Papers

Proximal muscle rehabilitation is effective for PFP: A SR with MA.

(Lack, Barton, Sohan, Crossley, & Morrissey, 2015)

Aims: This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP; (2) compares the efficacy of various rehabilitation protocols; and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group.

Methods: SR, 2 independent reviewers, PEDro scale and a PFP inclusion/exclusion criteria checklist. 12 studies included.

Results: Strong evidence indicates proximal combined with quadriceps rehabilitation is significantly better at reducing pain than quadriceps rehabilitation alone. Moderate evidence indicates proximal rehabilitation is better at improving pain compared to quadriceps rehabilitation alone. In the medium term, strong and moderate evidence indicates proximal and proximal combined with quadriceps rehabilitation, respectively, is more effective at reducing pain then quadriceps rehabilitation alone. In the longer term, limited evidence indicates proximal combined with quadriceps rehabilitation is more effective at reducing pain than quadriceps rehabilitation alone. Greater improvements in function were also reported for proximal, and proximal combined with quadriceps rehabilitation compared with quadriceps rehabilitation alone in the short (strong evidence), medium (strong to moderate evidence) and longer (limited evidence) term.

Unknown which protocol is the most efficacious to reduce pain, in the medium and long term. In terms of function, low quality evidence.

Limitations: Variability in study design, type of protocol (OKC or CKC), and differing outcome measures limited further data pooling. Data reporting lacks in included studies.

In Practice: These findings support the implementation of proximal muscle rehabilitation programmes for the management of PFP in clinical practice. Strength, strength-endurance and neuromuscular activity of proximal musculature are effective in the management of PFP and should be incorporated in clinical practice. As none is superior it can allow clinicians to be guided by patient response, preference or available equipment, without negatively impacting on patient care.

Lack, S., Barton, C., Sohan, O., Crossley, K., & Morrissey, D. (2015). Proximal muscle rehabilitation is effective for patellofemoral pain: A systematic review with metaanalysis. British Journal of Sports Medicine, 49(21), 1365–1376. https://doi.org/10.1136/bjsports-2015-094723

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