EFFECTIVENESS OF ISOLATED HIP EXERCISE, KNEE EXERCISE, OR FREE PHYSICAL ACTIVITY FOR PATELLOFEMORAL PAIN

Review written by Dr Teddy Willsey info

BACKGROUND & OBJECTIVE

Patellofemoral pain (PFP) has an annual prevalence of 23% in the general population and up to 29% amongst adolescents (1). Treatment of PFP is typically conservative, consisting of exercise emphasizing mechanics and strengthening of the involved limb. In recent years, strengthening of both the hip and knee musculature has been emphasized in the treatment of PFP.

The objective of this paper was to compare the effect of three distinct treatment approaches for PFP, all combined with a standardized self-efficacy-based approach to patient education. With the influence of patient education and positive psychology being a growing area of research in recent years, this paper aimed to isolate the potential treatment effects of patient education alone by using a control group that received education but no formal exercise intervention.

METHODS

A single-blind randomized controlled trial (n= 112) was performed with participants, aged 16 to 40 years old, presenting with a 3+ month history of reproducible PFP pain, split into 3 groups. Exclusion criteria included the presence of additional lower extremity or knee pathology or a history of surgery or any treatment in the past 3 months. All 3 groups received a standardized 1-hour examination focused on patient education and minimizing kinesiophobia and catastrophizing.

The two exercise groups attended physiotherapy 1 time per week and performed 2 unsupervised sessions at home, totaling 3 times per week for 6 weeks. The hip-focused exercise group performed side-lying hip abductions, clamshells, and prone hip extensions. The knee-focused exercise group performed straight leg raises, supine terminal knee extensions, and bilateral mini squats. The control group had no formal exercise intervention. Instead, they were encouraged by their evaluating physiotherapist to gradually resume pain-free activity and return for a re-evaluation in 6 weeks.

RESULTS

Participants were assessed at baseline, 6 weeks, and 3 months. Observers were blinded to treatment allocation groups. The primary outcome measure used was the anterior knee pain scale (AKPS), a 13 question self-report questionnaire. Secondary outcome measures used included maximal

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