Patellofemoral pain: a small trial suggests a benefit from squats with hip adduction

Two squat variations compared at home

The researchers divided the 30 participants into two groups of 15. The first performed standard squats. The second performed squats while squeezing a Swiss ball to add hip adduction. Both groups followed a home-based program for eight weeks, with the same stretches.

Fifteen healthy people formed a reference group. They allowed comparisons of neuromuscular characteristics but did not replace the active comparator consisting of standard squats.

Before and after the intervention, the researchers assessed pain, symptom severity, alignment measures and the electrical activity of several muscles, including the vastus medialis obliquus, vastus lateralis and adductors.

A benefit for pain, but no effect size available

Both groups improved their pain and symptom severity scores. The improvement in pain measured using a visual analog scale was greater in the group performing squats with hip adduction.

This difference was statistically significant, but the abstract provides neither absolute scores nor the effect size. It therefore does not establish whether the benefit was large enough to be noticeable or useful in everyday life.

Patellar tilt also decreased within the hip adduction group. However, the comparison between the two groups was not statistically significant. This finding does not demonstrate that this variation corrects patellar tilt better than standard squats.

A neuromuscular clue, not a proven explanation

After the intervention, the muscle activation sequence became closer to that observed in healthy people: the vastus medialis obliquus activated before the vastus lateralis and the adductors. This change was particularly apparent in the hip adduction group.

Some neuromuscular measures were correlated with clinical outcomes. These associations support a hypothesis involving the retraining of muscle control, but do not prove that these changes explain the reduction in pain.

The small sample and follow-up limited to eight weeks restrict the scope of the finding. The source material does not establish whether the benefit persists or whether this variation can be applied to people without patellofemoral pain syndrome.

What we can take away

Squats with hip adduction are a potential short-term rehabilitation approach for patellofemoral pain syndrome. This trial is not enough to establish a clinically important or lasting advantage over standard squats.