Update on Rehabilitation of Patellofemoral Pain

Journal of Sport Rehabilitation, 2004

Objective:To determine the effect of exercise on patients with patellofemoral-pain syndrome (PFPS).Patients:29 subjects with unilateral PFPS, assigned to control, home-exercise (HE), or physical therapy (PT) group.Intervention:8-wk exercise program.Main Outcome Measures:A knee survey, visual analog scale (VAS), and 5 weight-bearing tests.Results:MANOVA indicated an overall statistical difference between groups (P < .05). The HE and PT groups experienced less pain than control, and PT experienced less pain than HE (P < .05). In overall knee function and most weight-bearing tests, HE and PT were stronger and more functional than control (P < .05). For anteromedial lunge only PT was stronger and more functional than control (P < .05).Conclusions:Intervention helps PFPS, but there appear to be no differences between home and in-clinic interventions.

Journal of Sport Rehabilitation, 2005

Objective:To provide evidence regarding the therapeutic effects of exercise on subjects with patellofemoral-pain syndrome (PFPS).Data Sources:Evidence was compiled with data located using the Medline, CINAHL, and SPORTDiscus databases from 1985 to 2004 using the key words patellofemoral pain syndrome, exercise, rehabilitation, and strength.Study Selection:The literature review examined intervention studies evaluating the effectiveness of exercise in subjects specif-cally diagnosed with PFPS. Articles were selected based on clinical relevance to PFPS rehabilitation that required an intervention of a minimum of 4 weeks.Data Synthesis:The review supports using exercise as the primary treatment for PFPS.Conclusions:Evidence exists regarding the use of isometric, isotonic, isokinetic, and closed kinetic chain exercise. Although clinicians have advocated the use of biofeedback and patella taping, there is limited evidence regarding the efficacy of these interventions on subjects diagnosed...

2023

Background Patellofemoral pain (PFP) is a common musculoskeletal condition that affects many individuals. Hence our objective was to identify the effectiveness of functional stabilization exercises on pain relief, functionality, and biomechanics of the lower extremity in patients with PFP. Methods It was a double-blinded, randomized controlled trial that enrolled 60 participants diagnosed with PFP, randomly assigned to functional stabilization and conventional treatment group. Both groups received exercises for 8 weeks with 3 sessions on non-consecutive days of the week. Pain levels, functional performance, and lower extremity biomechanics were assessed. Results The mean age of the participants was 23.48± 4.89 in FST and 21.98±3.42 in the CT group, with improvements observed in all variables in both groups. However, more significant results were reported in the FST group with mean differences of 2.15±0.5, 6.75±3.88, 14.47±12.21, and 1.7±0.47 for pain, physical function, single-leg triple hop, and Q-angle respectively. Conclusion Functional stabilization exercises are an effective treatment option for patients with PFPS. It can significantly improve pain levels, functional performance, and lower extremity biomechanics in patients with PFPS. The findings of this study support the use of functional stabilization training as a treatment option for patients with PFPS.

2015

Patellofemoral pain syndrome (PFPS) is the most common type of knee pain. It is estimated that PFPS accounts for 25-30% of all knee pathologies. The condition can be very painful and the symptoms can take a long time to settle. There is general consensus that effective treatment strategies should be based on a thorough understanding of pathological changes of PFPS. This mini review briefly outlines biomechanical aspects of pathophysiology of the structures involved and describes current treatment strategies available in the literature, in particular it looks at muscle tightness and provides an insight into stretching techniques as an effective physiotherapy choice for the condition.

Journal of Orthopaedic & Sports Physical Therapy, 2014

P atellofemoral pain syndrome (PFPS) is one of the most commonly reported injuries in sports medicine. 10,11,38 PFPS is characterized by diffuse retropatellar and peripatellar pain that is aggravated with squatting, prolonged sitting, and stair activities, and is diagnosed in the absence of other pathologies, such as patellar tendinopathy, chondral defects, or patellofemoral osteoarthri-tis. 12,25,39 Although quadriceps muscle-strengthening exercises are often included as part of the intervention for PFPS, 7,16 the most recent literature review, published in 2003 by Heintjes et al, 16 concluded that there was little evidence to support exercises as an intervention. However, this conclusion was based on the results of only 2 ran-domized controlled trials (RCTs) and 1 clinically controlled trial. 16 Since the review by Heintjes et al, 16 a number of studies investigating the effectiveness of quadriceps strengthening for the treatment of PFPS have been published. Therefore, an updated thorough review of the literature on the clinical effectiveness of quadriceps-strengthening exercises appears warranted. The aim of this systematic review was to evaluate and summarize the evidence for therapist guided quadriceps muscle-strengthening exercises (alone or combined with other interventions) as a treatment for PFPS when compared to advice and information or a placebo treatment. T T STUDY DESIGN: Systematic literature review. T T OBJECTIVE: To summarize the evidence for physical therapist-guided quadriceps-strengthening exercises as a treatment for patellofemoral pain syndrome. T T BACKGROUND: Although quadriceps strengthening is often included in the plan of care for patellofemoral pain syndrome, a systematic review published in 2003 found only limited evidence that exercise was more effective than no exercise for this common condition. T T METHODS: The PubMed, Embase/MEDLINE, and Cochrane Central Register of Controlled Trials databases, from inception to January 9, 2014, were searched for randomized controlled trials comparing the use of quadriceps-strengthening exercises to interventions consisting of advice/information or a placebo. Outcomes of interest were pain measures and function, as measured with self-report questionnaires. The methodological quality of the randomized controlled trials was assessed with the Physiotherapy Evidence Database scale. Results were summarized using a best-evidence synthesis and graphically illustrated using forest plots without meta-analysis. T T RESULTS: Seven studies were included in the literature review. These studies reported strong evidence that isolated quadriceps strengthening is more effective in reducing pain and improving function than advice and information alone. In addition, compared to advice and information or placebo, there was strong evidence that quadriceps-strengthening exercises combined with other interventions may be more effective in reducing pain immediately postintervention and after 12 months, but not in improving function. T T CONCLUSION: The literature provides strong evidence for the use of quadriceps-strengthening exercises, with or without other interventions, for the treatment of patellofemoral pain syndrome. T T LEVEL OF EVIDENCE: Therapy, level 1a- .

