Sports Medicine Research: In the Lab & In the Field: Education is the Key to Addressing Runners’ Patellofemoral Pain (Sports Med Res)

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Thursday, May 24, 2018

Education is the Key to Addressing Runners’ Patellofemoral Pain


Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? A randomised clinical trial

Esculier JF, Bouyer LJ, Dubois B, Fremont P, Moore L, McFadyen B, Roy JS. Br J Sports Med. 2018 May; 52(10):659-666. doi: 10.1136/bjsports-2016-096988.

Take Home Message: Education, education with home exercises, and education with gait retraining offered similar improvements in pain and function among runners with patellofemoral pain. Adding home exercises or gait retraining offered some added benefits, which were unique to the intervention (e.g., improved strength or improved joint loading; respectively).

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There are multiple approaches to address patellofemoral pain in runners, including education on best running practices to reduce stress to the knee, rehabilitation focusing on hip and knee muscles, and gait retraining to change foot strike pattern or cadence (steps/minute). However, it is unknown which combination of treatment with education may be most effective. Therefore, the authors conducted a randomized control trial to compare the effects of education, education with home exercises, and education with gait retraining on changes in pain, function, strength, and running outcomes among 69 runners with patellofemoral pain. Education included instructions to decrease length and speed of runs, avoid downhill and stair running, and to maintain low levels of pain, which should return to normal shortly after exercise. The progression was to gradually increase distance, and then incorporate speed and hill running. The home exercise group received the education with home exercises to target strength and control of the lower legs. The final group received the education along with gait retraining to increase cadence by 7.5 to 10%, and if applicable, to “run softer” or to not land on their heels. The interventions lasted for 8 weeks, and outcomes were compared at baseline, and at 4-, 8- and 20-week follow-up (86% attended the final follow-up).  All groups improved pain and function at each follow-up visit; however, the authors found no differences in pain or function over time between groups. The education and exercise group alone had better improvements in quadriceps and hip abductor strength compared with the exercise group. The gait retraining and education group alone had increased cadence, decreased average vertical loading rates at 8 weeks, and lower peak patellofemoral joint forces compared to the education group.

These authors found that the benefits runners with patellofemoral pain received corresponded specifically to what an intervention targeted. These benefits lasted for another 12 weeks after the training ended. However, the addition of home exercises or gait retraining to education failed to offer additional benefit for improving pain or function compared to education alone. Therefore, the authors concluded that each of these interventions may be beneficial for certain outcomes; but, education should always be a key part of the treatment strategy. It is important to consider what specific goals and running activities may be important to an individual patient so we can tailor interventions accordingly (for example, gait retraining for distance to reduce cumulative loading). Additionally, it may be important to consider patient-specific limitations, such as adding hip/quadriceps strengthening for patients that present with weakness. In all, runners with patellofemoral pain responded well to running education in terms of pain and functional outcomes, with no differences in these outcomes among runners who also received additional interventions. Thus, running education should be an integral component of treatment for runners with patellofemoral pain.

Questions for Discussion: What interventions have you tried for runners with patellofemoral pain that have been successful? What advice do you give runners to improve their pain and function during activity?

Written by: Alexandra F DeJong
Reviewed by: Jeffrey Driban

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