Hip Strength in Females With and Without

Patellofemoral Pain
Mary Lloyd Ireland, MD 1
John D. Willson, MSPT 2
Bryon T. Ballantyne, PT, MA 2
Irene McClay Davis, PT, PhD 3

Study Design: Cross-sectional. Current literature suggests that,

Objectives: To determine if females with anterior knee pain are more likely to demonstrate hip in the absence of direct trauma,
abduction or external rotation weakness than a similar, asymptomatic, age-matched control group. the etiology of PFP is multifacto-
Background: Diminished hip strength has been implicated as being contributory to lower-extremity rial. Factors related directly to the
malalignment and patellofemoral pain. The identification of reliable and consistent patterns of

RESEARCH
patellofemoral joint, including
weakness in this population may assist health care professionals establish a more effective
vastus medialis obliquus insuffi-
treatment plan.
ciency, decreased hamstring,
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Methods and Measures: Hip abduction and external rotation isometric strength measurements
were recorded for the injured side of 15 female subjects with patellofemoral joint pain (mean ±
quadriceps, or iliotibial band flex-
SD age, 15.7 ± 2.7 years; age range, 12-21 years). These were compared with strength ibility, patella alta, and femoral
measurements from the corresponding hip of 15 age-matched female control subjects (mean ± SD anteversion, have received the
age, 15.7 ± 2.7 years; age range, 12-21 years). All strength measurements were made using most attention. 7,10,18,26,29,31,37,38
hand-held dynamometers. Such factors may also contribute
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

REPORT
Results: Subjects with patellofemoral pain demonstrated 26% less hip abduction strength (P⬍.001) to PFP through their role in caus-
and 36% less hip external rotation strength (P⬍.001) than similar age-matched controls. ing patellofemoral malalignment,
Conclusions: The results indicate that young women with patellofemoral pain are more likely to which is a universally accepted
demonstrate weakness in hip abduction as well as external rotation than age-matched women contribution to PFP.12,31
who are not symptomatic. J Orthop Sports Phys Ther. 2003;33:671-676. Factors distal to the knee have
Key Words: anterior knee pain, hip abduction, hip external rotation, knee, also been frequently suggested to
patella contribute to patellofemoral
malalignment and pain. Numerous
Journal of Orthopaedic & Sports Physical Therapy®

authors have explored the rela-

tionship between excessive or pro-

P
atellofemoral joint pain (PFP) remains one of the most
common orthopaedic complaints among adolescents and longed foot pronation during
young adults, with reported incidence rates among athletes functional activities and lateral
greater than 25%.2,26,31,38 It has also been reported that patellar compression syn-
females, as compared with their male counterparts, are drome.28,30,36 Specifically, consider-
significantly more likely to experience PFP.9,35 Typically, patients com- ing the ‘‘screw-home’’ mechanism
plain of generalized retropatellar symptoms that present insidiously and of the tibiofemoral joint, these au-
tend to be exacerbated by prolonged sitting or repetitive weight-bearing thors report that the tibia must be
activities over a flexed knee. Unfortunately for these individuals, this externally rotated relative to the
pain often becomes a chronic condition that may fail to respond to femur so that knee extension can
conservative measures. be achieved during the midstance
and terminal stance phases of gait.
1
However, it is hypothesized that, in
Orthopedic Surgeon, Kentucky Sports Medicine Clinic, Lexington, KY.
2
Clinical Research Coordinator, Joyner Sportsmedicine Institute, Lexington, KY. the presence of excessive or pro-
3
Associate Professor, University of Delaware, Department of Physical Therapy, Newark, DE; Clinical longed foot pronation, the tibia
Research Coordinator, Joyner Sportsmedicine Institute, Lexington, KY. remains internally rotated as the
The protocol for this study was approved by Essex Institutional Review Board, Inc.
