Introduction
Patellofemoral pain (PFP) is common in adolescents and young adults, especially women. It is characterised by retropatellar or peripatellar pain with knee loading activities particularly stairs, squatting and prolonged sitting. There is some evidence of associated thigh and hip muscle strength deficits in people with PFP.
Intervention
Hip and knee strengthening exercises
Indication
To treat patellofemoral pain
Precautions
Other differential diagnoses of patellar pain
Adverse effects
None reported
Availability
The hip and knee strengthening exercises can be done at home.
Description
There is low quality but consistent evidence across several systematic reviews that hip and knee strengthening exercises can lead to improvement in pain and function. 1 - 4
There is insufficient evidence to determine the optimal type of hip or knee strengthening exercise for PFP (e.g. exercise that involves more than one muscle group or joint versus exercise that focuses on a single muscle group or joint, or high intensity versus low intensity exercise).
A network meta-analysis found the combination of exercise, education and patellar taping/mobilisation to be most effective for the primary outcome of ‘any improvement’ in the short term. A ‘wait and see’ approach (no intervention) was the least effective approach. 4
Tips and challenges
- As the trials were 4–8 weeks in duration, people with PFP should be advised to try the exercises regularly for this minimum period.
- Education includes information about PFP and advice on how to manage activity and pain. This is important as the natural history of PFP can be one of chronicity or recurrence with about 60% of people with PFP for at least 6 weeks continuing to have symptoms after 2 years.
- Foot orthoses did not appear to add benefit to education and exercise. 4
Grading
Moderate (We are moderately confident in this research evidence, ie further research could have an important impact, which may change the estimates.)