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Ethics code: IR.IAU.CTB.REC.1404.079

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Department of Sport Biomechanics, Ha.C., Islamic Azad University, Hamedan, Iran
Abstract:   (186 Views)

Introduction: Lateral Patellar Compression Syndrome (LPCS), one of the most common patellofemoral disorders among athletes, is associated with both proximal biomechanical impairments (e.g., hip muscle weakness) and local dysfunctions (e.g., imbalance between vastus medialis and vastus lateralis activity). Despite conflicting evidence about the effectiveness of isolated exercise protocols, this study aimed to compare the effects of targeted hip, knee, and combined exercise protocols on key muscle activation patterns in LPCS.
Methods: In a quasi-experimental pretest-posttest study with a control group, 57 athletes with LPCS were assigned to three intervention groups (Hip: n = 13; Knee: n = 15; Combined: n = 14) and a healthy control group (n = 15). Electromyographic activity of the vastus medialis obliquus (VMO), vastus lateralis (VL), and gluteus medius (GM) was recorded during a single-leg stance task using surface EMG, following SENIAM guidelines. Intervention groups completed their respective 8-week training protocols (3 sessions/week). Root mean square values were analyzed using paired t-tests, repeated-measures ANOVA, and one-way ANOVA in IBM SPSS Statistics software (Version 26).
Results: Compared to controls, LPCS participants exhibited significantly lower activation of  VMO and GM, and higher activation of VL (all P < 0.01). The combined protocol resulted in the most remarkable simultaneous improvements in VMO and GM (P < 0.01), while isolated knee and hip protocols specifically enhanced VMO and GM, respectively (P < 0.01). VL activity remained unchanged (P > 0.01).
Conclusions: The combined exercise protocol, due to its synergistic effect on the simultaneous activation of the VMO and GM, seems to be the most effective approach for neuromuscular rehabilitation in athletes with LPCS. These findings highlight the importance of incorporating both hip- and knee-focused exercises into rehabilitation programs.

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Type of Study: Research | Subject: occupational therapy
Received: 2025/08/28 | Accepted: 2025/10/21 | ePublished ahead of print: 2025/11/11