Send Correspondence to John D. Willson, Joyner Sportsmedicine Institute, 601 Perimeter Dr., Suite 110, knee begins to extend. To com-
Lexington, KY 40517. E-mail: jdwillson@yahoo.com pensate for this excessive tibial

Journal of Orthopaedic & Sports Physical Therapy 671

 internal rotation, it is thought that the femur must
internally rotate excessively, such that the tibia is in
relative external rotation.36 This compensation cre-
ates a larger quadriceps angle and may significantly
increase lateral retropatellar contact pressure.17,21,27
Proximal factors including hip muscle weakness
have also been proposed to contribute to patel-
lofemoral malalignment and the development of
PFP.12,34 Recent kinetic analysis of running reveals
that, although the largest knee joint moments occur
in the sagittal plane, the knee is also subject to
significant frontal and transverse plane moments.24
Additional research has shown that women, as com-
pared to their male counterparts, exhibit significantly
greater external knee valgus moments33 and associ-
ated movement into knee valgus23 and hip internal
rotation.22 The ability of women to control these
motions may depend on the strength of proximal
muscle groups that are antagonistic to these move-
ment tendencies. In the absence of sufficient proxi-
mal strength, the femur may adduct or internally
rotate, further increasing lateral patellar contact pres-
sure.17,21,27 Repetitive activities with this malalign-
ment may eventually lead to the retropatellar
articular cartilage damage generally associated with
Downloaded from www.jospt.org at on April 10, 2018. For personal use only. No other uses without permission.
this syndrome.
Although some authors have postulated that hip
weakness may have a role in the etiology of patel-
lofemoral pain,12,14,34 no studies have documented
this weakness in a symptomatic population. There-
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
fore, the purpose of this investigation was to examine
hip strength in women with PFP. It is hypothesized
that women with PFP will demonstrate decreased hip
abduction and external rotation strength versus their
nonsymptomatic, age-matched counterparts.
METHODS
Subjects
Journal of Orthopaedic & Sports Physical Therapy®
Fifteen female subjects with PFP were recruited for
this study (mean ± SD age, 15.7 ± 2.7 years; age
range, 12-21 years; mean ± SD weight, 63.1 ± 16.5 kg;
weight range, 43.5-93.0 kg). Fifteen age-matched fe-
male control subjects who denied any history of
previous knee injury or pain were also recruited from
the community for the purpose of comparison (mean
± SD age, 15.7 ± 2.7 years; age range, 12-21 years;
mean ± SD weight, 56.6 ± 12.5 kg; weight range,
37.2-81.6 kg). All subjects reported routine participa-
tion in either recreational or organized sports such as
basketball, volleyball, track, equestrian, swimming, or
cheerleading. Prior to participation in the study,
informed consent was received from all participants
and by the parents of those participants less than 18
years of age. The study protocol was approved by
Essex Institutional Review Board, Inc.
672 J Orthop Sports Phys Ther • Volume 33 • Number 11 • November 2003
Inclusion criteria for the PFP group were satisfied
through a thorough evaluation at a local orthopaedic
practice. Each subject with PFP reported complaints
of patellofemoral joint pain for at least 3 months
duration associated with activities including sports,
climbing stairs, or prolonged sitting. Objective signs
were also consistent with PFP, including pain with
compression of the patella into the femoral condyles
or palpation of the posterior surface of the patella.
The subjects with PFP also underwent a physical
examination by the same orthopaedic surgeon to
exclude the possibility of concurrent ligament insta-
bility or meniscal pathology. Potential subjects from
either group who reported a history of patellar
dislocation, knee surgery, or other significant trauma
to either lower extremity were excluded from the
study.
One limb was used for comparison between groups
for each subject. In cases of unilateral pain, measure-
ments were recorded for the injured limb and the
corresponding limb of the age-matched control sub-
ject. For subjects with bilateral symptoms, their domi-
nant limb (identified by asking which leg the patient
would use to kick a ball as hard as possible) was used
for comparison with the corresponding limb of the
age-matched control subject. Bilateral symptoms were
present in 8 subjects. Five subjects presented with
right-sided symptoms and 2 subjects had symptoms
on their left side.
