Patellofemoral (PF) pain (or pain in the area of the knee cap) is a very common problem, especially in women because they naturally have a wider pelvis. A wider pelvis can cause a “knock-knee” effect, which can be exacerbated by flat feet and ankle pronation (rolling in at the ankles). The net result is that outward pressure increases on the patella, which can be quite disabling and interfere with weight bearing activities. So, what can be done for individuals with patellofemoral pain?
Because we cannot change the width of the pelvis, the focus must shift to the foot/ankle and hip/knee muscle balance. A 2014 study set out to prove (or disprove) that exercises that target BOTH the hip and knee vs. the knee only would yield better long-term outcomes.
Here, researchers randomly assigned 31 women with PF pain to one of two treatment groups: Group A participated in BOTH hip & knee exercises for eight weeks and Group B engaged in ONLY knee exercises for eight weeks. Following the completion of each eight-week exercise program, the researchers examined each participant, followed by a re-examination three months later. The investigators found that patients in Group A experienced greater improvements with regards to pain and function.
The authors of the study concluded, “An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.”
The “take-home” message here is that patients obtain the best results when treatment—in this case, exercise—is applied to more than just the area of complaint. Chiropractic care includes assessment of the whole person, not just a localized area where the patient feels pain. Perhaps this is why chiropractic almost always scores highest in “patient satisfaction” surveys when compared with other healthcare delivery systems.
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