Effects of different lunge exercises on lower limb mechanics and muscle activation in patellofemoral pain syndrome patients

doi:10.12307/2026.294

Abstract

Abstract: BACKGROUND: Lunge exercises are often used in strengthening programs for patellofemoral pain syndrome and have been shown to help strengthen the quadriceps. However, limited data exist to evaluate the effects of lunge exercises with medial or lateral resistance on patellofemoral joint stress and lower limb muscle activation.
OBJECTIVE: To compare the effect of three lunge exercises (traditional lunge, lunge with hip adduction resistance, and lunge with hip abduction resistance) on lower limb muscle activation and patellofemoral joint stress in subjects with patellofemoral pain syndrome and health control group.
METHODS: Totally 29 subjects with patellofemoral pain syndrome and 29 healthy subjects completed three different lunge exercises. Lower limb dynamics and electromyography data were simultaneously acquired using an infrared motion capture system, a three-dimensional force table, and a surface electromyography analyzer. A mixed-design analysis of variance was used to determine the effects of group and exercise on patellofemoral joint stress and lower limb muscle activation characteristics during different lunge exercises.
RESULTS AND CONCLUSION: (1) During the squatting phase, the vastus lateralis muscle activation was significantly lower in both groups during the lunge exercises with hip adduction (P < 0.05), while the vastus medialis/vastus lateralis activation ratio was significantly higher in the healthy group (P < 0.05). In the patellofemoral pain syndrome group, gluteus medius muscle activation was significantly higher during the squatting phase of the lunge exercises with hip abduction (P < 0.05), and peak stress at the patellofemoral joint was significantly reduced (P < 0.05). (2) During the ascending phase, vastus lateralis muscle activation was significantly lower in both groups during the lunge exercises with hip abduction (P < 0.05), while peak stress at the patellofemoral joint was significantly reduced (P < 0.05) and gluteus medius muscle activation was significantly increased (P < 0.05) in the patellofemoral pain syndrome group. The vastus medialis/lateralis muscle activation ratio was significantly higher in the healthy group during the ascending phase of the lunge with hip adduction (P < 0.05), while the peak stress on the patellofemoral joint in the patellofemoral pain syndrome group was significantly lower than in the healthy group (P < 0.05). (3) These findings suggest that traditional lunge exercises can be considered a suitable training method for strengthening the quadriceps in the early stages of rehabilitation for patellofemoral pain syndrome. Lunges with lateral adduction/abduction exercises offer the benefits of improving activation imbalances in the vastus medialis/lateralis muscles, increasing gluteus medius activation, and reducing patellofemoral joint stress during squatting, which aids in restoring neuromuscular control of the lower limb kinetic chain in the later stages of rehabilitation. For patients with patellofemoral pain syndrome, lunge exercises with lateral abduction resistance are more highly recommended to relieve pain and improve function.

Key words: anterior knee pain, patellofemoral pain syndrome, lunge exercises, patellofemoral joint stress, muscle activation level

CLC Number:

Yang Kexin, Yang Xiaowei, Zhao Yuting, Zhou Zhipeng, Zheng Liangliang. Effects of different lunge exercises on lower limb mechanics and muscle activation in patellofemoral pain syndrome patients[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(29): 7565-7571.

