STUDY DESIGN: Systematic review with meta-analysis. BACKGROUND: The addition of hip strengthening to knee strengthening for persons with patellofemoral pain has the potential to optimize treatment effects. There is a need to systematically review and pool the current evidence in this area. OBJECTIVE: To examine the efficacy of hip strengthening, associated or not with knee strengthening, to increase strength, reduce pain, and improve activity in individuals with patellofemoral pain. METHODS: A systematic review of randomized or controlled trials was performed. Participants in the reviewed studies were individuals with patellofemoral pain and the experimental intervention was hip and/or knee strengthening. Outcome data related to muscle strength, pain, and activity were extracted from the eligible trials and combined using a meta-analysis approach. RESULTS: Fourteen trials involving 673 participants were included. Random effects meta-analyses revealed that hip and knee strengthening decreased pain (MD -3.3, 95% CI -5.6 to -1.1) and improved activity (SMD 1.4, 95% CI 0.03 to 2.8), compared to no training/placebo. In addition, hip and knee strengthening was superior to knee strengthening alone for decreasing pain (MD -1.5, 95% CI -2.3 to -0.8) and improving activity (SMD 0.7, 95% CI 0.2 to 1.3). Results were maintained beyond the intervention period. Meta-analyses showed no significant changes in strength for any of the interventions. CONCLUSIONS: Hip and knee strengthening is effective and superior to knee strengthening alone for decreasing pain and improving activity in persons with patellofemoral pain, however these outcomes were achieved without a concurrent change in strength. LEVEL OF EVIDENCE: Therapy, level 1a-.

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