Procedure
Subjects underwent isometric muscle strength test-
ing for hip abduction and external rotation using
hand-held dynamometers and stabilization straps.
Testing for each subject took approximately 10 min-
utes and was randomly performed according to
muscle action. The test positions were selected based
on their similarity to traditional manual muscle test-
ing procedures20 and have been reported to be
highly reliable for testing isometric strength with
hand-held dynamometers.6,19
Hip abduction isometric strength testing was per-
formed with subjects positioned in sidelying on a
treatment table (Figure 1). A pillow was placed
between the subjects’ legs, using additional toweling
as needed, such that the hip of the leg to be tested
was abducted approximately 10° as measured with
respect to a line connecting the anterior superior
iliac spines. A strap placed just proximal to the iliac
crest and secured firmly around the underside of the
table was used to stabilize the subjects’ trunk. The
center of the force pad of a Nicholas hand-held
dynamometer (Lafayette Instruments, Lafayette, IN)
was then placed directly over a mark located 5.08 cm
proximal to the lateral knee joint line. This dyna-
mometer uses a load cell force-detecting system to
 TABLE. Isometric hip strength comparison between female subjects with patellofemoral joint pain (PFP) and a control group. All values
are expressed as a percentage (mean ± SD [95% confidence interval]) of body weight (kg).
Hip abduction†
Hip external rotation†
*
n = 15.
†
Significant difference between groups (P⬍.001).
measure static force ranging from 0 to 199.9 kg, with
accuracy to 0.1 kg ± 2%, and has been reported to
have excellent interrater reliability for testing hip
abduction isometric strength.11 The dynamometer
was secured between the leg and a second strap that
was wrapped around the leg and the underside of the
table. The strap eliminated the effect of tester
strength on this measure, which has been reported to
be a limitation of hand-held dynamometry.4 After
zeroing the dynamometer, the subject was instructed
to push the leg upward with maximal effort for 5
seconds. The force value displayed on the dynamom-
eter was recorded and the device was rezeroed. One
practice trial and 3 experimental trials were per-
formed, with 15 seconds of rest between trials. The
peak value from the 3 experimental trials was re-
corded.
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Hip external rotation (ER) isometric strength test-
ing was performed with subjects positioned on a
padded chair with the hips and knees flexed to 90°
(Figure 2). To prevent substitution by the hip adduc-
tors, a strap was used to stabilize the thigh of the
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
tested leg and a towel roll was placed between the
subjects’ knees. The dynamometer was then placed
such that the center of the force pad was directly
Journal of Orthopaedic & Sports Physical Therapy®
FIGURE 1. Isometric strength testing of hip abduction using straps and hand-held dynamometer.
J Orthop Sports Phys Ther • Volume 33 • Number 11 • November 2003
PFP Group* Control Group*
23.3 ± 6.9 (19.8-26.7) 31.4 ± 6.2 (28.4-34.5)
10.8 ± 4.0 (8.8-12.8) 16.8 ± 5.5 (14.0-19.6)
over a mark that was 5.08 cm proximal to the medial
malleolus. A strap around the leg and around the
base of a stationary object held the dynamometer in
place during contractions. After zeroing the dyna-
mometer, the subject was instructed to push the leg
inward with maximal effort for 5 seconds. The force
value displayed on the dynamometer was recorded
and the device was rezeroed. One practice trial and 3
experimental trials were performed with 15 seconds
of rest between trials. The peak value from the 3
experimental trials was recorded.
Data Analysis
We used a clinically significant strength difference
RESEARCH
of 15% between groups and estimates of sample
variability from previous literature3,5 to perform an a
priori power analysis. This analysis suggested that 25
to 30 subjects would provide adequate protection
from type I and II errors using ␣ = .05 and ␤ = .20.
However, during data collection, it became evident
that the true difference between groups was signifi-
cantly larger than the difference used in the power
REPORT
analysis. Therefore, data analysis was performed after
15 subjects had been tested per group. Independent t
tests were used to compare hip abduction and exter-
673

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FIGURE 2. Isometric strength testing of hip external rotation using
straps and hand-held dynamometer.
