Glutes vs. Quads Strength Training for PFP

Glute and Quad Strength Training for PFP

The age-old debate, should we train the glutes or quads when it comes to managing patellofemoral pain (PFP).

Before we discuss this topic, let’s get a quick summary of what PFP is, how it typically presents itself, the anatomy, some risk factors and the evidence when it comes to strength/resistance training for this common condition.

What is PFP:

Patellofemoral pain, also known as PFP, is characterized by pain behind or around the kneecap. It worsens during activities that put increased pressure on the patellofemoral joint (PFJ), like running, climbing stairs, and squatting. This condition is very common and typically more prevalent in women.

Anatomy:

The patellofemoral joint (PFJ) is where the kneecap (patella) meets the thigh bone (femur). The pressure on this joint is influenced by the way the knee is bent, so when the contact area between the femur and patella is larger, there is effectively less stress on the tissues. This is why certain exercises can help offload and reduce the stress depending on the ankle/range of motion achieved through exercises such as a leg extension or leg press for PFP.

Risk Factors:

There are many non-modifiable/modifiable factors that increase the prevalence of PFP. Let’s take a look at some of the non-modifiable risk factors that are common:

Some of these include:

• Maltracking of the patella and subsequent reduction in patellofemoral contact
• Increased hip adduction and internal rotation moments
• Weakness in quadriceps/glutes/surrounding lower limb musculature

Quads vs. Glutes:

Now that we have an idea about the condition, let’s discuss the evidence for the quads versus glutes debate.

A 2018 systematic review highlighted that adding hip-strengthening exercises to knee-strengthening programs provides positive results for patients with PFP. In isolation hip strength alone was able to reduce pain and function with PFP, as did quadriceps strength training alone.

Now why does this matter? Well, the quadriceps have a direct attachment to the patella (knee cap) through the quadriceps tendon, which is why these muscles can impact the amount of force that travels through the PFJ. Conversely, the glutes directly oppose the forces through hip abduction and external rotation, which means that patients with PFP typically present with reduced hip abductor and external rotation strength.

This means that we should implement strength training for both the glutes and quads, but that doesn’t mean that we can’t work other muscle groups!

Exercise Recommendations:

• Hip Abduction and External Rotations
  • Banded Side-lying Clam
  • Banded Side-lying Abduction Raise
• Eccentric and Isometric Loading for Glutes
• Knee Extension Exercises for Quads
  • Leg Press Machine
  • Leg Extensions
• Hip Extension Exercises
  • Bridges
  • Hip Thrusts
• Open Chain Exercises between 30-90 degrees of knee flexion
  • Seated Leg Extension Machine
  • Banded Knee Extension
• Lower limb stability work for hip and knee

The most important thing to note is that you can’t go wrong with strengthening the glutes or quads for PFP. The evidence supports both so work on both!

If this is something that is bothering you or you want come in for a screening or assessment. Give us a call or make a booking online!

References:

Andrish, J. T. (2015). Biomechanics of the Patellofemoral Joint. Operative Techniques in Sports Medicine. 23:62-67

Barton CJ, Lack S, Hemmings S, et al. (2015). The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. British Journal of Sports Medicine. 49:923–934.

Lack, S. Morrisey, D. & Malliaras, P. (2012). Gluteal muscle activity and patellofemoral pain syndrome: A systematic review. British Journal of Sports Medicine DOI: 10.1136/bjsports-2012-090953

Nascimento, L. R., Teixeira-Salmela, L.F., Souza, R. B. & Resende, R.A. (2018). Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis. Journal of Orthopedic & Sports Physical Therapy. 48(1):19-30.

Van der Heijden, R.A., Lankhorst, N.E., van Linschoten, R., Bierma-Zeinstra, S.M.A., van Middelkoop, M. (2015). Exercise for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews. 1. No.: CD010387. DOI: 10.1002/14651858.CD010387.pub2.

Jamie Cheok – BeFit Training Physio Coogee

Jamie Cheok is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Jamie has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.