Volume 8, Issue 11, November 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Core Stability in Patellofemoral Pain Syndrome

Dr. Nensi V. Gandhi1
Assistant Professor
College of Physiotherapy
Sumandeep Vidyapeeth University

Abstract:- The participants with patellofemoral pain One of the most prevalent lower extremity disorders in
syndrome and core stability in their functional daily orthopaedic practise is patellofemoral pain syndrome.5There
activities will be examined in this article. accompanied have been reports indicating that the likelihood of PFPS is
by the prevalence ratio and definition of patellofemoral substantially higher in females compared to males.6
pain. It is relatively widespread knowledge of the
mechanism of damage as well as risk factors and II. DEFINITION
variables influencing signs and symptoms. This article
also examines clinical categorization and treatment, PFPS may be diagnosed in patients who have a clinical
encompassing conservative, therapeutic, and surgical presentation of anterior knee pain; patients with intra-
approaches. In patients with patellofemoral pain articular pathologies such as patellar tendinopathy,
syndrome, the paper described how to employ core peripatellar bursitis, plica syndrome, Sinding Larsen
muscles and the concepts of core muscles and core Johanson's and Osgood Schlatter's lesions, Hoffa's disease,
stability. and other uncommon pathologies will not be eligible for this
diagnosis.7
Keywords:- Core Stability, Pilates, Patellofemoral Pain
Syndrome, Management. III. ANATOMY AND BIOMECHANICS

I. INTRODUCTION TO PFPS Allowing for knee extension is the patella's primary

purpose. In addition, the patella serves to uniformly transfer
Active adults and adolescents frequently suffer from the quadriceps' divergent forces to the patellar tendon and
patellofemoral pain syndrome (PFPS). Patients frequently the underlying bone by centralising them.
report generalised peripatellar and retro patellar discomfort,
which can make it difficult for them to carry out everyday By keeping the patella apart from the femur, the
tasks requiring stress on a flexed knee. These include sitting patellar tendon is thus shielded from friction. Patellar
for extended periods of time, crouching, and descending tracking is the process by which the patella articulates with
stairs.1 and passes through the trochlea, or femoral groove. The
patella sits superior and lateral to the trochlea at full knee
Abnormal patella tracking causes excessive extension. To articulate with the trochlea at the beginning of
compressive stress on the patellar facets, which in turn flexion, the patella must shift somewhat medially.The
causes PFPS. An increased quadriceps angle (Q-angle), hip patella is fully engaged in the trochlea by 45° of knee
weakness, quadriceps muscle imbalances, excessive knee flexion, and tracking is mostly controlled by the bony
soft tissue tension, quadriceps weakness, and changed foot architecture and the congruity of the patella and trochlea's
kinematics are some of the factors that may lead to aberrant articular surfaces.
patella tracking. The goal of therapies used to treat PFPS is
to enhance patella tracking and lessen aberrant load on the An increase in quadriceps tension is produced during
components of the patellofemoral joint, according to this vigorous knee flexion. A compressive force is produced that
clinical hypothesis.2 operates on the PATELLOFEMORAL articular surfaces as a
result of this tension being transferred from the quadriceps
Soft tissue tightness in the gastrocnemius, quadriceps, to the patellar tendon. The name patellofemoral joint
hamstring, and ITB/TFL has also been proposed as a factor response force (PFJR) is given to this force. As active knee
influencing PFPS. It is hypothesised that during athletic flexion rises, PFJR also increases gradually.8
activities, a limited range of motion in the quadriceps may
pull the patella superiorly, causing compression of the A. Prevalence:
patellofemoral joint.3 A frequent knee condition that affects both athletes and
non-athletes is patellofemoral pain syndrome. Thirty percent
It was suggested more recently that PFP may be of all injuries seen in a sports medicine clinic are related to
connected to a decrease in hip strength and core endurance. it. Anterior knee discomfort affects women more frequently
To find out whether improvements in hip muscle strength than it does men; among young athletes, it affects 10% of
and core endurance enhance rehabilitation results for female athletes and 7% of male players. In female athletes,
individuals with PFPS, few randomised controlled studies patellofemoral discomfort is responsible for 33% of all knee
have been conducted.4 injuries, whereas in male athletes, it accounts for 18% of all
knee injuries.8