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Journal of Orthopaedic & Sports Physical Therapy®
FIGURE 3. Isometric strength comparisons in percent body weight
(% BW) between a control group and subjects with patellofemoral
joint pain (PFP) for hip abduction and external rotation. Error bars
represent 1 standard deviation. (The PFP groups are significantly
different [P⬍.001]).
nal rotation strength between subjects with patel-
lofemoral pain and their age-matched control sub-
jects. Prior to data analysis, strength measurements,
recorded in kg, were normalized to body weight for
each subject.
RESULTS
Subjects with patellofemoral pain syndrome exhib-
ited significantly lower isometric strength values than
their healthy, age-matched counterparts for both hip
abduction (P⬍.001) and external rotation (P⬍.001)
(Table). On average, these subjects were 26% weaker
674 J Orthop Sports Phys Ther • Volume 33 • Number 11 • November 2003
in hip abduction and 36% weaker in hip external
rotation than the members of the control group
(Figure 3).
DISCUSSION
The role of hip strength in the etiology of knee
pain has received increased attention in recent years.
However, in the absence of objective evidence, this
relationship has been reported based on observation
and professional conjecture. The purpose of this
investigation was to compare hip strength between
females with and without PFP. While the strength test
results for the healthy control subjects in this study
are in line with established isometric norms,5,6 fe-
males with PFP demonstrated significant weakness.
The apparent strength difference between groups
in this study supports the suggestions of other au-
thors who have associated PFP with hip muscle
weakness.6,32,34 Sommer34 visually observed a stereo-
typical motion pattern into knee valgus and femoral
internal rotation during the acceleration phase be-
fore take-off during jumping in healthy, fatigued,
male and female subjects. Similarly, more recent,
sophisticated kinematic analysis of subjects during
athletic movements has confirmed this movement
pattern, particularly in women.22,23,33 Our results
indicate that females with PFP may have insufficient
strength to resist these external valgus and internal
rotation moments. Consequently, the femur may ex-
cessively adduct and internally rotate during athletic
movements, promoting lateral patellar tracking and
increasing lateral retropatellar contact pressure.17,21,27
Repetitive movements with this alignment may cause
injury to the retinaculum, retropatellar articular carti-
lage, or subchondral bone.12
These results in combination with previous empiri-
cal evidence suggest that proximal stabilization pro-
grams may be beneficial for the treatment of
PFP.8,11,34 Fredericson et al11 documented the ten-
dency for distance runners who present with iliotibial
band syndrome to have weakness in hip abduction.
Following a 6-week rehabilitation protocol with a
focus on gluteus medius strengthening, over 90% of
the patients were pain free and had returned to their
prior level of function. The authors felt that strength-
ening of the gluteus medius fostered increased con-
trol of thigh adduction and internal rotation
tendencies during running, thereby minimizing the
valgus vector at the knee. Our results indicate that
hip abduction and external rotation strengthening
may also benefit individuals with PFP by improving
stability in the frontal and transverse planes of
motion during running and other sport-specific activi-
ties.
Unfortunately, studies that investigate the relation-
ship between lower-extremity frontal- or transverse-
plane stability and the prevention of knee injuries are
scarce. Hewett et al14 demonstrated a 50% reduction
 in knee adduction/abduction moments during the
landing phase of a vertical jump following a 6-week
training program that included lower-extremity
plyometric drills as well as general strength and
flexibility exercises. Although this intervention pro-
gram did not focus on hip muscles specifically, the
decrease in frontal plane knee moment was the only
significant predictor of the athlete’s risk for knee
ligamentous injury. Subsequent prospective analysis
has shown that female athletes who participated in
this program over the course of the sport season had
a significantly lower incidence of serious knee liga-
mentous injury than those who did not.13 Because
only ligamentous injuries were included for analysis
in this study by Hewett et al,13 the value of a
prophylactic hip strengthening program for
nonsymptomatic athletes in the prevention of PFP
remains purely speculative. Prospective studies are
needed to truly validate this relationship.
