Overall Clinical Bottom Line: Results from this systematic review are inconclusive in determining whether a closed kinetic chain exercise program incorporating gluteal strengthening is more effective at decreasing pain and improving function in patients with patellofemoral pain syndrome than a traditional physical therapy rehabilitative plan that does not incorporate gluteal strengthening. A majority of the studies addressing this specific issue are of poor methodological quality, which leads us to this conclusion. Future high-quality randomized controlled trials comparing programs with gluteal strengthening to programs without this component are needed to determine if strengthening of the proximal hip stabilizers is an effective or necessary aspect to treating this syndrome. Additionally, a clinical prediction rule would be useful for determining which patients with this syndrome might benefit most from a program incorporating gluteal strengthening. Clinical Scenario: We operate in an outpatient orthopedic clinic in Portland, OR. Recently, a 20 year old female club soccer player has entered our clinic complaining of anterior knee pain. After completing a detailed evaluation, conclusions have been made that the patient is suffering from Patellofemoral Pain Syndrome (PFPS). Recent literature has indicated that patients commonly have weak hip musculature associated with this diagnosis. Our research efforts have identified systematic reviews indicating that exercise programs, specifically strengthening of quadriceps musculature, have been beneficial for improving pain and function for patients with PFPS. However, no one exercise intervention program has been proven better than any other to this point. It is our goal to search the literature to find out if intervention programs that incorporate hip strengthening are better than programs that do not add this specific component to the plan of care to determine the best program to treat our patient most effectively.
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