Background: Exercise for patellofemoral pain (PFP) is traditionally knee focused, targeting quadriceps muscles. In recent years, hip-focused exercise has gained popularity. Patient education is likely an important factor but is underresearched.
Purpose: To compare 3 treatment methods for PFP, each combined with patient education: hip-focused exercise, knee-focused exercise, or free physical activity.
Study design: Randomized controlled trial; Level of evidence, 1.
Methods: A single-blind randomized controlled trial was performed with 112 patients who were 16 to 40 years old (mean, 27.6 years) and had a symptom duration >3 months (mean, 39 months) with a clinical diagnosis of PFP and no radiograph or magnetic resonance evidence of other pathology. Patients were randomized to a 6-week intervention consisting of patient education combined with isolated hip-focused exercise (n = 39), traditional knee-focused exercise (n = 37), or free physical activity (n = 36). The primary outcome was Anterior Knee Pain Scale (0-100) at 3 months. Secondary outcomes were visual analog scale for pain, Tampa Scale for Kinesiophobia, Knee Self-efficacy Scale, EuroQol, step-down, and isometric strength.
Results: There were no between-group differences in any primary or secondary outcomes at 3 months except for hip abduction strength and knee extension strength. Between-group differences at 3 months for Anterior Knee Pain Scale were as follows: knee versus control, 0.2 (95% CI, -5.5 to 6.0); hip versus control, 1.0 (95% CI, -4.6 to 6.6); and hip versus knee, 0.8 (95% CI, -4.8 to 6.4). The whole cohort of patients improved for all outcomes at 3 months except for knee extension strength.
Conclusion: The authors found no difference in short-term effectiveness in combining patient education with knee-focused exercise, hip-focused exercise, or free training for patients with PFP.
Registration: NCT02114294 (ClinicalTrials.gov identifier).
Keywords: anterior knee pain; education; exercise therapy; hip strengthening; patellofemoral pain.
Patellofemoral Pain: One Year Results of a Randomized Trial Comparing Hip Exercise, Knee Exercise, or Free ActivityA Hott et al. Scand J Med Sci Sports. PMID 31846113.After 1 year, there was no difference in effectiveness of knee exercise, hip exercise, or free physical activity, when combined with patient education in PFP.
Study Protocol: A Randomised Controlled Trial Comparing the Long Term Effects of Isolated Hip Strengthening, Quadriceps-Based Training and Free Physical Activity for Patellofemoral Pain Syndrome (Anterior Knee Pain)A Hott et al. BMC Musculoskelet Disord 16, 40. PMID 25879452. - Randomized Controlled TrialClinicalTrials.gov reference: NCT02114294.
Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: A Multicenter Randomized Controlled TrialR Ferber et al. J Athl Train 50 (4), 366-77. PMID 25365133. - Randomized Controlled TrialBoth the HIP and KNEE rehabilitation protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulte …
Exercise for Treating Patellofemoral Pain SyndromeRA van der Heijden et al. Cochrane Database Syst Rev 1, CD010387. PMID 25603546. - ReviewThis review has found very low quality but consistent evidence that exercise therapy for PFPS may result in clinically important reduction in pain and improvement in func …
High-intensity Versus Low-Intensity Physical Activity or Exercise in People With Hip or Knee OsteoarthritisJP Regnaux et al. Cochrane Database Syst Rev (10), CD010203. PMID 26513223. - ReviewWe found very low-quality to low-quality evidence for no important clinical benefit of high-intensity compared to low-intensity exercise programs in improving pain and ph …