A limitation of the cross-sectional nature of this
study lies in our ability to discern cause and effect.
Symptomatic individuals in our study had at least a
3-month history of PFP. Therefore, the strength
differences observed in this study may be the conse-
quence of disuse atrophy or altered motor recruit-
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ment patterns.14 However, whether hip muscle
weakness precipitated the PFP symptoms or not,
measures to improve the strength of these muscles is
likely to have a positive influence on patients with
this clinical presentation, either as a prophylactic
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
measure of prevention or as a rehabilitation response
to minimize the risk for further injury.
Strength measurements in this study were reported
in units of force instead of torque. Although the
females in both groups were similar in many respects,
including age, weight, and participation in recre-
ational or varsity sports, we did not control for
possible differences in leg length between groups.
Therefore, a systematic difference in moment arm
Journal of Orthopaedic & Sports Physical Therapy®
between groups could have biased our results. We
chose to report force, rather than torque, to facilitate
the comparison of our results to previously estab-
lished normative values that were also reported in
units of force (or percent body weight).1,3,5,19 Future
studies using hand-held dynamometry should weigh
the merits of reporting force versus torque. However,
when reporting units of force, we acknowledge that
some assurance of equality of height between groups
should be included.
Future study of a prospective nature is necessary to
more completely delineate the role of proximal
muscle strength in the etiology of lower-extremity
injuries including PFP. These studies should include
males as well as subjects of different age groups to
determine if our results translate to individuals other
than young females. Future studies are also indicated
to evaluate the influence of proximal muscle weak-
ness on lower-extremity kinematics and kinetics. In
J Orthop Sports Phys Ther • Volume 33 • Number 11 • November 2003
addition to hip abduction and external rotation
strength, these studies could include strength mea-
sures of other proximal muscle groups including the
abdominals, quadratus lumborum, gluteals, and back
extensors which further contribute to proximal stabil-
ity.14,15,16,25 Reliable dynamometry techniques for
these muscles must first be described.
Based on the results of this study, clinicians should
be encouraged to perform a thorough musculo-
skeletal evaluation of the hip musculature when
designing a treatment program for individuals with
PFP. Exercises to address weakness in hip abduction
or external rotation may foster a more effective and
lasting recovery with respect to each patient’s goals.
CONCLUSION
The results of our investigation indicate that fe-
males presenting with PFP demonstrate significant
hip abduction and external rotation weakness com-
pared to age-matched, nonsymptomatic controls.
RESEARCH
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Mechanics in Men With Iliotibial Band Syndrome. Journal of Orthopaedic & Sports Physical Therapy 44:3, 217-222. [Abstract] [Full Text]
[PDF] [PDF Plus]
7. Reddy Abagale, Bage Julie, Levine David. The Hip 1-21. [Abstract] [Full Text] [PDF]
8. Richard W. Willy, Irene S. Davis. 2013. Varied Response to Mirror Gait Retraining of Gluteus Medius Control, Hip Kinematics, Pain,
and Function in 2 Female Runners With Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy 43:12, 864-874. [Abstract]
[Full Text] [PDF] [PDF Plus] [Supplemental Material]
9. Kyung-Mi Park, Heon-Seock Cynn, Sung-Dae Choung. 2013. Musculoskeletal Predictors of Movement Quality for the Forward Step-down
Test in Asymptomatic Women. Journal of Orthopaedic & Sports Physical Therapy 43:7, 504-510. [Abstract] [Full Text] [PDF] [PDF Plus]
