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Patellofemoral Pain Syndrome The Evidence in Sum

Current evidence reveals that patellofemoral pain syndrome is common and exhibits a strong tendency toward chronicity. Targeted quadricep strengthening appears to be the most validated intervention at present, but evidence is building in support of other strengthening and stretching. Referrals for organised exercise intervention appear to add to the results of usual care plus patient education.

Patellofemoral pain syndrome (PFPS) describes a set of common pathologies that cause retropatellar and peripatellar pain.  Pain typically occurs during loading of the knee in flexion or extension. Prolonged sitting can also trigger pain. PFPS ranks as one of the most common causes of pain in the lower extremity, with prevalence estimates as high as 26%. Despite being regarded as generally benign and self-limiting, multiple long-term studies now reveal chronicity between 73% and 96% more than four years after diagnosis.


The likely mechanism is sub-optimal tracking of the patella. However, the etiology is not completely agreed upon, and the pathophysiology is sometimes referred to as nebulous. This may be a contributing factor to the increase in research on the subject over the past several years, more than 70 peer-reviewed and published studies per year. With that much new research coming out, sometimes with contradictory conclusions, it can be challenging to maintain up-to-date, evidence-based practice.  To help with this, The Open Sports Medicine Journal published a systematic review of reviews this year. The studies gathered include evidence on risk factors and best exercise treatment.


The proper functioning of the quadriceps stands apart as the most agreed-upon risk factor and target for intervention. There is also some support for hip abductor strengthening as an effective intervention. Between isometric, isokinetic, or eccentric exercises, all three protocols seem to be effective overall. There is also good support in the evidence that targeted stretching improves exercise therapy results - primarily for the iliotibial band.  Some evidence also supports targeted stretching for the hamstrings, quadriceps, gastrocnemius, and anterior hip.  


Of course, the more practical question for doctors is will exercise therapy intervention improve patient outcomes compared to usual care with patient education alone. Two recent studies demonstrate that a referral for exercise therapy will improve patient outcomes when added to usual care and patient education. Participants in the physiotherapy groups report less pain and better function at both three and 12-month follow-ups. At 12 months, the physio groups report at-rest pain scores that are 45% lower on average compared to the no-physio groups. Even though both groups had the same access to medical care, the no-physio groups report a 200% to 300% greater usage of NSAIDs and a 400% greater usage of topical agents.




In addition to exercise therapy, other physiotherapy interventions for patellofemoral pain syndrome may prove useful for selected patients.12-14 At Advanced Physiotherapy and Injury Prevention, we use an integrative 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



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