Figures/Tables 3

效应(P > 0.05)。动作对股外侧肌激活水平存在影响，两组受试者在弓步蹲伴髋内收拉力中的股外侧肌激活水平显著低于传统弓步蹲(P=0.013，η2=0.087)。股内侧肌/股外侧肌比值(P=0.010，η2=0.095)及臀中肌(P < 0.001，η2=0.517)激活水平在动作和组别之间存在交互效应；经简单效应分析的结果显示，健康组在弓步蹲伴髋外展拉力中的股内侧肌/股外侧肌比值均显著小于传统弓步蹲(P=0.009)和弓步蹲伴髋内收拉力(P < 0.001)，且髌股疼痛综合征组在传统弓步蹲和弓步蹲伴髋外展拉力中的股内侧肌/股外侧肌比值高于健康组(P < 0.001)，在弓步蹲伴髋内收拉力中低于健康组(P < 0.001)；髌股疼痛综合征组在弓步蹲伴髋外展拉力中的臀中肌激活水平均显著高于传统弓步蹲(P < 0.001)和弓步蹲伴髋内收拉力(P < 0.001)，且髌股疼痛综合征组在传统弓步蹲(P=0.001)和弓步蹲伴髋内收拉力(P < 0.001)中臀中肌激活水平低于健康组；此外，健康组在弓步蹲伴髋内收拉力中的臀中肌激活水平均显著大于传统弓步蹲(P < 0.001)和弓步蹲伴髋外展拉力(P < 0.001)。如表3所示，在蹬起阶段，股外侧肌激活水平在动作与组别之间无交互效应(P > 0.05)。动作对股外侧肌激活水平存在影响，两组受试者在弓步蹲伴髋外展拉力中的股外侧肌激活水平较传统弓步蹲显著降低(P=0.012，η2=0.083)。股内侧肌/股外侧肌比值(P=0.038，η2=0.062)及臀中肌(P < 0.001，η2=0.422)激活水平在动作和组别之间存在交互效应；经简单效应分析的结果显示，健康组在弓步蹲伴髋外展拉力中的股内侧肌/股外侧肌比值均显著小于传统弓步蹲(P=0.015)和弓步蹲伴髋内收拉力(P=0.002)，且髌股疼痛综合征组在传统弓步蹲(P < 0.001)和弓步蹲伴髋内收拉力(P < 0.001)中的股内侧肌/股外侧肌比值低于健康组，在弓步蹲伴髋外展拉力中高于健康组(P < 0.001)；与传统弓步蹲相比，髌股疼痛综合征组在弓步蹲伴髋外展拉力中的臀中肌激活水平显著增加(P=0.004)，弓步蹲伴髋内收拉力的臀中肌激活水平显著减少(P=0.016)，且髌股疼痛综合征组在传统弓步蹲(P=0.006)和弓步蹲伴髋内收拉力(P < 0.001)中的臀中肌激活水平显著小于健康组。 2.5 不同弓步蹲动作髌股关节应力如图3所示，在下蹲(P < 0.001，η2=0.128)和蹬起(P < 0.001，η2=0.161)阶段髌股关节应力峰值上动作和组别之间均存在交互效应。经简单效应分析的结果显示，在下蹲阶段，与弓步蹲伴髋外展拉力相比，髌股疼痛综合征组在传统弓步蹲中的髌股关节应力峰值显著增大(P < 0.001)，健康组在弓步蹲伴髋内收拉力中的髌股关节应力峰值显著减小(P=0.011)，且髌股疼痛综合征组显著小于健康组(P < 0.001)；在蹬起阶段，与弓步蹲伴髋内收拉力相比，髌股疼痛综合征组在传统弓步蹲(P=0.001)和弓步蹲伴髋外展拉力(P < 0.001)中髌股关节应力峰值均显著减小，且髌股疼痛综合征组显著小于健康组(P < 0.001)。"