10. Szu-Ping Lee, Christopher Powers. 2013. Description of a Weight-Bearing Method to Assess Hip Abductor and External Rotator Muscle
Performance. Journal of Orthopaedic & Sports Physical Therapy 43:6, 392-397. [Abstract] [Full Text] [PDF] [PDF Plus]
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11. David M. Selkowitz, George J. Beneck, Christopher M. Powers. 2013. Which Exercises Target the Gluteal Muscles While Minimizing
Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes. Journal of Orthopaedic & Sports Physical
Therapy 43:2, 54-64. [Abstract] [Full Text] [PDF] [PDF Plus]
12. Gretchen B. Salsich, Valentina Graci, Dwayne E. Maxam. 2012. The Effects of Movement-Pattern Modification on Lower Extremity
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Kinematics and Pain in Women With Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy 42:12, 1017-1024. [Abstract]
[Full Text] [PDF] [PDF Plus]
13. Thiago Yukio Fukuda, William Pagotti Melo, Bruno Marcos Zaffalon, Flavio Marcondes Rossetto, Eduardo Magalhães, Flavio Fernandes
Bryk, Robroy L. Martin. 2012. Hip Posterolateral Musculature Strengthening in Sedentary Women With Patellofemoral Pain Syndrome: A
Randomized Controlled Clinical Trial With 1-Year Follow-up. Journal of Orthopaedic & Sports Physical Therapy 42:10, 823-830. [Abstract]
[Full Text] [PDF] [PDF Plus]
14. Christopher M. Powers, Lori A. Bolgla, Michael J. Callaghan, Natalie Collins, Frances T. Sheehan. 2012. Patellofemoral Pain: Proximal,
Distal, and Local Factors—Second International Research Retreat, August 31–September 2, 2011, Ghent, Belgium. Journal of Orthopaedic
& Sports Physical Therapy 42:6, A1-A54. [Abstract] [Full Text] [PDF] [PDF Plus]
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15. Khalil Khayambashi, Zeynab Mohammadkhani, Kourosh Ghaznavi, Mark A. Lyle, Christopher M. Powers. 2012. The Effects of Isolated
Hip Abductor and External Rotator Muscle Strengthening on Pain, Health Status, and Hip Strength in Females With Patellofemoral Pain:
A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy 42:1, 22-29. [Abstract] [Full Text] [PDF] [PDF Plus]
16. Richard W. Willy, Irene S. Davis. 2011. The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-
Leg Squat. Journal of Orthopaedic & Sports Physical Therapy 41:9, 625-632. [Abstract] [Full Text] [PDF] [PDF Plus]
17. Kornelia Kulig, John M. Popovich, Jr, Lisa M. Noceti-Dewit, Stephen F. Reischl, Dong Kim. 2011. Women With Posterior Tibial Tendon
Dysfunction Have Diminished Ankle and Hip Muscle Performance. Journal of Orthopaedic & Sports Physical Therapy 41:9, 687-694.
[Abstract] [Full Text] [PDF] [PDF Plus]
18. Kimberly L. Dolak, Carrie Silkman, Jennifer Medina McKeon, Robert G. Hosey, Christian Lattermann, Timothy L. Uhl. 2011. Hip
Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain
Syndrome: A Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy 41:8, 560-570. [Abstract] [Full Text] [PDF]
[PDF Plus]
19. Chatchada Chinkulprasert, Roongtiwa Vachalathiti, Christopher M. Powers. 2011. Patellofemoral Joint Forces and Stress During Forward
Step-up, Lateral Step-up, and Forward Step-down Exercises. Journal of Orthopaedic & Sports Physical Therapy 41:4, 241-248. [Abstract]
[Full Text] [PDF] [PDF Plus]
20. Alon Rabin, Zvi Kozol. 2010. Measures of Range of Motion and Strength Among Healthy Women With Differing Quality of Lower
Extremity Movement During the Lateral Step-Down Test. Journal of Orthopaedic & Sports Physical Therapy 40:12, 792-800. [Abstract]
[Full Text] [PDF] [PDF Plus]
21. Thiago Yukio Fukuda, Flavio Marcondes Rossetto, Eduardo Magalhães, Flavio Fernandes Bryk, Paulo Roberto Garcia Lucareli, Nilza
Aparecida De Almeida Carvalho. 2010. Short-Term Effects of Hip Abductors and Lateral Rotators Strengthening in Females With
 Patellofemoral Pain Syndrome: A Randomized Controlled Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy 40:11, 736-742.
