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Conditions

Exercise for patellofemoral pain syndrome

Musculoskeletal
        1. Exercise for patellofemoral pain syndrome
First published August 2021

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.)

  1. Hip and knee exercises for kneecap pain
  2. Information on kneecap pain
  3. Taping for kneecap pain
  4. Manage my knee cap pain has information for consumers on managing knee pain, videos of exercises and patellar taping.
  1. Thomson C, Krouwel O, Kuisma R, et al. The outcome of hip exercise in patellofemoral pain: A systematic review. Man Ther 2016;26:1-30.
  2. Rogan S, Haehni M, Luijckx E, et al. Effects of hip abductor muscle exercises on pain and functioning in patients with patellofemoral pain: A systematic review and meta-analysis. J Strength Cond Res 2019;33:3174–87.
  3. van der Heijden RA, Lankhorst NE, van Linschoten R, et al. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev 2015;1:CD010387.
  4. Winters M, Holden S, Lura CB, et al. Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Br J Sports Med 2020;55:369–77.
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