Summary
In recent years there has been increased interest in the role of exercise in the alleviation of patellofemoral pain syndrome. Contradictions which result in a lack of a consensus amongst clinicians and researchers as to the most beneficial type of exercise are reviewed. The popularly held belief that there are imbalances between some components of the quadriceps femoris is also reviewed and conflicting evidence that quadriceps contractions can be enhanced by altering hip and knee positions is found. Some traditional exercises, previously considered essential to any regime for this common condition, were not found to be as beneficial as previously thought. Consequently, some of these exercises should be less prominent in a rehabilitation programme for patellofemoral pain syndrome.
Similar content being viewed by others
References
Kettelkamp DB. Current concepts review: management of patellar malalignment. J Bone Joint Surg Am 1981; 63: (1344–7)
Tria AJ, Palumbo RC, Alicea JA. Conservative care of patellofemoral pain. Orthop Clin North Am 1992; 23 (4): (545–54)
Steiner ME, Grana WA. The young athlete’s knee: recent advances. Clin Sports Med 1988; 7: (527–46)
Ficat RP, Hungerford DS. Disorders of the patellofemoral joint. Baltimore: Williams and Wilkins, 1977
Lieb FJ, Perry J. Quadriceps function. An anatomical and mechanical study using amputated limbs. J Bone Joint Surg Am 1968; 50 (8): (1535–48)
Lieb FJ, Perry J. Quadriceps function. An electromyographic study under isometric conditions. J Bone Joint Surg Am 1971; 53 (4): (749–58)
Williams JGP, Street M. Sequential faradism in quadriceps rehabilitation. Physiotherapy 1976; 62 (8): (252–4)
Williams PL, Warwick R, editors. Gray’s Anatomy, 36th ed. Edinburgh: Churchill Livingstone, 1980: 598
Brownstein BA, Lamb RL, Mangine RE. Quadriceps torque and integrated electromyography. J Orthop Sports Phys Ther 1985; 6: (309–14)
Javadpour SM, Finegan PJ, O’Brien M. The anatomy of the extensor mechanism and its clinical relevance. Clin J Sport Med 1991; 1: (229–35)
Thiranagama R. Nerve supply of the vastus medialis muscle. J Anat 1990; 170: (193–8)
Fisher RG. Conservative treatment of patellofemoral pain. Orthop Clin North Am 1986; 17 (2): (269–71)
Bennett JG, Stauber WT. Evaluation and treatment of anterior knee pain using eccentric exercises. Med Sci Sports Exerc 1986; 18 (5): (526–30)
Souza DR, Gross MT. Comparison of vastus medialis obliquus: vastus lateralis muscle integrated electromyographic ratios between healthy subjects and patients with patellofemoral pain. Phys Ther 1991; 71 (4): (310–20)
Aglietta P, Insall JN, Walker PS, et al. A new patellar prosthesis. Design and application. Clin Orthop 1975; 107: (175–87)
Stokes M, Young A. Investigations of quadriceps inhibition: implications for clinical practice. Physiotherapy 1984; 70 (11): (425–8)
Karst GM, Jewett PD. Electromyographic analysis of exercises proposed for differential activation of medial and lateral quadriceps femoris component. Phys Ther 1993; 73 (5): (286–99)
Grabiner MD, Koh TJ, Miller GF. Fatigue rates of vastus medialis oblique and vastus lateralis during static and dynamic knee extension. J Orthop Res 1991; 9: (391–7)
Boucher JP, King, MA, Lefebvre R, et al. Quadriceps femoris activity in patellofemoral pain syndrome. Am J Sports Med 1992; 20 (5): (527–32)
Signorile JF, Kaczik D, Perry A, et al. The effect of knee and foot position on the elctromyographical activity of the superficial quadriceps. J Orthop Sports Phys Ther 1995; 22 (1): 2–8
Wild JJ, Franklin TD, Woods GW Patellar pain and quadriceps rehabilitation — an EMG study. Am J Sports Med 1982; 10 (1): 12–5
Reynolds L, Levin TA, Medeiros JM, et al. EMG activity of the vastus medialis oblique and the vastus lateralis in their role in patellar alignment. Am J Phys Med 1983; 62 (2): (61–70)
Moller BN, Krebs B, Tidemand-Dal C, et al. Isometric contractions in the patellofemoral pain syndrome — an electromyographic study. Arch Orthop Trauma Surg 1986; 105: (24–7)
Wessel J. Straight leg raise: an overused exercise. Physiother Can 1994; 46(1): 17–9
Moller BN, Jurik AG, Tidemand-Dal C, et al. The quadriceps function in patellofemoral disorders. Arch Orthop Trauma Surg 1987; 106: (195–8)
Steidler A. Kinesiology of the human body under normal and pathological conditions. Springfield (IL): Charles C. Thomas, 1973
Rivera JE. Open versus closed kinetic chain rehabilitation of the lower extremity: a functional and biomechanical analysis. J Sport Rehabil 1994; 3: (154–67)