[Abstract] [Full Text] [PDF] [PDF Plus]
22. Eduardo Magalhães, Thiago Yukio Fukuda, Sylvio Noronha Sacramento, Andrea Forgas, Moisés Cohen, Rene Jorge Abdalla. 2010. A
Comparison of Hip Strength Between Sedentary Females With and Without Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports
Physical Therapy 40:10, 641-647. [Abstract] [Full Text] [PDF] [PDF Plus]
23. Kirsty McKenzie, Victoria Galea, Jean Wessel, Michael Pierrynowski. 2010. Lower Extremity Kinematics of Females With Patellofemoral
Pain Syndrome While Stair Stepping. Journal of Orthopaedic & Sports Physical Therapy 40:10, 625-632. [Abstract] [Full Text] [PDF]
[PDF Plus]
24. Alyson Filipa, Robyn Byrnes, Mark V. Paterno, Gregory D. Myer, Timothy E. Hewett. 2010. Neuromuscular Training Improves
Performance on the Star Excursion Balance Test in Young Female Athletes. Journal of Orthopaedic & Sports Physical Therapy 40:9, 551-558.
[Abstract] [Full Text] [PDF] [PDF Plus] [Supplemental Material]
25. Richard B. Souza, Christie E. Draper, Michael Fredericson, Christopher M. Powers. 2010. Femur Rotation and Patellofemoral Joint
Kinematics: A Weight-Bearing Magnetic Resonance Imaging Analysis. Journal of Orthopaedic & Sports Physical Therapy 40:5, 277-285.
[Abstract] [Full Text] [PDF] [PDF Plus]
26. 2010. Patellofemoral Pain Syndrome: Proximal, Distal, and Local Factors—An International Research Retreat: April 30–May 2, 2009, Fells
Point, Baltimore, MD. Journal of Orthopaedic & Sports Physical Therapy 40:3, A1-A48. [Abstract] [Full Text] [PDF] [PDF Plus]
27. Reed Ferber, Brian Noehren, Joseph Hamill, Irene Davis. 2010. Competitive Female Runners With a History of Iliotibial Band Syndrome
Demonstrate Atypical Hip and Knee Kinematics. Journal of Orthopaedic & Sports Physical Therapy 40:2, 52-58. [Abstract] [Full Text]
[PDF] [PDF Plus]
28. Flug Jennifer, Schneider Jeffrey, Greenberg Eric, Manal Tara Jo. Figure Skating 1-59. [Abstract] [Full Text] [PDF]
29. Gerard C. Gorniak. 2009. Patterns of Patellofemoral Articular Cartilage Wear in Cadavers. Journal of Orthopaedic & Sports Physical Therapy
39:9, 675-683. [Abstract] [PDF] [PDF Plus]
30. Michael O. Harris-Love, Joseph A. Shrader. 2009. Patellofemoral Knee Pain in an Adult With Radiographic Osteoarthritis and Human
Immunodeficiency Virus Infection. Journal of Orthopaedic & Sports Physical Therapy 39:8, 612-617. [Abstract] [PDF] [PDF Plus]
31. Lindsay J. Distefano, J. Troy Blackburn, Stephen W. Marshall, Darin A. Padua. 2009. Gluteal Muscle Activation During Common
Therapeutic Exercises. Journal of Orthopaedic & Sports Physical Therapy 39:7, 532-540. [Abstract] [PDF] [PDF Plus] [Supplemental
Material]
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32. 2009. March 2009 Letters to the Editor-in-Chief. Journal of Orthopaedic & Sports Physical Therapy 39:3. . [Abstract] [PDF] [PDF Plus]
33. Richard B. Souza, Christopher M. Powers. 2009. Differences in Hip Kinematics, Muscle Strength, and Muscle Activation Between Subjects
With and Without Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy 39:1, 12-19. [Abstract] [PDF] [PDF Plus]
34. John D. Willson, Irene S. Davis. 2008. Utility of the Frontal Plane Projection Angle in Females With Patellofemoral Pain. Journal of
