From the Guidelines
For patients with patellofemoral pain, delivering knee-targeted exercise therapy, with supportive interventions as required, is the most effective approach, as it addresses the underlying causes of the pain and improves functional outcomes, as evidenced by the most recent and highest quality study 1.
Key Interventions
- Deliver knee-targeted exercise therapy, with a focus on hip and knee strengthening, as this has been shown to improve patellofemoral pain outcomes 1
- Education should underpin all interventions, adjusted to reflect the needs of the person, to challenge inaccurate beliefs, build confidence, and promote autonomy 1
- Consider supportive approaches, such as prefabricated foot orthoses, movement/running retraining, and taping, based on subjective and objective findings 1
Exercise Therapy
- Prescribe exercise therapy relative to specific severity and irritability, with a greater focus on hip exercises in people with poor tolerance to loaded knee flexion 1
- Modify task/load/intensity/frequency as required to ensure effective and safe exercise therapy 1
Additional Considerations
- Objectively evaluate physical impairments, including muscle strength, movement patterns, and tissue tolerance to load, to inform treatment selection 1
- Consider the contextual factors related to symptoms, such as fear avoidance during functional tasks, to develop an effective treatment plan 1 By prioritizing knee-targeted exercise therapy, education, and supportive interventions, healthcare providers can effectively manage patellofemoral pain and improve patient outcomes, as supported by the most recent and highest quality evidence 1.
From the Research
Interventions for Patellofemoral Pain
The following interventions are used to treat patellofemoral pain:
- Exercise therapy to strengthen the quadriceps, as studied in 2 and 3
- Physiotherapy interventions, including specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching), as mentioned in 3
- Hip, knee, and core strengthening as well as stretching and aerobic exercise, as discussed in 4
- Patellofemoral and tibiofemoral joint mobilizations, patellofemoral taping, neuromuscular training, and gait retraining, as mentioned in 4
- Correction of imbalance between vastus medialis and vastus lateralis, as discussed in 5
- Improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restoration of good knee function, as mentioned in 5
Types of Exercise Therapy
Different types of exercise therapy have been studied, including:
- Closed kinetic chain exercise (foot in contact with a surface), as compared to open kinetic chain exercise (foot not in contact with a surface) in 2
- Quadriceps strengthening exercises, as studied in 2 and 3
- Hip and core strengthening exercises, as discussed in 4
Other Interventions
Other interventions that have been studied include: