4)
(c) Severe (0)
(c) Painful each time (3)
(d) Possible with partial weight bearing (2) 13. Flexion deficiency
(a) None (5)
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19. Clare E. Milner, Joseph Hamill, Irene S. Davis. 2010. Distinct Hip and Rearfoot Kinematics in Female Runners With a History of Tibial
Stress Fracture. Journal of Orthopaedic & Sports Physical Therapy 40:2, 59-66. [Abstract] [Full Text] [PDF] [PDF Plus]
20. Christopher M. Powers. 2010. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. Journal of
Orthopaedic & Sports Physical Therapy 40:2, 42-51. [Abstract] [Full Text] [PDF] [PDF Plus]
21. Lindsay J. Distefano, J. Troy Blackburn, Stephen W. Marshall, Darin A. Padua. 2009. Gluteal Muscle Activation During Common
Therapeutic Exercises. Journal of Orthopaedic & Sports Physical Therapy 39:7, 532-540. [Abstract] [PDF] [PDF Plus] [Supplemental
Material]
22. Richard B. Souza, Christopher M. Powers. 2009. Differences in Hip Kinematics, Muscle Strength, and Muscle Activation Between Subjects
With and Without Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy 39:1, 12-19. [Abstract] [PDF] [PDF Plus]
23. Carina D. Lowry, Joshua A. Cleland, Kelly Dyke. 2008. Management of Patients With Patellofemoral Pain Syndrome Using a Multimodal
Approach: A Case Series. Journal of Orthopaedic & Sports Physical Therapy 38:11, 691-702. [Abstract] [PDF] [PDF Plus]
24. John D. Willson, Irene S. Davis. 2008. Utility of the Frontal Plane Projection Angle in Females With Patellofemoral Pain. Journal of
Orthopaedic & Sports Physical Therapy 38:10, 606-615. [Abstract] [PDF] [PDF Plus]
25. Christian J. Barton, Kate E. Webster, Hylton B. Menz. 2008. Evaluation of the Scope and Quality of Systematic Reviews on
Nonpharmacological Conservative Treatment for Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 38:9,
529-541. [Abstract] [PDF] [PDF Plus]
26. Christine A. Iverson, Thomas G. Sutlive, Michael S. Crowell, Rebecca L. Morrell, Matthew W. Perkins, Matthew B. Garber, Josef
H. Moore, Robert S. Wainner. 2008. Lumbopelvic Manipulation for the Treatment of Patients With Patellofemoral Pain Syndrome:
Development of a Clinical Prediction Rule. Journal of Orthopaedic & Sports Physical Therapy 38:6, 297-312. [Abstract] [PDF] [PDF Plus]
27. Lori A. Bolgla, Terry R. Malone, Brian R. Umberger, Timothy L. Uhl. 2008. Hip Strength and Hip and Knee Kinematics During
Stair Descent in Females With and Without Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 38:1, 12-18.
[Abstract] [PDF] [PDF Plus]
28. Richard A. Ekstrom, Robert A. Donatelli, Kenji C. Carp. 2007. Electromyographic Analysis of Core Trunk, Hip, and Thigh Muscles
During 9 Rehabilitation Exercises. Journal of Orthopaedic & Sports Physical Therapy 37:12, 754-762. [Abstract] [PDF] [PDF Plus]
Downloaded from www.jospt.org at Suny Downstate Medical Center on April 7, 2015. For personal use only. No other uses without permission.
29. Shaw Bronner, Thomas Novella, Laura Becica. 2007. Management of a Delayed Union Sesamoid Fracture in a Dancer. Journal of Orthopaedic
& Sports Physical Therapy 37:9, 529-540. [Abstract] [PDF] [PDF Plus]
30. Ryan L. Robinson, Robert J. Nee. 2007. Analysis of Hip Strength in Females Seeking Physical Therapy Treatment for Unilateral
Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 37:5, 232-238. [Abstract] [PDF] [PDF Plus]
31. Terese L. Chmielewski, Michael J. Hodges, MaryBeth Horodyski, Mark D. Bishop, Bryan P. Conrad, Susan M. Tillman. 2007. Investigation
of Clinician Agreement in Evaluating Movement Quality During Unilateral Lower Extremity Functional Tasks: A Comparison of 2 Rating
Methods. Journal of Orthopaedic & Sports Physical Therapy 37:3, 122-129. [Abstract] [PDF] [PDF Plus]
32. Sara R. Piva, Edward A. Goodnite, John D. Childs. 2005. Strength Around the Hip and Flexibility of Soft Tissues in Individuals With and
Without Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 35:12, 793-801. [Abstract] [PDF] [PDF Plus]
33. Lori A. Bolgla, Timothy L. Uhl. 2005. Electromyographic Analysis of Hip Rehabilitation Exercises in a Group of Healthy Subjects. Journal
of Orthopaedic & Sports Physical Therapy 35:8, 487-494. [Abstract] [PDF] [PDF Plus]
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34. David J. S. Wadsworth, Nathan T. Eadie. 2005. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. Journal of
Orthopaedic & Sports Physical Therapy 35:3, 154-164. [Abstract] [PDF] [PDF Plus]
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