Patellofemoral pain (PFP) is the most common lower extremity
diagnosis among those who are physically active.1-3 Historically,
the etiology of PFP has been attributed to abnormal patella
tracking secondary to impairments in quadriceps muscle performance
(eg, weakness or insufficiency of the vastus medialis
oblique relative to the vastus lateralis).4-7 As such, conservative
interventions (eg, patella taping, vastus medialis oblique
strengthening) are commonly prescribed for persons with PFP.8,9
Although the ability to selectively strengthen the vastus medialis
oblique has been questioned,10,11 several clinical trials have
shown that quadriceps strengthening is beneficial for persons
with PFP.12-16
The premise that a strength imbalance between the vastus
medialis oblique and vastus lateralis contributes to abnormal patella
tracking has been recently challenged. Dynamic imaging
studies performed in weight-bearing suggest that lateral patella
displacement and lateral tilt are a function of medial rotation of
the femur as opposed to patella motion.17,18 This suggests that
impaired hip muscle performance may be a contributing factor