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Volume 8, Issue 11, November 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
B. Pathophysiology: A few high loading circumstances of the patellofemoral
Biologic elements are becoming more prominent in the joint may be large enough to cause the symptomatic loss of
origin of patellofemoral pain, replacing the decades-old tissue homeostasis, which can then continue forever once it
paradigm of a purely structural and biomechanical starts. From this new biologic perspective, if the pain-free
explanation. It is becoming more and more clear that the state of tissue homeostasis is safely reached and maintained,
majority of patients' patellofemoral discomfort is most likely then clinically, it makes little difference what structural
the result of a diverse mosaic of potential pathophysiologic variables may be present in a certain joint (e.g.,
processes, many of which are brought on by simple chondromalacia, patellar tilt, or a Q angle over a certain
overload. value).9

It has been established that a number of factors, C. Mechanism of Injury:

including inflammatory synovial lining and fat pad tissues, Trauma, overuse, and aberrant patellar tracking are the
retinacular neuromas, elevated intraosseous pressure, and three primary processes that cause patellofemoral
elevated osseous metabolic activity of the patella, can cause discomfort. These reasons can result in greater stress on the
anterior knee discomfort. When taken into account together, patellofemoral joint, increased strain on the peripatellar soft
these mechanisms may be described as a loss of tissue tissues, or both. The mechanism of damage is often complex
homeostasis and offer a fresh and different perspective on and multifaceted.
the mystery of anterior knee pain.

Fig. 1: Clinical Classification of Pfps:7

D. Ethology: 9 IV. RISK FACTORS:8

 Mechanical Environment A. Trauma

 Direct patella femoral trauma Articular cartilage can be crushed by blunt trauma to a
 Overly high inherent forces of compression and tensile flexed knee, such as that which happens after a fall or a
strength direct hit on the dashboard in a car accident. Running causes
 Normal alignment periodic spikes in PATELLOFEMORAL stress, which might
 Malalignment (load shifting) result in patellofemoral discomfort due to the repeating
 Intra-articular structural interference micro-trauma.
 Increased intraosseous pressure B. Overuse
 Barometric pressure changes Increased activity levels have been linked in clinical
 Chemical environment trials to patellofemoral pain, indicating that patellofemoral
pain is more likely to occur when the patellofemoral joint
 Presence of cytokines
and supporting soft-tissue structures are overworked and
 Altered pH of damaged tissues
chronically overloaded.
 Localized peripheral neuropathy
 Painful neuroma C. Mal alignment of lower extremity
Because lower extremity malalignment is believed to
 Nonpatellofemoral sources affect patellar tracking, it is frequently considered a
 Referred pain (such as hip arthrosis) significant risk factor for pelvis-related discomfort. Genu
 Phantom limb discomfort in amputees above the knee. valgum, genu varum, genu recurvatum, leg-length
discrepancy, femoral anteversion, external tibial torsion,
lateral displacement of the tibial tubercle, and excessive

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Volume 8, Issue 11, November 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
pronation of the subtalar joint are some of the factors that V. MANAGEMENT
cause malalignment.
A. Conservative Management: 8
D. Muscle imbalance or weakness
One of the most significant risk factors for  Rest
patellofemoral discomfort may be weakness in the It has been demonstrated that taking a break from taxing
quadriceps. Certain researchers have proposed that the more sports, especially running and leaping, might lessen
particular issue might be imbalances in the neuromuscular patellofemoral discomfort.
regulation of the VMO and VL, or a relative weakening of
the VMO. B. Patellar taping and biofeedback

