Patellofemoral Pain

In July, the British Journal of Sports Medicine published the consensus statement of the 5th International Patellofemoral Pain Research Symposium which was led by Dr. Natalie Collins of The University of Queensland.1 Our own practice principal, Cameron Bulluss, attended the after conference

. Fifty-one authorities representing ten countries convened to synthesise six new systematic reviews and 13 randomised controlled trials into the already large collection of evidence guiding the previous consensus statement.

Patellofemoral pain proves to be a pervasive and recalcitrant challenge for healthcare professionals. The condition affects 23% of adults and 29% of adolescents.2 For roughly half of those people, symptoms persist into the long term, sometimes for decades.3-6 In addition to limiting athletic participation and occupational tasks,3,7 the condition may contribute to the development of patellofemoral osteoarthritis.8

Utilizing therapies proven to be effective in the long term can help promote quality of life for a significant portion of patients affected by patellofemoral pain. The new consensus statement continues to recommend exercise therapy as the “intervention of choice.” Specifically, they recommend a combination of knee and hip exercises. Additionally, the authors recommend a combined treatment approach adding foot orthoses, taping, or manual therapy. Of the three, foot orthoses seem to get the strongest recommendation as some forms of manual therapy and taping/bracing are recommended against as stand alone therapies, while foot orthoses receive a singular recommendation for pain reduction.

This area needs more research. The exact exercise therapy protocol that would be the most efficient and most effective has not been proven in the scientific literature. For instance, Rathleff and colleagues demonststrated a dose-response relationship wherein greater exercise frequency produced greater recovery, but the optimal frequency was not determined.

At Advanced Physiotherapy and Injury Prevention, we use a combined treatment approach to enhance outcomes. According to individual patient presentations, the Advanced Physiotherapy approach can include:

Targeted strengthening and flexibility work
Custom foot orthotics
Taping and/or knee sleeves
Manual therapy
Home exercise plans
Footwear recommendations
General fitness and weight loss programs
Workplace ergonomics consultation