The Effect of Valgus Control Instruction Exercises on Pain, Strength, and Functionality in Active Females With Patellofemoral Pain Syndrome

Abstract

Background: Patellofemoral pain syndrome (PFPS) is sometimes related to excessive hip adduction and internal rotation, as well as knee valgus during weightbearing activities in females. Research on injury prevention and rehabilitation strategies has shown the positive effects of valgus control instruction (VCI) exercise programs in training. Hypothesis: A VCI program would result in a positive change in pain, eccentric hip muscle torque, and performance in females with PFPS. Study Design: Controlled laboratory study. Level of Evidence: Level 1. Methods: Sixty-four amateur female volleyball players from our university (age, 18-25 years) with PFPS and equal years of exercise experience were randomly divided into VCI (n = 32; age, 22.1 ± 5.88 years) and control (n = 32; age, 23.1 ± 6.49 years) groups. Function (single, triple, and crossover hops), strength (hip abductor and external rotators), pain (visual analog scale), and knee valgus angle (single-leg squat) were assessed at baseline and after intervention. Results: There was a significant difference before and after implementation of the VCI program with regard to pain (49.18% ↓, P = 0.000), single-leg hop test (24.62% ↑, P = 0.000), triple-hop test (23.75% ↑, P = 0.000), crossover hop test (12.88% ↑, P = 0.000), single-leg 6-m timed hop test (7.43% ↓, P = 0.000), knee dynamic valgus angle (59.48% ↓, P = 0.000), peak abductor to adductor eccentric torque ratio (14.60% ↑, P = 0.000), peak external (59.73% ↑, P = 0.023) and internal rotator (15.45% ↑, P = 0.028) eccentric torques, and the ratio of peak external to internal rotator eccentric torque (40.90% ↑, P = 0.000) ( P < 0.05). Conclusion: PFPS rehabilitation and prevention programs should consider VCI exercises to decrease pain, improve strength, and increase athletes’ functional performance. Clinical Relevance: This study investigated the effect of VCI exercises on knee valgus angle, pain, and functionality of individuals with PFPS. The VCI program improves performance, knee dynamic valgus angle, and strength in participants with PFPS. A controlled and optimal knee valgus angle during a functional task is the most important factor for injury prevention specialists. VCI training can be used as a supplemental method to prevent and treat lower extremity injury in patients with PFPS.