References
1. Saper MG, Shneider DA. Diagnosis and treatment of lateral patellar compression syndrome. Arthrosc Tech. 2014;3(5):e633-e638. [DOI:10.1016/j.eats.2014.07.004]
2. Hosseini SH, Nezhad SG. Morphological differences of knee extensor muscles between women with and without lateral patellar compression syndrome. Sci J Rehabil Med. 2022;11(5):754-769. [DOI:10.32598/SJRM.11.5.7]
3. Xie P, István B, Liang M, editors. The relationship between patellofemoral pain syndrome and hip biomechanics: A systematic review with meta-analysis. Healthcare. 2022. [DOI:10.3390/healthcare11010099]
4. Kordi Yoosefinejad A, Mazaheri M, Sobhani S, Motealleh A. Electromyographic onset and activity level of medial and lateral hamstrings, vastus medialis obliquus, and vastus lateralis in women with patellofemoral pain during stair descent. J Rehabil Sci Res. 2022;9(3):128-133.
5. Foroughi F, Sobhani S, Yoosefinejad AK, Motealleh A. Added value of isolated core postural control training on knee pain and function in women with patellofemoral pain syndrome: A randomized controlled trial. Arch Phys Med Rehabil. 2019;100(2):220-229. [DOI:10.1016/j.apmr.2018.08.180]
6. Saad MC, de Vasconcelos RA, de Oliveira Mancinelli LV, de Barros Munno MS, Liporaci RF, Grossi DB. Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises. Braz J Phys Ther. 2018;22(5):408-416. [DOI:10.1016/j.bjpt.2018.03.009]
7. Hosseini SH, Farahmand F. Effect of two quadriceps strengthening protocols on morphological characteristics of knee vastus muscles in patients with lateral patellar compression syndrome. J Bodyw Mov Ther. 2024;40:726-732. [DOI:10.1016/j.jbmt.2024.05.017]
8. Keyhanfar A, Hosseini S, Nemati N. Comparison of the effect of two methods of muscular exercise therapy on pain relief, functional abilities and static balance in patients with chronic patellofemoral pain. J Health Care. 2017;19(2):117-128.
9. Asadi S, Hosseini SH, Daneshmandi H. Comparison of the effects of knee local, proximal, and distal training on knee pain, function, and dynamic balance in athletes with patellofemoral pain syndrome. Sci J Rehabil Med. 2020;9(2):219-227.
10. Manojlović D, Kozinc Ž, Šarabon N. Trunk, hip and knee exercise programs for pain relief, functional performance and muscle strength in patellofemoral pain: systematic review and meta-analysis. J Pain Res. 2021;14:1431-1449. [DOI:10.2147/JPR.S301448]
11. Hashim H, Mohammed SA, Mohammed Ali B, Ismaeel SA, Nasir M. Biceps and triceps muscle activation under progressive loads: a study on functional symmetry of the upper limbs. J Sport Biomech. 2025;11(1):64-78. [DOI:10.61186/JSportBiomech.11.1.64]
12. Pal S, Draper CE, Fredericson M, Gold GE, Delp SL, Beaupre GS, et al. Patellar maltracking correlates with vastus medialis activation delay in patellofemoral pain patients. Am J Sports Med. 2011;39(3):590-598. [DOI:10.1177/0363546510384233]
13. Yang J-S, Fredericson M, Choi J-H. The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions. PLoS One. 2020;15(9):e0239907. [DOI:10.1371/journal.pone.0239907]
14. Lotfi H, Nodehi Moghadam A, Shati M. Comparing electromyographic activity of quadriceps muscle during straight leg raise in individuals with and without patellofemoral pain syndrome. Phys Treat Spec Phys Ther J. 2018;7(4):197-204. [DOI:10.32598/ptj.7.4.197]
15. Bennell K, Duncan M, Cowan S, McConnell J, Hodges P, Crossley K. Effects of vastus medialis oblique retraining versus general quadriceps strengthening on vasti onset. Med Sci Sports Exerc. 2010;42(5):856-864. [DOI:10.1249/MSS.0b013e3181c12771]
16. Balogun J, Broderick K, Dolan-Aiello M. Comparison of the EMG activities in the vastus medialis oblique and vastus lateralis muscles during hip adduction and terminal knee extension exercise protocols. Afr J Physiother Rehabil Sci. 2010;2(1):1-5. [DOI:10.4314/ajprs.v2i1.62597]
17. Cavazzuti L, Merlo A, Orlandi F, Campanini I. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Gait Posture. 2010;32(3):290-295. [DOI:10.1016/j.gaitpost.2010.06.025]
18. Shi H, Huang H, Ren S, Yu Y, Liang Z, Wang Q, et al. The relationship between quadriceps strength asymmetry and knee biomechanics asymmetry during walking in individuals with anterior cruciate ligament reconstruction. Gait Posture. 2019;73:74-79. [DOI:10.1016/j.gaitpost.2019.07.151]
19. Glaviano NR, Marshall AN, Mangum LC, Hart JM, Hertel J, Russell S, et al. Improvements in lower-extremity function following a rehabilitation program with patterned electrical neuromuscular stimulation in females with patellofemoral pain: a randomized controlled trial. J Sport Rehabil. 2019;29(8):1075-1085. [DOI:10.1123/jsr.2019-0278]
