Hip, Knee, and Combined Exercise Programs for Lateral Patellar Compression Syndrome: Effects on Pain, Function, Alignment, and Muscle Activity

Abstract

Purpose

Lateral patellar compression syndrome (LPCS) is a common source of anterior knee pain in athletes, arising from abnormal lateral tilt and maltracking of the patella due to imbalances between proximal and distal stabilizers. Although exercise therapy is the cornerstone of management, the relative effectiveness of hip-, knee-, and combined hip–knee programs on pain, function, patellar alignment, and muscle activity remains unclear.

Methods

In this randomized controlled trial, athletes with LPCS were assigned to knee exercise (KEG), hip exercise (HEG), or combined exercise (CEG) groups. After participant withdrawal, the final analysis included 15 participants in the control (CG) and KEG groups, 13 in the HEG, and 14 in the CEG. Interventions were performed over 8 weeks (3 sessions/week). Outcomes included pain (VAS), function (WOMAC), patellar tilt and congruence angles (radiographs), and electromyographic activity of vastus medialis oblique (VMO), vastus lateralis (VL), and gluteus medius (GM). A 2 × 4 mixed-model repeated measures ANOVA assessed main and interaction effects.

Results

Significant Group × Time interactions were observed for all outcomes except VL activity (P < 0.001). Pain and WOMAC scores decreased significantly in all intervention groups, with the largest improvements in CEG (≈ 4-fold pain reduction, 335% functional improvement). Patellar tilt and congruence angles improved in all groups, with CEG showing the most substantial decreases (≈ 44% and 67% reductions, respectively). EMG data revealed significant increases in VMO (KEG, CEG) and GM activation (HEG, CEG), while VL activity remained stable. Notably, only CEG outcomes approached those of the control group.

Conclusion

An 8-week combined hip–knee exercise program produced the most comprehensive improvements in pain, function, patellar alignment, and muscle activity among athletes with LPCS. These findings highlight the synergistic value of addressing both proximal and distal deficits and support combined protocols as the most effective rehabilitation strategy for LPCS.

Keywords

Patellofemoral pain / Lateral patellar compression syndrome / Exercise therapy / Hip strengthening / Knee rehabilitation / Electromyography

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