Exercises are Effective in Treating Patellofemoral Pain Syndrome: A Systematic

Peters JSJ & Tyson NL. International Journal of Sports Physical
. 2013; 8 (5): 689-700. PMCID: PMC3811739

Take Home Message:  Hip exercises consistently provide greater
improvements for PFPS than knee exercises alone.  However, any exercise provides alleviation
from PFPS.   

Patellofemoral pain syndrome (PFPS) is
relatively common and a disabling condition. 
We often opt for conservative management, yet it remains unclear which
exercises may yield the best results 
This systematic review evaluated the effectiveness of proximal strengthening
exercises (lumbar, pelvic, & hip exercises) in comparison with knee-only
strengthening exercises. The authors identified 8 relevant articles that met
the inclusion criteria (studies on adults or adolescents with PFPS who
underwent exercise programs focused on proximal OR knee musculature and
reported functional outcomes). The authors then evaluated the methodological
quality and extracted key data from each study. 
All studies were of moderate to high quality – three were randomized
clinical trials.  On average, the 4 studies
that utilized proximal exercises demonstrated a 65.1% reduction in pain levels and
a 37.5% improvement in function while only 3 of the 4 studies that focused on
knee exercises demonstrated an improvement. Overall studies focused on knee
exercises only found an average reduction of 36.8% in pain and a 20.5% improvement
in function.  Among the studies that
focused on proximal exercises, all four targeted hip muscles with single joint
movements (e.g., hip abduction), 1 included lumbo-pelvic exercises, and 2
included stretching.

Nearly all exercises provided some
relief of pain; however, proximal exercises consistently and drastically
alleviated symptoms associated with PFPS. 
This information confirms to clinicians that some form of activity is
better than nothing.  Despite pain or an
inability to perform certain exercises, modifications should be made, and
exercises should focus on strengthening the areas that a patient is able
to.  Furthermore, most of the proximal
exercises can easily be done without the need for expensive equipment, which is
commonly needed for knee exercises.  The
results of this review should be interpreted with caution as they did not focus
on studies that did  a direct comparison
of proximal and knee exercises.  Another
limitation recognized by the authors was that interventions are recommended to
be daily with 2 to 4 sets of 10 repetitions for more for six or more weeks; however,
more than half of the included studies did less than this.  The studies included a variety of length of
programs, exercises, participants, and randomization among included studies,
which can make interpreting the results challenging.  There is a need for more high quality
research to compare standardized exercise protocols that meet minimum
recommendations.  However, despite these
limitations proximal exercises seem to be a good selection for addressing symptoms
associated with PFPS.     

Questions for Discussion: 
Given the multifactorial etiology of PFPS, are there any other variables
that you have found to be potential culprits other than hip strength?  Has anyone seen or addressed distal
(foot/ankle) interventions to alleviate PFPS?  
by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Peters JS, & Tyson NL (2013). Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review. International Journal of Sports Physical Therapy, 8 (5), 689-700 PMID: 24175148