Importance of Hip Strengthening When Treating Athletes with PFPS

The importance of hip strength in athletes' ability to control their knee alignment, especially gluteus medius and external rotators, are well documented. Hip muscle weakness has been liked to injuries such as ankle sprain, ACL sprain, etc. Patellofemoral pain syndrome (PFPS) is another injury suffered by many athletes often leading to loss of practice time and competition. PFPS, however, can be caused by many causes including patella maltracking, patella instability, quad muscle weakness, hip muscle weakness, etc. And this condition is more prevalent in female athletes than in male athletes. It is very important when treating athletes with this condition to identify underlying causes and treating them instead of treating the symptoms, whether it is in the ankles, knees, or in the hips. One thing that we focus when rehabilitating athletes with PFPS is to make sure they have good hip strength and good control of their lower extremities. A study published a few years ago verifies this. In this study, they put athletes with PFPS into 2 groups with one being quad strengthening group and the other being hip strengthening group. After 4 weeks of exercises, the hip strengthening group improved in pain level significantly more than the quad strengthening group. This tells us how important it is to include hip strengthening in a rehab process. This does not mean that it is not important to do quad strengthening exercises because, in this study, the quad strengthening group also got better in pain level and in function. It is important to do both of quad and hip strengthening when treating athletes with PFPS. Some of the hip exercises that can be done easily are side-lying hip abduction, monster walk, clam shell, etc. And again, it is very important to find out what is causing PFPS and treating the causes instead of just treating the symptoms.

Monster walk exercise

Core Stabilization Exercise: Dead Bug

Even though it is every important to know draw-in exercise (pelvic tilt) is the most basic core exercise and the fundamental to any other core exercises, at some point, athletes will need to advance to more difficult core exercises. We have already discussed a few different ways to make it harder. One of more advanced core exercises is dead-bug exercise and this is often used to evaluate athletes' core strength as well. However, to many athletes, it is very difficult to do this exercise correctly. According to our data, about 50% of 300 elite junior tennis players failed to correctly perform dead-bug exercise. The picture below shows a starting position of dead-bug exercise. Then, athletes will lower one arm and an opposite leg towards the table while maintaining neutral spine and pelvis (without arching the back). As we mentioned, even for elite athletes, this is not an easy exercise to do. But there are variations of this exercise, which are easier to do.

 

1) From starting position, they can just lower their arm and alternate.

2) They can also lower a leg only but with their knees bent at 90 degrees. 

3) They can slide a physio ball under their legs and roll the ball out instead of lowering a leg on their own power. Or they can put both legs on the ball.

 

These are some of examples to make it a little easier. As they get stronger, they can advance to full dead-bug exercise. Dead-bug exercise is just one of many core exercises and just one of many advanced forms of draw-in (pelvic tilt) exercise. Most sports are played in their feet, so eventually, they need to advance to core exercises in upright position and their feet. But again, the fundamental of any core exercises is maintaining neutral spine and pelvic positions and maintaining stable 'core' during those exercises.