E. Muscle and soft tissue tightness  Shoe orthosis

The lateral patellofemoral joint is subjected to undue Despite the fact that research has not been able to link
tension when the lateral retinaculum is too tight. A major excessive subtalar pronation to an increased risk of
cause of patellofemoral discomfort is lateral patellar patellofemoral discomfort. It has been demonstrated that
compression syndrome, which can result from this. The individuals with severe subtalar pronation have less
patellar and quadriceps tendons, which are neighboring discomfort while wearing orthotic shoe inserts.
tissues, must bear the brunt of this strain since a taut C. Knee sleeves
quadriceps muscle is less able to absorb energy
eccentrically.  A resistive knee braces
The progressive resistance exercise knee brace is
F. Proprioception deficit designed to help with patellar tracking by providing
It has been demonstrated that patients with resistance against flexion and extension motions of the knee
patellofemoral discomfort exhibit impaired knee joint during walking. The progressive resistance exercise knee
proprioception. The peripatellar tissues' proprioceptive nerve brace has been demonstrated to reduce pain and enhance
fibres may be damaged or the source of abnormal patellar function in individuals with patellofemoral discomfort,
tracking. while it is uncertain if the brace genuinely alters patellar
G. Congenital anomalies of patella position.
Subluxation and dislocation of the patellar tendon have  Acupuncture
been linked to global flattening of the trochlear groove and It seems that acupuncture works well for treating
hypoplasia of the medial trochlea. patellofemoral discomfort. Afferent nerve stimulation from
H. Ligamentous laxity acupuncture is thought to cause central pain inhibition,
Patients with chronic posterior cruciate ligament (PCL) which in turn reduces pain, however the precise process is
deficit (48%) and patients with chronic ACL deficiency unknown.
(20% to 27%) report having anterior knee discomfort. In D. Medical treatment:
knees lacking in PCL, elevated patellofemoral stresses have
 NSAIDS
been reported.
 Intra articular and intramuscular injections of
I. Age glycosaminoglycan polysulfide.
All age groups can experience patellofemoral
E. Surgical Treatment: 8
discomfort; however, the prevalence is higher in the second
and third decades of life.  Arthroscopy: Understanding the ethology and
pathophysiology of anterior knee pain in individuals who
J. Gender do not respond to conservative therapy can be aided by
Clearly, women experience patellofemoral discomfort arthroscopy.
more frequently than men.  The surgical management of a painful medial synovial
plica may involve its removal.
K. Specific sports and training techniques.  Synovectomy: For a patient with persistent synovial
Patellofemoral pain syndrome is the most common inflammation, a synovectomy could be beneficial.
injury in runners the risk is higherwithrunning on crowned
roads or hills. This is most likely because running on F.Physiotherapy Treatment:8
crownedRoads causes excessive subtalar pronation in the  Strengthening of
foot on the elevated side, and hill running increases  Quadriceps muscles
patellofemoral contact stress.  Gluteal region muscles
 Vastus medialis obliquus
 Stretching of Iliotibial band
 Patellar mobilisation from the mediolateral direction to
reduce retinal
 Applying a deep friction massage to the delicate tissues
of the patella.