References

[1] BOLING M, PADUA D, MARSHALL S, et al. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(5):725-730.
[2] CROSSLEY KM, VAN MIDDELKOOP M, CALLAGHAN MJ, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med. 2016;50(14):844-852.
[3] WYNDOW N, COLLINS N, VICENZINO B, et al. Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med. 2016;46(12):1797-1808.
[4] 陈一言, 陆阿明. 髌股疼痛综合征下肢动作模式特征与康复治疗研究进展[J]. 医用生物力学,2022,37(3):555-561.
[5] 杨晓巍, 姚英策, 吴菁, 等. 肌肉电刺激结合肌力训练对髌股疼痛综合征人群单腿下蹲动作生物力学特征的影响[J]. 体育科学,2023,43(8): 52-60,66.
[6] 许杰,周文琪,罗小兵.髌股关节疼痛综合征研究热点与内容的可视化分析[J]. 中国组织工程研究,2022,26(12):1877-1887.
[7] BESIER TF, GOLD GE, DELP SL, et al. The influence of femoral internal and external rotation on cartilage stresses within the patellofemoral joint. J Orthop Res. 2008;26(12):1627-1635.
[8] ESCAMILLA RF, ZHENG N, MACLEOD TD, et al. Patellofemoral Joint Loading in Forward Lunge With Step Length and Height Variations. J Appl Biomech. 2022;38(4):210-220.
[9] BOUDREAU SN, DWYER MK, MATTACOLA CG, et al. Hip-muscle activation during the lunge, single-leg squat, and step-up-and-over exercises. J Sport Rehabil. 2009;18(1):91-103.
[10] EKSTROM RA, DONATELLI RA, CARP KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther. 2007;37(12):754-762.
[11] MIAO P, XU Y, PAN C, et al. Vastus medialis oblique and vastus lateralis activity during a double-leg semisquat with or without hip adduction in patients with patellofemoral pain syndrome. BMC Musculoskelet Disord. 2015;16:289.
[12] IRISH SE, MILLWARD AJ, WRIDE J, et al. The effect of closed-kinetic chain exercises and open-kinetic chain exercise on the muscle activity of vastus medialis oblique and vastus lateralis. J Strength Cond Res. 2010;24(5): 1256-1262.
[13] COQUEIRO KRR, BEVILACQUA-GROSSI D, BÉRZIN F, et al. Analysis on the activation of the VMO and VLL muscles during semisquat exercises with and without hip adduction in individuals with patellofemoral pain syndrome. J Electromyogr Kinesiol. 2005;15(6):596-603.
[14] REECE MB, ARNOLD GP, NASIR S, et al. Barbell back squat: how do resistance bands affect muscle activation and knee kinematics? BMJ Open Sport Exerc Med. 2020;6(1):e000610.
[15] JANCOVÁ J. Measuring the balance control system--review. Acta Medica (Hradec Kralove). 2008;51(3):129-137.
[16] SONG JE, CHOI HS, SHIN WS. Effect of applying resistance in various directions on lower extremity muscle activity and balance during squat exercise. Phys Ther Rehabil Sci. 2019;8(2):61-66.
[17] DREW BT, CONAGHAN PG, SMITH TO, et al. The effect of targeted treatment on people with patellofemoral pain: a pragmatic, randomised controlled feasibility study. BMC Musculoskelet Disord. 2017;18(1):338.
[18] SHI D, ZHANG W, DING X, et al. Parametric generation of three-dimensional gait for robot-assisted rehabilitation. Biol Open. 2020;9(3):bio047332.
[19] 高原, 熊哲宇, 郑尉, 等. 髌股关节疼痛患者下台阶动作的下肢生物力学特征[J]. 中国组织工程研究,2025,39(32):6913-6919.
[20] JAKOBSEN MD, SUNDSTRUP E, ANDERSEN CH, et al. Muscle activity during leg strengthening exercise using free weights and elastic resistance: effects of ballistic vs controlled contractions. Hum Mov Sci. 2013;32(1):65-78.
[21] ALANAZI A, MITCHELL K, RODDEY T, et al. Landing Evaluation in Soccer Players with or without Anterior Cruciate Ligament Reconstruction. Int J Sports Med. 2020;41(13):962-971.
[22] WU G, SIEGLER S, ALLARD P, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002;35(4):543-548.
[23] BELL AL, PEDERSEN DR, BRAND RA. A comparison of the accuracy of several hip center location prediction methods. J Biomech. 1990;23(6):617-621.
[24] 杨辰. 基于下肢生物力学特征的髌股关节痛危险因素研究[D]. 北京:北京体育大学,2018.
[25] 杨辰, 万祥林, 冯茹, 等. 膝痛对髌股关节痛业余跑者跑步和落地起跳缓冲期膝关节生物力学特征的影响[J]. 中国体育科技,2022,58(2): 62-68.
[26] SOUZA DR, GROSS MT. Comparison of vastus medialis obliquus: vastus lateralis muscle integrated electromyographic ratios between healthy subjects and patients with patellofemoral pain. Phys Ther. 1991;71(4): 310-316;discussion 317-320.
