BACKGROUND: Patellofemoral pain syndrome (PFPS) involves complex biomechanical interactions affecting lower extremity function. OBJECTIVE: This study investigated the effects of integrated ankle-knee and hip-knee strengthening exercises on gait and lower extremity function in individuals with PFPS. METHODS: In this 6-week randomized controlled trial, 39 adults with PFPS were randomly assigned to the ankle-knee exercise group (AKG), hip-knee exercise group (HKG), or conventional knee exercise group (KG). The primary outcome was gait-related parameters, while secondary outcomes included lower extremity function parameters and the subjective measures of pain and function. Changes in these parameters were assessed and compared across three groups before and after the intervention. RESULTS: Significant time x group interaction effects on gait speed and the Korean version of the Western Ontario and McMaster Universities Osteoarthritis (K-WOMAC) stiffness were observed in the AKG, with post-intervention improvements in gait speed (1.05 +/- 0.20 to 1.21 +/- 0.19, p = 0.003) and K-WOMAC stiffness (5.63 +/- 1.62 to 2.81 +/- 1.07, p = 0.01). The AKG showed a significant increase in cadence (103.54 +/- 10.42 to 111.61 +/- 5.71, p = 0.021), whereas the HKG showed a significant increase in hip flexion angle during a single-leg squat (39.67 +/- 4.49 to 41.88 +/- 3.17, p = 0.012). CONCLUSION: This study supports incorporating joint strengthening exercises beyond the knee joint to address complex biomechanical factors in managing PFPS. Further studies are required to optimize exercise regimens for better therapeutic outcomes.

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