The Forgotten Muscle
If you pick-up any popular running or cycling magazine that includes exercise medicine you will surely see kneecap pain as a common topic. Knee problems, particularly kneecap or patellofemoral pain, are the most common injuries among those that exercise. But for all the experts and carefully designed research on the subject, the majority of articles miss the boat.
The current trend in physical therapy and sports medicine is to consider hip strengthening, specifically of the outside or lateral hip muscles, to be silver bullet of kneecap rehabilitation. While many studies examining the hip strength of injured subjects have found consistent correlations between decreased hip strength and kneecap pain, they are limited in their analysis of the problem. As the majority of these articles use subjects that already have developed kneecap pain, the researchers cannot accurately state that weak hips cause kneecap pain.
A review article in the British Journal of Sports Medicine recommends “more prospective research is needed to clarify whether less hip abduction strength and hip external rotation strength rather is a consequence of PFPS than a cause.”
In fact one of the few studies to examine the hip strength of runners before beginning a running program did not find any correlation between decreased hip strength and kneecap pain.
This current thinking has everyone spending time exercising the hip but neglecting the muscle with the most influence on the health of the kneecap, the quadriceps. While the quad’s importance would seem difficult to overlook as it is attached to the kneecap and is a critical shock absorber for the entire leg, strengthening the muscle is often a secondary consideration.
While lateral hip strengthening is an important component of treating kneecap pain, clinical and research evidence points to the value of focusing on quad strengthening. A review study in the Journal of Sports and Orthopedic Physical Therapy used gold-standard prospective studies to examine potential risk factors for patellofemoral pain. What did the combined research determine was the singular factor that predicted future problems? Lack of quad strength.
Adding to the problem, reconditioning the quad can be difficult as a loss in muscle tone after disuse and pain can make strengthening the muscle possible only with skilled guidance. Many common gym exercises that are used to strengthen the quad, like the knee extension machine, can further aggravate the problem.
So if you want to look good in tight jeans, follow the advice of many popular magazines and only focus on hip strengthening. If you want to stop your kneecap from hurting AND look good in tight pants, strengthen your quads and your hips.