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Orthopaedic & Sports Physical Therapy 38:10, 606-615. [Abstract] [PDF] [PDF Plus]
35. Christian J. Barton, Kate E. Webster, Hylton B. Menz. 2008. Evaluation of the Scope and Quality of Systematic Reviews on
Nonpharmacological Conservative Treatment for Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 38:9,
529-541. [Abstract] [PDF] [PDF Plus]
36. Tracy A. Dierks, Kurt T. Manal, Joseph Hamill, Irene S. Davis. 2008. Proximal and Distal Influences on Hip and Knee Kinematics in
Runners With Patellofemoral Pain During a Prolonged Run. Journal of Orthopaedic & Sports Physical Therapy 38:8, 448-456. [Abstract]
[PDF] [PDF Plus]
37. Christine A. Iverson, Thomas G. Sutlive, Michael S. Crowell, Rebecca L. Morrell, Matthew W. Perkins, Matthew B. Garber, Josef
Journal of Orthopaedic & Sports Physical Therapy®

H. Moore, Robert S. Wainner. 2008. Lumbopelvic Manipulation for the Treatment of Patients With Patellofemoral Pain Syndrome:
Development of a Clinical Prediction Rule. Journal of Orthopaedic & Sports Physical Therapy 38:6, 297-312. [Abstract] [PDF] [PDF Plus]
38. Lori A. Bolgla, Terry R. Malone, Brian R. Umberger, Timothy L. Uhl. 2008. Hip Strength and Hip and Knee Kinematics During
Stair Descent in Females With and Without Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 38:1, 12-18.
[Abstract] [PDF] [PDF Plus]
39. Liederbach Marijeanne. Common Knee Injuries in Dance 1-20. [Abstract] [Full Text] [PDF]
40. Richard A. Ekstrom, Robert A. Donatelli, Kenji C. Carp. 2007. Electromyographic Analysis of Core Trunk, Hip, and Thigh Muscles
During 9 Rehabilitation Exercises. Journal of Orthopaedic & Sports Physical Therapy 37:12, 754-762. [Abstract] [PDF] [PDF Plus]
41. Shaw Bronner, Thomas Novella, Laura Becica. 2007. Management of a Delayed Union Sesamoid Fracture in a Dancer. Journal of Orthopaedic
& Sports Physical Therapy 37:9, 529-540. [Abstract] [PDF] [PDF Plus]
42. Ryan L. Robinson, Robert J. Nee. 2007. Analysis of Hip Strength in Females Seeking Physical Therapy Treatment for Unilateral
Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 37:5, 232-238. [Abstract] [PDF] [PDF Plus]
43. Jennifer E. Earl, Sarika K. Monteiro, Kelli R. Snyder. 2007. Differences in Lower Extremity Kinematics Between a Bilateral Drop-Vertical
Jump and A Single-Leg Step-down. Journal of Orthopaedic & Sports Physical Therapy 37:5, 245-252. [Abstract] [PDF] [PDF Plus]
44. Sara R. Piva, Edward A. Goodnite, John D. Childs. 2005. Strength Around the Hip and Flexibility of Soft Tissues in Individuals With and
Without Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy 35:12, 793-801. [Abstract] [PDF] [PDF Plus]
45. Lori A. Bolgla, Timothy L. Uhl. 2005. Electromyographic Analysis of Hip Rehabilitation Exercises in a Group of Healthy Subjects. Journal
of Orthopaedic & Sports Physical Therapy 35:8, 487-494. [Abstract] [PDF] [PDF Plus]
46. David J. S. Wadsworth, Nathan T. Eadie. 2005. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. Journal of
Orthopaedic & Sports Physical Therapy 35:3, 154-164. [Abstract] [PDF] [PDF Plus]