Effectiveness of conservative treatment for patellofemoral pain syndrome: A systematic review and meta-analysis

Saltychev, Mikhail; Dutton, Rebecca A.; Laimi, Katri; Beaupré, Gary S.; Virolainen, Petri; Fredericson, Michael

doi:10.2340/16501977-2295

Cited by 47 publications

(37 citation statements)

References 44 publications

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“…Clinicians should consider a variety of movement quality assessments concordant with the patient’s complaints and activity limitations given that aberrant mechanics and neuromuscular activation patterns are often present in individuals with PFP (23,26,40–44). The position of dynamic knee valgus, characterized by hip adduction and internal rotation, may be associated with PFP (23,40,44,45), thus clinicians should pay particular attention for these aberrant mechanics.…”

Section: Discussionmentioning

confidence: 99%

“…It is thus imperative to individually assess each patient to identify and subsequently address his or her impairments, functional limitations, and activity restrictions. Management of PFP should consist of an individualized (47), multi-modal approach with exercise therapy as the hallmark of the plan (9,16,26,59–61).…”

Section: Treatmentmentioning

confidence: 99%

“…Neuromuscular activation deficits are common in individuals with PFP, especially in the hip abductors and external rotators, knee extensors, and core musculature (23,26,40,44,45). Evaluating movements during functional tasks (described above) is essential to identifying and treating neuromuscular activation deficits.…”

Section: Treatmentmentioning

confidence: 99%

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The current management of patients with patellofemoral pain from the physical therapist’s perspective

Capin¹,

Snyder‐Mackler²

2018

Ann. Joint

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Patellofemoral pain (PFP) is a common diagnosis that includes an amalgam of conditions that are typically non-traumatic in origin and result in peripatellar and/or retropatellar knee pain. The purpose of this review is to provide an overview of the physical therapist’s management, including the evaluation and treatment, of the patient with PFP. A thorough history is critical for appropriately diagnosing and optimally managing PFP; the history should include the date of symptom onset, mechanism of injury and/or antecedent events, location and quality of pain, exacerbating and alleviating symptoms, relevant past medical history, occupational demands, recreational activities, footwear, and patient goals. Physical examination should identify the patient’s specific impairments, assessing range of motion (ROM), muscle length, effusion, resisted isometrics, strength, balance and postural control, special tests, movement quality, palpation, function, and patient reported outcome measures. Objective assessments should guide treatment, progression, and clinical decision-making. The rehabilitation program should be individually tailored, addressing the patient’s specific impairments and functional limitations and achieving the patient’s goals. Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of PFP. Other complimentary treatments may include patellofemoral and tibiofemoral joint mobilizations, patellofemoral taping, neuromuscular training, and gait retraining. Appropriate progression of interventions should consider objective evaluations (e.g., effusion, soreness rules), systematic increases in loading, and the chronicity of symptoms. Although short-term changes or reductions in movement often are necessary in a protective capacity, the persistence of altered movement is a key characteristic of chronic pain, which may be managed in part through emphasis on function over symptoms, graded exposure, patient education, and perhaps referral. PFP etiology is largely movement related and a comprehensive conservative treatment using movement can be successful.

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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The current management of patients with patellofemoral pain from the physical therapist’s perspective

Capin¹,

Snyder‐Mackler²

2018

Ann. Joint

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“…Due to multiple contributing factors to PFPS, no one set physical therapy regimen is recommended. Instead, treatment should be individualized to each patient [40]. While going through physical therapy, patients should remain physically active and should continue flexibility and strengthening exercises even after physical therapy has been completed.…”

Section: Treatmentmentioning

confidence: 99%

Athletic Injuries

Meredith¹,

Falk²,

Rennicke³

et al. 2020

Family Medicine

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“…Some factors including lower extremity malalignment, patella alta, lateral patellar tilt, increased Quadriceps (Q) angle, knee valgus, femoral anteversion, foot hyperpronation influence patellofemoral biomechanics and increase the risk for PFPS [4,5]. In addition, soft tissue imbalance such as lateral retinaculum shortening or medial retinaculum weakness, iliotibial band tightness, hamstring and gastrocnemius can indirectly increase the forces on the patellofemoral joint [6,7]. Quadriceps muscle (especially VMO and VL parts) plays a critical role in maintaining patella in the trochlea groove.…”

Section: Introductionmentioning

confidence: 99%

Comparing Electromyographic Activity of Quadriceps Muscle During Straight Leg Raise in Individuals With and Without Patellofemoral Pain Syndrome

Lotfi

Moghadam

Shati

2018

PTJ

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This study aimed to investigate the electromyographic activities and balance of Vastus Medialis Obliquus (VMO) and Vastus Lateralis (VL) muscles during Straight Leg Raise (SLR) in individuals with and without Patellofemoral Pain Syndrome (PFPS). Methods: Through an analytical case-control study, 26 persons with PFPS and 26 healthy subjects were recruited by non-random and convenience sampling method. All subjects performed SLR movement. The EMG activity of VMO, VL and VMO/VL ratio were recorded and measured. The muscles activation level were compared between the 2 groups using the Independent t test. The obtained data were analyzed using SPSS. Results: The mean and maximum EMG activity of VMO, VL and VMO/VL ratio did not have any significant differences between the PFPS and healthy groups (P>0.05). In other words, during SLR, the VMO and VL muscles activation in the PFPS group were approximately the same as the healthy group. Conclusion: These data suggest that not all individuals with PFPS had weak quadriceps muscles. Many factors may contribute to PFPS that should be considered in the assessment and rehabilitation of individuals with PFPS.

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Effectiveness of conservative treatment for patellofemoral pain syndrome: A systematic review and meta-analysis

Abstract: There is no evidence that a single treat-ment modality works for all patients with patellofemoral pain. There is limited evidence that some treatment modalities may be beneficial for some subgroups of patients with patellofemoral pain.

Cited by 47 publications

References 44 publications

The current management of patients with patellofemoral pain from the physical therapist’s perspective

The current management of patients with patellofemoral pain from the physical therapist’s perspective

Athletic Injuries

Comparing Electromyographic Activity of Quadriceps Muscle During Straight Leg Raise in Individuals With and Without Patellofemoral Pain Syndrome

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