International journal of sports physical therapy, 2011

Patellofemoral pain syndrome (PFPS) is one of the most common and clinically challenging knee pathologies. Historically, clinicians have used a myriad of interventions, many of which have benefited some but not all patients. Suboptimal outcomes may reflect the need for an evidence-based approach for the treatment of PFPS. The authors believe that integrating clinical expertise with the most current scientific data will enhance clinical practice. The purpose of this systematic review is to provide an update on the evidence for the conservative treatment of PFPS. The PubMed, CINAHL, and SPORTDiscus databases were searched for studies published between January 1, 2000 and December 31, 2010. Studies used were any that utilized interventions lasting a minimum of 4 weeks for subjects with PFPS. Data were examined for subject sample, intervention duration, intervention type, and pain outcomes. General quadriceps strengthening continues to reduce pain in patients with PFPS. Data are inconcl...

Patellofemoral pain (PFP) accounts for 25% of all knee pain presentations in active individuals to outpatient physical therapy clinics. Historically, the etiology of PFP has been attributed to altered patellofemoral joint mechanics and stresses. However, recent research has suggested insufficient strength of the proximal hip musculature may contribute to PFP. Many studies exploring the effectiveness of hip strengthening include confounding interventions such as hip strengthening combined with quadriceps strengthening. Therefore, there is a lack of literature exploring the effectiveness of hip strengthening as an isolated intervention in the treatment of PFP. A structured review was conducted to answer the following clinical question: “What is the effect of hip strengthening on pain and function in the rehabilitation of patients under 45 years of age with patellofemoral pain?” Based on results of 11 studies, there is moderate evidence to suggest that hip strengthening is effective in (1) decreasing general pain and pain during activity and (2) improving generalized lower extremity function during activities such as squatting, walking, and stair negotiation, functional strength and health status in people with PFP. The population that best applies to this review includes active and sedentary men and women 22-35 years old with chronic PFP. Additionally, this review indicates that hip strengthening alone or in combination with quadriceps strengthening or trunk stability training is more effective at improving pain and function compared to quadriceps strengthening alone.

2015

Merchants classification (1988), is the clinical entity of pain on- activity, on patellofemoral joint examination and on stair climbing, squatting, pseudo locking, prolonged sitting etc [1]. Varieties of conservative treatments are suggested, including quadriceps strengthening, patellar taping, stretching, electrotherapy and biofeedback with no single intervention being most effective. Hence, comparison between the two techniques patellar taping and the conventional method was undertaken to determine their effectiveness with respect to pain and function. Methods: 20 subjects diagnosed with unilateral PFPS knee were randomly selected and allocated into two group- Group A (Mc Connell taping and vastus medialis obliques (VMO exercises) and Group B (Short Wave Diathermy and VMO exercises). Treatment was continued for two weeks with pre and post Pain and Function recorded. Students t test was used for statistical analy-sis. Results: Both groups showed statistically significant pain relie...

Clinical Rheumatology, 2012

Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. While treatment for PFPS may be successful in the short term, long-term results are less promising. The purpose of this study was to record longterm pain and functionality outcomes following rehabilitation in patients affected by PFPS. A prospective cohort study of 44 patients with a diagnosis of PFPS and an activation imbalance between the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles were enrolled. Patients underwent patellar taping (2 weeks) followed by a rehabilitation program lasting until the end of the third month. Primary outcome measures were pain and the functional level of the patellofemoral joint. Secondary outcome measures were surface electromyographic (sEMG) onset timing of the VMO/VL during seated knee extension and squat and isometric knee extensor muscle strength. Significant differences in all the outcome measures were observed between the affected and unaffected sides before treatment. The pain score significantly decreased both posttreatment (Δ=−4.7; 95% CI=−5.4 to −3.9) and at the 12-month follow-up (Δ=−5.5; 95% CI=−6.1 to −4.8), while the functional level significantly increased both posttreatment (Δ=24; 95% CI=18.3 to 30.2) and at the 12-month follow-up (Δ=26; 95% CI=21.4 to 30.6). Posttreatment, 35/44 patients (79.5%) and 31/44 patients (70.5%) achieved normal sEMG onset timing of the VMO and VL in the seated knee extension exercise and in the squat exercise, respectively. A short period of patellar taping followed by an exercise program results in long-lasting pain control in PFPS associated with muscular dysfunction.

Journal of Physical Therapy Science, 2015

The aim of this study was to analyze the effectiveness of conservative treatment of patellofemoral pain syndrome with physical exercise. [Subjects and Methods] A computer-based review conducted of four databases (PubMed, the Cochrane Library, PEDro, and the University Library) was completed based on the inclusion criteria of patellofemoral pain syndrome patients treated with physical exercise methods and examination with self-reported pain and/or functional questionnaires. [Results] The findings of ten clinical trials of moderate to high quality were evaluated to determine the effectiveness of physical exercise as conservative management for patellofemoral pain syndrome. [Conclusion] The intervention programs that were most effective in relieving pain and improving function in patellofemoral pain syndrome included proprioceptive neuromuscular facilitation stretching and strengthening exercises for the hip external rotator and abductor muscles and knee extensor muscles.