Miyagawa H, Furukawa R, Shimono T, et al. Electromyographic analysis of knee muscles during the lateral step-up exercise. J Phys Ther Sci 1993; 5: (45–50)
Hsu A, Perry J, Gronley JK, et al. Quadriceps force and myoelectric activity during flexed knee stance. Clin Orthop 1993; 288; 254–62
Le Veau BF, Bernhardt DB. Vastus lateralis versus vastus medialis during stationary cycling. Med Sci Sports Exerc 1987; 19 Suppl.: 266
Flynn TW, Soutas-Little RW. Mechanical power and muscle action during forward and backward running. J Orthop Sports Phys Ther 1993; 17 (2): (108–12)
Schaub PA, Worrell TW. EMG activity of six muscles and VMO: VL ratio determination during a maximal squat exercise J Sport Rehab 1995; 4: 195–202
Yack HT, Collins CE, Whieldon TJ. Comparison of closed and open kinetic chain exercise in the anterior cruciate ligament deficient knee. Am J Sports Med 1993; 21(1): 49–54
Beard DJ, Dodd CAF, Trundle HR, et al. Proprioception enhancement for anterior cruciate ligament deficiency. J Bone Joint Surg Br 1994; 76 (4): (654–9)
McConnell J. The management of chondromalacia patellae: a long term solution. Aust J Physiother 1986; 32: (215–22)
Westfall DC, Worrell TW. Anterior knee pain syndrome: role of vastus medialis oblique. J Sport Rehabil 1992; 1: (317–25)
Dvir Z, Shklar A, Halperin N, et al. Concentric and eccentric torque variations of the quadriceps femoris in patellofemoral pain syndrome. Clin Biomech 1990; 5 (2): (68–72)
Macintyre D, Wessel J. Knee muscle torques in patellofemoral pain syndrome. Physiother Can 1988; 40 (1): (20–4)
Bentley G, Dowd G. Current concepts of etiology and treatment of chondromalacia patellae. Clin Orthop 1984; 189: (209–28)
LaBrier K, O’Neill DB. Patellofemoral stress syndrome: current concepts. Sports Med 1993; 16 (6): (449–59)
Voight ML, Wieder DL. Comparative reflex response times of vastus medialis obliques and vastus lateralis in normal subjects with extensor mechanism dysfunction. Am J Sports Med 1991; 19: (131–7)
Karst GM, Willett GM. Onset timing of electromyographic activity in the vastus medialis oblique and vastus lateralis muscles in subjects with and without patellofemoral pain syndrome. Phys Ther 1995; 75 (9): (813–23)
Hallen IG, Lindahl O. Muscle function in knee extension — an EMG study. Acta Orthop Scand 1967; 38: (434–44)
Smith GP, Howe TE, Oldham JA, et al. Assessing quadriceps muscles recruitment order using rectified averaged surface EMG in young and ‘weak’ and healthy elderly subjects. Clin Rehabil 1995; 9: (40–6)
Minor SD. Comparison of vastus medialis obliquus; vastus lateralis muscle intergrated electromyographic ratios between healthy subjects and patients with patellofemoral pain [commentary]. Phys Ther 1991; 71 (4): (317–9)
Bose K, Kanagasuntheram R, Osman MBH. Vastus medialis oblique: an anatomic and physiologic study. Orthopedics 1980; 3 (9): (880–3)
Mariani PP, Caruso I. An electromyographic investigation of subluxation of the patella. J Bone Joint Surg Br 1979; 61-B (2): 169–71
Gunal I, Arac S, Sahinoglu K, et al. The innervation of vastus medialis obliquus. J Bone Joint Surg Br 1992; 74 (4): (624)
Hanten WP, Schuldes SS. Exercise effect of electromyographic activity of the vastus medialis oblique and vastus lateralis muscle. Phys Ther 1990; 70 (9): (561–5)
Pedersen AM, Hasson SM. Comparison of electromyographic activity of the quadriceps during two knee extension movement patterns [abstract]. J Orthop Sports Phys Ther 1995; 23 (1): (65)
Rice MA, Bennett JG, Ruhling RO. Comparison of two exercises on VMO and VL EMG acivity and force production. Isokin Exerc Sci 1995; 5: (61–67)
Hodges PW, Richardson CA. The influence of isometric hip adduction on quadriceps femoris activity. Scand J Rehabil Med 1993; 25: (57–62)
Cerny K. Vastus medialis oblique/vastus lateralis muscle activity ratios for selected exercises in persons with and without patellofemoral pain. Phys Ther 1995; 75 (8): (672–83)
Ventura A, Boschetti GF, Gualtieri D. A surface electromyography study of vastus medialis and vastus lateralis dominance in knee extension. J Sports Traumatol Rel Res 1994; 16 (4): (152–60)
Sczepanski TL, Gross MT, Duncan PW, et al. Effect of contraction type, angular velocity and arc of motion on VMO: VL EMG ratio. J Orthop Sports Phys Ther 1991; 14 (6): (256–62)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Callaghan, M.J., Oldham, J.A. The Role of Quadriceps Exercise in the Treatment of Patellofemoral Pain Syndrome. Sports Med. 21, 384–391 (1996). https://doi.org/10.2165/00007256-199621050-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-199621050-00005