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Strengthening the hip to relieve the knee, myth or science?

In the field of physiotherapy and sports medicine, there has long been a debate about the relationship between knee pain and hip health. Some experts claim that “the knee cries for the hip,” but is there really solid scientific evidence to support this assertion?

To answer this question, let’s delve into a scientific study conducted across four university laboratories, one in Canada and three in the United States. The aim was to assess whether patients with patellofemoral pain (PFP) experienced better outcomes by training hip and core muscles or by strengthening knee muscles.

Patellofemoral Pain: A Common Condition

Patellofemoral pain (PFP) is a condition that can significantly affect the quality of life and the ability to engage in physical activities. Characterized by pain around the kneecap area, this discomfort intensifies with activities such as climbing stairs, squatting, jumping, running, and prolonged sitting. This condition, the most common among musculoskeletal overuse injuries, affects both athletes and physically active individuals, regardless of gender or age.

Treatment of Patellofemoral Pain

Traditionally, research and clinical practice have focused on quadriceps muscle function, based on the theory of an imbalance between the vastus medialis obliquus and vastus lateralis that may lead to increased lateral stress on the patellofemoral joint. However, more recent research suggests that PFP might be related to reduced hip strength and core stability.

Scientific Study: Comparing 2 Protocols

A total of 199 patients with patellofemoral pain participated in a 6-week rehabilitation program, following one of two protocols. The knee protocol was followed by 88 patients and consisted of quadriceps exercises in both open and closed chain, including lunges, squats, and isometrics. On the other hand, the hip protocol was performed by 111 patients and incorporated strengthening of hip extensors, rotators, and abductors, along with balance exercises.

Study Results

Both groups experienced significant improvements in patellofemoral pain, function, and strength during the treatment period. However, patients who followed the hip protocol experienced a reduction in pain intensity one week earlier than those in the knee group. Additionally, they demonstrated greater overall strength gains.


Considering the evidence from this and other scientific articles, it’s important to assess the hip when a patient suffers from knee pain. This assessment will enable us to design a personalized and effective plan for our patient, and apparently, 6 weeks is sufficient to achieve good results.

Therapeutic exercise is a fundamental ally in rehabilitation, and it’s crucial for the patient to comply with the prescribed program to achieve the best results.

Best for Your Patient

If you want to offer your patients the most up-to-date and adaptable treatment, we invite you to discover ReHub. Through the platform, you’ll have access to a wide variety of over 3000 exercises to choose from and prescribe to your patients. Additionally, you’ll be able to monitor patient adherence and progress easily and effectively. Join ReHub and take your clinical practice to the next level. Your patient deserves the best!

Ferber R, Bolgla L, Earl-Boehm JE, Emery C, Hamstra-Wright K. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. J Athl Train. 2015 Apr;50(4):366-77. doi: 10.4085/1062-6050-49.3.70. Epub 2014 Nov

3. PMID: 25365133; PMCID: PMC4560005.

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