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Volume 8, Issue 11, November 2023 International Journal of Innovative Science and Research Technology
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 Proprioception training sports medicine is core stability. Popular exercise regimens
 Exercise and patellar taping combined like Pilates, yoga, and tai chi are based on fundamental
strengthening concepts. The interacting components that
G. Introduction To Core make up the spine stability system are as follows:
 Neuromuscular control (neural elements)
 Core Muscles:  Passive subsystem (osseous and ligamentous elements)
Major Muscles Include in Core Stability:
 Active subsystem (muscular elements)
 Pelvic floor muscles
 Transversus abdominis Coordination of all the muscles around the lumbar
 Multifidus spine is essential for stability and mobility. Despite the fact
 Internal and external oblique that current studies support the notion that all of the core
 Rectus abdominis muscles are necessary for the best possible stability and
 longissimus dorsi performance, 13
 Diaphragm
To put it another way, adequate sensory input—which
 Minor Muscles informs the central nervous system about interactions
 Latissimus dorsi between the body and its surroundings and provides
 Gluteus maximus continuous feedback—is just as important for spine stability
as muscle strength. This allows for the optimisation of
The diaphragm acts as the top of the muscular box that movement. For the best spinal stability, a comprehensive
is the core, with the pelvic floor and hip girdle musculature core stabilisation plan would take into account the sensory
as the bottom, the paraspinals and gluteus in the rear, and the and motor elements associated with these systems.
abdominals in the front. There are 29 pairs of muscles in this
box that support and stabilise the kinetic chain, pelvis, and A recent study by the Queensland physiotherapy group
spine during functional motions. highlights the importance of the transversus abdominis and
multifidi deep core muscles for core stability.10
The two main purposes of the abdominal muscles in
human motion and sports are: (1) movement, which includes Conventional exercises for strengthening the core have
rotation, forward trunk flexion, and lateral trunk flexion gained popularity and are beginning to be used in sports
(bending to the side), and (2) stabilisation of the low back medicine. Exercises that strengthen the core have been
and trunk. A single muscle group or many muscle groups linked to a variety of advantages, including reduced back
can be activated simultaneously to produce the previously discomfort, enhanced sports performance, and injury
described actions. prevention. Sports and other activities need the strength of
the core muscles, whose endurance is crucial for
Four paired muscles that go from the rib cage to the maintaining core stability over extended periods of physical
pelvis make up the abdominal wall. There are two sets of exertion and for preventing injury. Fatigue affects the
muscles: one anterior group and two lateral groups that are neuromuscular control elements that contribute to spinal
mirror images of one another. The rectus abdominis, the stability. The main factor in stability is the mechanical
only paired muscle in the anterior group, is split into a right rigidity of the muscles that support the spine and contract
and left half by the body's midline. The remaining three actively.10
paired muscles, the transversus abdominis, internal oblique,
and external oblique, are each represented by a side in one In order to maintain core stability, the transversus
of the two lateral groups. abdominis and multifidi deep core muscles are critical,
according to a new study by the Queensland physiotherapy
The spine would become mechanically unstable under group.10
compression stresses without this muscle support. Proper
force distribution and maximal force generation with Traditional core strengthening exercises are becoming
minimum compressive, translational, or shearing forces at more and more popular and are starting to be applied in
the joints of the system indicate that it is functioning as sports medicine. Core-strengthening exercises have been
intended.1 associated with several benefits, such as decreased back
pain, improved athletic performance, and injury avoidance.
VI. CORE STABILITY The strength of the core muscles is essential for sports and
other physical activity because their endurance is key to
The body's core is made up of the proximal lower preserving core stability during prolonged physical exertion
extremities, hips, pelvis, spine, and abdominal area.11 Eleven and avoiding injury. The neuromuscular control components
The capacity of the lumbopelvic-hip complex to keep the that provide spinal stability are impacted by fatigue. The
vertebral column from buckling and to restore balance after mechanical stiffness of the muscles that actively contract
a disturbance is known as core stability. and support the spine is the primary determinant of
stability.10
The capacity to stabilise one's core is referred to as
core stability. It needs to be seen as the capacity to regulate
the core's location and motion.12 Twelve A well-known
fitness fad that is beginning to spread throughout the field of

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Volume 8, Issue 11, November 2023 International Journal of Innovative Science and Research Technology
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VII. PRINCIPLES OF PILATES complete inhale. Breathing fully and rhythmically is a
must for all workouts. Inhale at the point of exertion to
 Cantering: All energy originates at the centre of the body, oxygenate all body tissues, and exhale to remove all
sometimes referred to as the "powerhouse," from whence waste products from the cells.
it radiates to the extremities.  Precision: Instead of doing several clumsy movements,
 Concentration: Since the mind controls the body, doing the emphasis is on performing one exact and flawless
Pilates movements requires paying close attention to the action. Teachers frequently use the proverb "It's not how
complete body throughout each activity. many, but how" to emphasize this.
 Control: One will be in control of the performed motions  Flow: There aren't any single, immobile motions since
when the exercise is performed from the centre with that's not how our bodies work by nature. In order to
attention. create purposeful and economical movement, each
 Breathing: Pilates maintained that learning to breathe exercise flows into the next with a seamless transition
correctly is the most crucial component of his system, and a "minimum of motion" that translates into daily
even if you don't follow any other guidelines. Forcible life.14
exhalation is regarded by Pilates as the secret to a

