From the Guidelines
Patellar tilting is not explicitly indicated for physiotherapy as a standalone treatment, but it may be considered as part of a comprehensive treatment plan that includes knee-targeted exercise therapy and other interventions. The most recent and highest quality study, published in the British Journal of Sports Medicine in 2024 1, found that knee-targeted exercise therapy, hip-and-knee-targeted exercise therapy, prefabricated foot orthoses, and lower quadrant manual therapy demonstrated primary efficacy for treating patellofemoral pain. While patellar tilting is not specifically mentioned as an effective intervention, the study suggests that a combination of interventions, including exercise therapy, manual therapy, and education, may be beneficial for patients with patellofemoral pain. Another study published in the same journal in 2024 1 also supports the use of knee-targeted exercise therapy and hip-and-knee-targeted exercise therapy, and suggests that interventions such as patellar taping and movement retraining may be useful in supporting the delivery of exercise therapy. However, the evidence for patellar tilting as a specific treatment is limited, and it is not clear whether it provides any additional benefits when combined with other interventions. Therefore, physiotherapists should consider using patellar tilting as part of a comprehensive treatment plan that includes knee-targeted exercise therapy and other evidence-based interventions, but should not rely on it as a standalone treatment. Some key points to consider when using patellar tilting as part of a treatment plan include:
- Combining patellar tilting with a progressive exercise program to address underlying muscle imbalances and movement patterns
- Using patellar tilting to reduce pressure on irritated joint surfaces and improve patellar tracking during knee movement
- Incorporating education and home exercises to complement in-clinic patellar mobilizations and promote sustained improvement.
From the Research
Patellar Tilting and Physiotherapy
- Patellar tilting is a complex issue that cannot be isolated from the confounding effect of its neighboring bone rotation (femoral and tibial rotation) in people sustaining patellofemoral pain syndrome (PFPS) 2.
- The effect of femoral, tibial rotation, and femoral rotation relative to tibia on patella tilting varied with the difference in the way of measuring the patella tilt angle 2.
- Abnormal patellar alignment and tracking may be potential risk factors that are associated with patellofemoral pain, but symptomatic patella do not consistently demonstrate lateral malalignment or tracking in patellar tilt and translation 3.
Physiotherapy Interventions for Patellofemoral Pain Syndrome
- Quadriceps-strengthening exercises, with or without other interventions, are strongly supported by research as effective treatment options for reducing pain and improving function in patients with PFPS 4, 5.
- A combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group, is the most effective treatment modality for patients with PFPS 5.
- Exercise therapy, especially the combination of hip-focused and knee-focused exercises, is recommended to improve pain and/or function in people with patellofemoral pain 6.
Patellar Tilting in Physiotherapy
- There is no direct evidence to suggest that patellar tilting is a specific indication for physiotherapy, but rather it is a component of the complex issue of patellofemoral pain syndrome that needs to be addressed through a comprehensive treatment approach 2, 3.
- Physiotherapy interventions for PFPS focus on strengthening the quadriceps and hip muscles, improving patellar tracking and alignment, and addressing any underlying biomechanical issues that may be contributing to the condition 4, 5, 6.