20. Mirzaie GH, Rahimi A, Kajbafvala M, Manshadi FD, Kalantari KK, Saidee A. Electromyographic activity of the hip and knee muscles during functional tasks in males with and without patellofemoral pain. J Bodyw Mov Ther. 2019;23(1):54-58. [DOI:10.1016/j.jbmt.2018.11.001]
21. dos Anjos Rabelo ND, Lucareli PRG. Do hip muscle weakness and dynamic knee valgus matter for the clinical evaluation and decision-making process in patients with patellofemoral pain? Braz J Phys Ther. 2018;22(2):105-109. [DOI:10.1016/j.bjpt.2017.10.002]
22. Rinaldi VG, Prill R, Jahnke S, Zaffagnini S, Becker R. The influence of gluteal muscle strength deficits on dynamic knee valgus: a scoping review. J Exp Orthop. 2022;9(1):81. [DOI:10.1186/s40634-022-00513-8]
23. Alsaleh S, Murphy N, Miller S, Morrissey D, Lack S. Local neuromuscular characteristics associated with patellofemoral pain: a systematic review and meta-analysis. Clin Biomech. 2021;90:105509. [DOI:10.1016/j.clinbiomech.2021.105509]
24. Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):207-214. [DOI:10.1136/bjsports-2012-090953]
25. Farahpour N, Jafarnezhadgero A, Allard P, Majlesi M. Muscle activity and kinetics of lower limbs during walking in pronated feet individuals with and without low back pain. J Electromyogr Kinesiol. 2018;39:35-41. [DOI:10.1016/j.jelekin.2018.01.006]
26. Bolgla LA, Malone TR, Umberger BR, Uhl TL. Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome. Int J Sports Phys Ther. 2011;6(4):285-293.
27. Honarpishe R, Bakhtiary AH, Olyaei G. Effect of quadriceps exercise training on muscle fiber angle in patients with patellofemoral pain syndrome. Middle East J Rehabil Health Stud. 2015;2(4):e32216. [DOI:10.17795/mejrh-32216]
28. Crouzier M, Hug F, Sheehan FT, Collins NJ, Crossley K, Tucker K. Neuromechanical properties of the vastus medialis and vastus lateralis in adolescents with patellofemoral pain. Orthop J Sports Med. 2023;11(6):23259671231155894. [DOI:10.1177/23259671231155894]
29. Ng G, Zhang A, Li C. Biofeedback exercise improved the EMG activity ratio of the medial and lateral vasti muscles in subjects with patellofemoral pain syndrome. J Electromyogr Kinesiol. 2008;18(1):128-133. [DOI:10.1016/j.jelekin.2006.08.010]
30. Qi Z, GYF N. EMG analysis of vastus medialis obliquus/vastus lateralis activities in subjects with patellofemoral pain syndrome before and after a home exercise program. J Phys Ther Sci. 2007;19(2):131-137. [DOI:10.1589/jpts.19.131]
31. Goller M, Quittmann OJ, Alt T. How to activate the glutes best? Peak muscle activity of acceleration-specific pre-activation and traditional strength training exercises. Eur J Appl Physiol. 2024;124(6):1757-1769. [DOI:10.1007/s00421-023-05400-3]
32. Neto WK, Soares EG, Vieira TL, Aguiar R, Chola TA, de Lima Sampaio V, et al. Gluteus maximus activation during common strength and hypertrophy exercises: a systematic review. J Sports Sci Med. 2020;19(1):195-203.
33. Glaviano NR, Saliba S. Differences in gluteal and quadriceps muscle activation during weight-bearing exercises between female subjects with and without patellofemoral pain. J Strength Cond Res. 2022;36(1):55-62. [DOI:10.1519/JSC.0000000000003392]
34. Banan Khojasteh M, Khalkhali Zavieh M, Kalantari KK, Akbarzadeh Baghban A, Daryabor A, Mikaili S. Effect of biofeedback training of hip muscles on pain, muscle strength and their electromyography in patellofemoral pain syndrome. Arch Rehabil. 2024;25(3):520-539. [DOI:10.32598/RJ.25.3.3826.1]
35. Kölle T, Alt W, Wagner D. Effects of a 12-week home exercise therapy program on pain and neuromuscular activity in patients with patellofemoral pain syndrome. Arch Orthop Trauma Surg. 2020;140(12):1985-1992. [DOI:10.1007/s00402-020-03543-y]
36. Felicio LR, de Carvalho CAM, Dias CLCA, dos Santos Vigário P. Electromyographic activity of the quadriceps and gluteus medius muscles during different straight leg raise and squat exercises in women with patellofemoral pain syndrome. J Electromyogr Kinesiol. 2019;48:17-23. [DOI:10.1016/j.jelekin.2019.05.017]
37. Moktasab M, Majlesi M, Farahpour N, Azadian E. Electromyographic patterns of lower limb muscles during gait in congenital blindness and sighted people. J Adv Sport Technol. 2019;3(2):1-8.
38. Earl-Boehm JE, Bolgla LA, Emory C, Hamstra-Wright KL, Tarima S, Ferber R. Treatment success of hip and core or knee strengthening for patellofemoral pain: development of clinical prediction rules. J Athl Train. 2018;53(6):545-552. [DOI:10.4085/1062-6050-510-16]

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