[27] TANG SF, CHEN CK, HSU R, et al. Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study. Arch Phys Med Rehabil. 2001;82(10):1441-1445.
[28] THONGDUANG P, CHATCHAWAN U, PUNTUMETAKUL R, et al. Quadriceps Electromyographic Activity in Closed and Open Kinetic-Chain Exercises with Hip-Adductor Co-Contraction in Sedentary Women. Int J Environ Res Public Health. 2022;19(19):12929.
[29] MIRZAIE GH, RAHIMI A, KAJBAFVALA M, et al. Electromyographic activity of the hip and knee muscles during functional tasks in males with and without patellofemoral pain. J Bodyw Mov Ther. 2019;23(1):54-58.
[30] HERTEL J, EARL JE, TSANG KKW, et al. Combining isometric knee extension exercises with hip adduction or abduction does not increase quadriceps EMG activity. Br J Sports Med. 2004;38(2):210-213.
[31] NEUMANN DA. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther. 2010;40(2):82-94.
[32] LIM DP, LAZARO LE, KYHOS JF, et al. Contributions of the Abductor Muscles to Rotational and Distractive Stability of the Hip in a Biomechanical Cadaveric Model. Orthop J Sports Med. 2024;12(3):23259671241231984.
[33] GLAVIANO NR, SALIBA S. Differences in Gluteal and Quadriceps Muscle Activation During Weight-Bearing Exercises Between Female Subjects With and Without Patellofemoral Pain. J Strength Cond Res. 2022;36(1):55-62.
[34] SOUZA RB, POWERS CM. Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther. 2009;39(1):12-19.
[35] DAI B, HEINBAUGH EM, NING X, et al. A resistance band increased internal hip abduction moments and gluteus medius activation during pre-landing and early-landing. J Biomech. 2014;47(15):3674-3680.
[36] DONG C, LI M, HAO K, et al. Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome. J Orthop Surg Res. 2021;16(1):128.
[37] POWERS CM, LANDEL R, PERRY J, et al. Timing and intensity of vastus muscle activity during functional activities in subjects with and without patellofemoral pain. Phys Ther. 1996;76(9):946-955; discussion 956-967.
[38] BRECHTER JH, POWERS CM. Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait Posture. 2002;16(2):115-123.
[39] HEINO BRECHTER J, POWERS CM. Patellofemoral stress during walking in persons with and without patellofemoral pain. Med Sci Sports Exerc. 2002;34(10):1582-1593.
[40] ESCAMILLA RF, ZHENG N, MACLEOD TD, et al. Patellofemoral Joint Force and Stress during the Wall Squat and One-Leg Squat. Med Sci Sports Exerc. 2009;41(4):879-888.
[41] KERNOEZK TW, GHEIDI N, ZELLMER M, et al. Effects of Anterior Knee Displacement During Squatting on Patellofemoral Joint Stress. J Sport Rehabil. 2018;27(3):237-243.
[42] POWERS CM, WARD SR, CHAN LD, et al. The effect of bracing on patella alignment and patellofemoral joint contact area. Med Sci Sports Exerc. 2004;36(7):1226-1232.
[43] CONNOLLY KD, RONSKY JL, WESTOVER LM, et al. Differences in patellofemoral contact mechanics associated with patellofemoral pain syndrome. J Biomech. 2009;42(16):2802-2807.
[44] BARTSCH A, ANDERSON FL, FREDERICSON M, et al. Biomechanical and biological factors of sexual dimorphism in anterior knee pain: Current concepts. J Isakos. 2024;9(4):788-793.
[45] 杨辰, 曲峰, 刘卉, 等. 髌股关节痛业余跑者性别特异的下肢生物力学特征[J]. 医用生物力学,2020,35(6):672-678.
[46] WALSH M, BOLING MC, MCGRATH M, et al. Lower extremity muscle activation and knee flexion during a jump-landing task. J Athl Train. 2012; 47(4):406-413.
[47] PENG HT, KERNOEZK TW, SONG CY. Muscle activation of vastus medialis obliquus and vastus lateralis during a dynamic leg press exercise with and without isometric hip adduction. Phys Ther Sport. 2013;14(1):44-49.
[48] GREUEL H, HERRINGTON L, LIU A, et al. How does acute pain influence biomechanics and quadriceps function in individuals with patellofemoral pain? Knee. 2019;26(2):330-338.