VIII. CORE STABILITY EXERCISES

A. Traditional Core strengthening exercises

A. Prone plank B. Side plank

C. Bridging D. Bird dog

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E. Dying bug F. Leg drop

IX. FIGURE: PILATES

A. The hundred B. Single leg stretch

C. Double leg stretch D. Side kick front and back

E. Kneeling side kick F. Leg pull prone

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X. CORE STABILITY IN RELATION WITH  Zahra RojhaniShirazi ET. AL .2014: Compared the
PATELLOFEMORAL PAIN SYNDROME electromyographic activity of the core muscles in
patients with patellofemoral pain syndrome and healthy
The body of current research points to the hip's individuals in order to assess the recruitment patterns of
multifaceted role in knee dysfunction over the life course. these muscles in response to abrupt external
An increasing amount of research indicates that hip disturbances. Women between the ages of 18 and 40,
weakness and abnormal lower extremity mechanics may be including 27 PFPS-diagnosed cases and 27 healthy
factors in a variety of lifetime knee problems. Moreover, controls. The findings of this study imply that, in order
authors of more current research have deduced that hip to provide core stability, the core muscles are engaged
therapies may enhance knee function. To avoid a potential differently in people with PFPS. Enhancing core
knee injury, screening for hip weakness and limited rotation neuromuscular function seems to be a promising
mobility appears appropriate.15To preserve the integrity of approach for PFPS sufferers' rehabilitation.
the spinal column, offer resistance to disturbances, and  Lori A. Bolgla ET AL. 2011: Conducted a study
provide a secure foundation for extremity movement, core comparing the neuromuscular activity and hip and knee
stability is essential. strength of participants with and without patellofemoral
pain syndrome, which has hitherto been thought to be
The intricate link between hip and trunk muscular
only a knee issue. In this study, 18 females with PFPS
capacity and motor control determines an individual's
and 18 matched controls took part. Hip and quadriceps
potential to exhibit core stability. According to recent
strengthening should be the main goals of rehabilitation.
research, core stability measures may be compromised by
Even though gluteus Medius training has been included
lower extremity injuries.
by physicians in rehabilitation programmes, it could be
Furthermore, the likelihood of lower extremity damage beneficial to pay more attention to the external rotators.
may be elevated by an underlying core weakness. For those  Lori A. Bolgla ET. AL. 2010: A comprehensive
with reduced core stability measures, identifying them and evaluation of the literature was conducted to provide an
providing the right kind of assistance may better prepare update on the conservative therapy of patellofemoral
them for the workforce or sports.12 pain syndrome. We looked through the databases of
PubMed, CINAHL, and SPORT Discus to find research
The findings of the studies imply that PFPS patients that was released between January 1, 2000, and
have altered neuromuscular control of the core. In contrast December 31, 2010. The available data is in favour of
to the healthy group, the unanticipated lateral pelvic maintaining the cautious therapy of PFPS with
disturbance caused the gluteus maximus to contract later, quadriceps exercise. Prospective studies have to
whereas the deep abdominal muscles and the erector spine concentrate on pinpointing groups of PFPS patients who
engaged earlier and for a longer period of time. might profit from the additional therapeutic modalities
Furthermore, there were differences in the recruitment covered in this comprehensive analysis.
patterns of the chosen core muscles between the two  Sara R. Piva ET. AL. 2005: Investigated whether
groups.15 differences in lower extremity muscle strength and soft
tissue length exist between patients with patellofemoral
XI. REVIEW OF LITERATURE pain syndrome (PFPS) and age- and gender-matched
control subjects. The study focused on hip strength and
 Mohomed Faisal Chevidikunnan: ET AL. 2016: To soft tissue flexibility in individuals with and without
evaluate the impact of core muscle strengthening in PFPS. The study included 30 age- and gender-matched
patients with patellofemoral pain syndrome, a study was controls without PFPS and 30 patients with PFPS.
conducted on the efficacy of this treatment for enhancing According to this study, more investigation is necessary
pain and dynamic balance in female patients. Twenty to determine if individuals with PFPS have these deficits
female patients with patellofemoral pain syndrome, ages in soft tissue length and muscle strength.
16 to 40, were split into two groups: ten for the trial and
 Werner S. ET. AL.2005: Research on the clinical
ten for the control. According to the study's findings,
classification of patellofemoral pain syndrome and the
female patients with patellofemoral pain syndrome
impact of non-operative treatment was carried out in
experience less discomfort and better dynamic balance
order to develop a system of classification that can assist
when a core muscle-strengthening programme is added
clinicians in determining the underlying cause of pain
to their traditional physical treatment regimen.
and in choosing the best non-operative treatment plan
 Reed Ferber. ET AL. 2015: Research was done on the that is unique to each patient with pfps.
benefits of strengthening the hip and core muscles over
 Mary Lloyd Ireland. ET. AL.2005: To demonstrate the
the knee muscles in treating patellofemoral discomfort.
advantages of core stability, a study was done on the
An investigation comparing PFP pain, function, hip- and
connection between lower extremity function and
knee muscle strength, and core endurance between
damage. Movement of the lower extremities and trunk
KNEE and HIP treatments following six weeks of
muscular activation are clearly related. According to
rehabilitation, using a multicentre randomised controlled
available data, injuries may be more likely to occur in
trial design. The HIP treatment produced better overall
people with lower core stability and may be less
increases in strength and a quicker remission of
common in those with proper training. It is possible to
discomfort than the KNEE protocol, despite equal
examine core stability via isometric, isokinetic, and is
results.

