Closed kinetic chain exercises with or without additional hip strengthening exercises in management of patellofemoral pain syndrome: a randomized controlled trial

Eur J Phys Rehabil Med. 2013 Oct;49(5):687-98. Epub 2013 Jul 2.


Background: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal pain condition, especially in females. Decreased hip muscle strength has been implicated as a contributing factor. Isolated open kinetic chain hip abductors and lateral rotators exercises were added by many authors to the rehabilitation program. However, Closed Kinetic Chain (CKC) exercises focusing on hip and knee muscles were not investigated if they can produce similar effect of hip strengthening and decreasing pain without the need of isolated exercises for hip musculature.

Aim: The aim of the present study was to determine the effect of a CKC exercises program with or without additional hip strengthening exercises on pain and hip abductors and lateral rotators peak torque.

Design: Prospective randomized clinical trial.

Setting: Patients with patellofemoral pain syndrome referred to the outpatient physical therapy clinic of the faculty of physical therapy, cairo university.

Population: Thirty two patients who had patellofemoral pain syndrome with age ranged from eighteen to thirty years.

Methods: Patients were randomly assigned into two groups: CKC group and CKC with hip muscles strengthening exercises as a control (CO) group. Treatment was given 3 times/week, for 6 weeks. Patients were evaluated pre- and post-treatment for their pain severity using VAS, function of knee joint using Kujala questionnaire, hip abductors and external rotators concentric/eccentric peak torque.

Results: There were significant improvements in pain, function and hip muscles peak torque in both groups (P<0.05). However, there was no statistically significant difference between groups in hip muscles torque (P<0.05) but pain and function improvements were significantly greater in the CO group (P<0.05).

Conclusion: Six weeks CKC program focusing on knee and hip strengthening has similar effect in improving hip muscles torque in patients with PFPS as a CKC exercises with additional hip strengthening exercises. However, adding isolated hip strengthening exercises has the advantage of more pain relief.

Clinical rehabilitation impact: CKC exercises with additional hip strengthening could be more beneficial in decreasing pain in PFPS than CKC exercises alone.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Egypt
  • Exercise Therapy / methods*
  • Female
  • Hip Joint / physiology
  • Hip Joint / physiopathology*
  • Humans
  • Kinetics
  • Knee Joint / physiology
  • Knee Joint / physiopathology*
  • Male
  • Muscle Strength / physiology
  • Pain Measurement
  • Patellofemoral Pain Syndrome / physiopathology
  • Patellofemoral Pain Syndrome / therapy*
  • Prospective Studies
  • Resistance Training / methods
  • Torque
  • Treatment Outcome
  • Young Adult