Patellofemoral syndrome and gluteal activation

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Author: Jeffrey Tucker
Date: July-August 2013
Publisher: American Chiropractic Association Inc.
Document Type: Article
Length: 1,322 words
Lexile Measure: 1400L

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Adequate activation of the gluteal muscles is essential in all ambulatory activities because they play a key role in synergistically stabilizing the pelvis and transferring forces from the lower extremities to the spine. The gluteals are an important part of the link between the hips, knees, and ankles. Studies have shown that any compromise to the hip musculature can result in different types of lower-extremity injuries. There are many exercises that activate these muscles but it is important to first determine the kinetic chain deficiency that must be addressed to target the appropriate muscles in a systematic and progressive fashion.

Traditionally, patellofemoral pain syndrome (PFPS) has been attributed to abnormal tracking of the patella. Rehabilitation has focused on increasing quadriceps strength and/or some type of stretching. It has been hypothesized that PFPS is the result of hip impairment or dysfunction--specifically, weakness of the hip abductors and external rotators, which then contribute to increased hip adduction and internal rotation during weight-bearing activities. In this case, strengthening the hip abductors, extensors, and external rotators should be the primary focus.

An exercise rehabilitation program can begin with bilateral bridging and side-lying "clams"--these will activate the muscles in a non-weightbearing position. Distefano, et al. (1) assert that side-lying hip abduction is the best exercise for targeting the gluteus medius. In my practice, I use side-lying hip abduction to assess the likelihood of an overactive TFL (hip flexion), quadratus lumborum (hip hiking), and/or a weak core (torso rotation). I do feel side-lying hip abduction is a great beginning exercise. Mascal, et al. (2) note that isometric strengthening for the gluteus medius using the side-lying abduction exercise must be conducted with slight flexion to the knees while preventing as much contribution of the tensor fascia latae as possible. It is common for the TFL to be overactive, allowing the iliotibial band to cause knee pain. In the case of an overactive TFL and inhibited gluteal muscles, I have successfully used one-legged squats and lateral stepping with...

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Gale Document Number: GALE|A353753374