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Volume 8, Issue 11, November 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
inertial approaches. Reducing the frequency of lower [10]. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core
extremities and back injuries may be possible with Stability Exercise Principles. 2008;80309:39–44.
appropriate management. [11]. C MF, S AA. Effectiveness Of Core Muscle
 Venu Akuthota. ET AL. 2004: Investigated the benefits Strengthening For Improving Pain And Dynamic
of core training as a preventative programme and a type Balance Among Female Patients With Patellofemoral
of therapy for a variety of lumbar spine and Pain Syndrome. 2016;1518–23.
musculoskeletal ailments. The purpose of this review is [12]. Ireland ML. Extremity Function And Injury . Core
to comprehend the notion and use a theoretical Stability And Its Relationship To Lower Extremity
framework to describe the existing literature on core Function And. 2005;(July 2015).
strengthening. [13]. V AA, Sf N. Core Strengthening. 2004;85(March):86–
 Mary Lloyd Ireland. ET AL. 2003:To find out if 92.
women with anterior knee discomfort are more likely [14]. Muscolino JE, Cipriani S. Pilates And The ‘
than a comparable, asymptomatic, age-matched control Powerhouse ’ F I. 2004;8592:15–9.
group to exhibit hip abduction or external rotation [15]. Reiman MP, Bolgla LA, Lorenz D. Hip Function ’ S
weakness, research on hip strength in women with and Influence On Knee Dysfunction : A Proximal Link To
without patellofemoral pain syndrome was conducted. A Distal Problem. 2009;33–46.
Fifteen female participants experiencing discomfort in
the patellofemoral joint had measures of their isometric
strength for hip abduction and external rotation on the
side that was damaged. According to the findings,
compared to age-matched women without symptoms,
young women with patellofemoral discomfort are more
likely to exhibit weakness in both hip abduction and
external rotation.

XII. CONCLUSION FOR STUDY

For individuals with patellofemoral pain syndrome,

core strengthening activities are particularly helpful in
lowering pain and suffering as well as enhancing dynamic
stability.

REFERENCES

[1]. Bolgla LA, Malone TR, Uhl TL. Comparison Of Hip

And Knee Strength And Neuromuscular Activity In
Subjects With And Without Patellofemoral Pain
Syndrome. 2011;
[2]. Bolgla La. Ijspt Systematic Review Of The Literature :
An Update For The Conservative Management Of
Patellofemoral Pain Syndrome : 2011;6(2):112–25.
[3]. Piva SR, Goodnite EA, Childs JD. Strength Around
The Hip And Flexibility Of. :793–802.
[4]. Ferber R, Cat C, 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. 2015;50(4):366–77.
[5]. Proximal PP. Patellofemoral Pain: Proximal, Distal,
And Local Factors 2nd International Research Retreat.
Vol. 42. 2012.
[6]. Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip
Strength In Females With And Without REPORT.
[7]. Werner S, Mikkelsen C. Clinical Classification Of
Patellofemoral Pain Syndrome : Guidelines For Non-
Operative Treatment. 2005;122–30.
[8]. Labella C. Patellofemoral Pain Syndrome : Evaluation
And Treatment. 2004;31:977–1003.
[9]. Dye SF. The Pathophysiology Of Patellofemoral Pain.
2005;(436):100–10.

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