Refining Home-Based Squat Training: The Role of Hip Adduction in Improving Neuromuscular Control for Clinically Diagnosed Patellofemoral Pain Syndrome.
6 affiliations
- 1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- 2Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- 3Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
- 4School of Chinese Medicine, China Medical University, Taichung, Taiwan.
- 5Department of Industrial Engineering & Management, National Chin-Yi University of Technology, Taichung, Taiwan.
- 6Department of Sports Medicine, China Medical University, Taichung, Taiwan.
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) often stems from neuromuscular imbalances, particularly vastus medialis obliques (VMO) dysfunction impairing patellar tracking. Research is shifting toward integrated rehabilitation strategies, such as combining hip adduction with squats to enhance VMO recruitment. MATERIAL AND METHODS Thirty participants with PFPS were randomized to traditional squatting (SQU, n=15) or squatting with hip adduction (SQU-HA, n=15) for an 8-week home-based program with identical stretching. SQU-HA squeezed a Swiss ball during squats. Fifteen healthy individuals served as a reference group (RG). Outcome measures assessed before and after intervention included Q-angle, patellar tilt, clinical scales (visual analog scale [VAS], patellofemoral pain severity scale [PSS]), and electromyographic parameters (VMO, vastus lateralis [VL], adductor [ADD] amplitudes, onset times, VMO/VL ratio, and VMO-VL onset difference). RESULTS Both PFPS groups showed significant improvements in VAS and PSS after intervention, with greater VAS improvement in the SQU-HA group (P<0.01). Within-group analysis showed reduced patellar tilt in the SQU-HA group (P=0.003); between-group comparison did not reach statistical significance (P=0.217). Muscle activation onset sequences shifted from an abnormal pattern, in which VL activation preceded VMO and ADD activation, to a more typical pattern, in which VMO activation preceded VL and ADD activation. This shift was particularly evident in the SQU-HA group, whose activation pattern resembled that of the RG after intervention. Only VMO-VL onset difference, VMO/VL ratio, and Q-angle were correlated with clinical outcomes (P<0.05). CONCLUSIONS An 8-week SQU-HA program demonstrates promising short-term improvements in VMO-related neuromuscular measures and pain reduction for patients with PFPS. This accessible motor re-education strategy serves as a practical, home-based approach to patellofemoral rehabilitation.
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BibTeX
@article{chen2026refining,
title = {{Refining Home-Based Squat Training: The Role of Hip Adduction in Improving Neuromuscular Control for Clinically Diagnosed Patellofemoral Pain Syndrome.}},
author = {Chia-Ling Chen and Sui-Foon Lo and Min-Chi Chiu and Chien-Chun Chang and Wei-Hsien Hong},
journal = {Medical science monitor : international medical journal of experimental and clinical research},
year = {2026},
month = oct,
doi = {10.12659/msm.953994},
url = {https://europepmc.org/article/MED/42864886},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Refining Home-Based Squat Training: The Role of Hip Adduction in Improving Neuromuscular Control for Clinically Diagnosed Patellofemoral Pain Syndrome.
AU - Chia-Ling Chen
AU - Sui-Foon Lo
AU - Min-Chi Chiu
AU - Chien-Chun Chang
AU - Wei-Hsien Hong
PY - 2026
DA - 2026/10/13
JO - Medical science monitor : international medical journal of experimental and clinical research
DO - 10.12659/msm.953994
UR - https://europepmc.org/article/MED/42864886
AB - BACKGROUND Patellofemoral pain syndrome (PFPS) often stems from neuromuscular imbalances, particularly vastus medialis obliques (VMO) dysfunction impairing patellar tracking. Research is shifting toward integrated rehabilitation strategies, such as combining hip adduction with squats to enhance VMO recruitment. MATERIAL AND METHODS Thirty participants with PFPS were randomized to traditional squatting (SQU, n=15) or squatting with hip adduction (SQU-HA, n=15) for an 8-week home-based program with identical stretching. SQU-HA squeezed a Swiss ball during squats. Fifteen healthy individuals served as a reference group (RG). Outcome measures assessed before and after intervention included Q-angle, patellar tilt, clinical scales (visual analog scale [VAS], patellofemoral pain severity scale [PSS]), and electromyographic parameters (VMO, vastus lateralis [VL], adductor [ADD] amplitudes, onset times, VMO/VL ratio, and VMO-VL onset difference). RESULTS Both PFPS groups showed significant improvements in VAS and PSS after intervention, with greater VAS improvement in the SQU-HA group (P<0.01). Within-group analysis showed reduced patellar tilt in the SQU-HA group (P=0.003); between-group comparison did not reach statistical significance (P=0.217). Muscle activation onset sequences shifted from an abnormal pattern, in which VL activation preceded VMO and ADD activation, to a more typical pattern, in which VMO activation preceded VL and ADD activation. This shift was particularly evident in the SQU-HA group, whose activation pattern resembled that of the RG after intervention. Only VMO-VL onset difference, VMO/VL ratio, and Q-angle were correlated with clinical outcomes (P<0.05). CONCLUSIONS An 8-week SQU-HA program demonstrates promising short-term improvements in VMO-related neuromuscular measures and pain reduction for patients with PFPS. This accessible motor re-education strategy serves as a practical, home-based approach to patellofemoral rehabilitation.
SN - 1234-1010
SN - 1643-3750
ER -