Exercise for treating PFPS Review

(Van der Heijden, Lankhorst, Van Linschoten, Bierma-Zeinstra, & Van Middelkoop, 2015)

Aim: To assess the effects (benefits and harms) of exercise therapy aimed at reducing knee pain and improving knee function for people with patellofemoral pain syndrome.

Methods: Cochrane Review of RCT and quasi RCT about exercise for PFP, 2 indep reviewers, outcomes : pain during activity (short-term: ≤ 3 months); usual pain (short-term); pain during activity (long-term: > 3 months); usual pain (long-term); functional ability (short-term); functional ability (long-term); and recovery (long-term). 31 heterogeneous trials including 1690 participants with PFP are included.

Results: Ex vs control: Pooled data from five studies (375 participants) for pain during activity (short-term) favoured exercise therapy. The CI included (MCID) of 1.3 indicating the possibility of a clinically important reduction in pain. The same finding applied for usual pain, pain during activity (long-term) and usual pain (long-term). Pooled data from seven studies (483 participants) for functional ability (short-term) also favoured exercise therapy. Clinically important improvement in function long term 12 months.

Hip + knee : Pooled data from three studies (104 participants) for pain during activity (short-term) favoured hip and knee exercise the CI included a clinically important effect. The same applied for usual pain (short- term). One study (49 participants) found a clinically important reduction in pain during activity (long-term) for hip and knee exercise. Although tending to favour hip and knee exercises, the evidence for functional ability (short-term and long-term) and recovery (one study) did not show that either approach was superior.

Limitations: heterogeneity.

In Practice: This 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 functional ability, as well as enhancing long-term recovery. However, there is insufficient evidence to determine the best form of exercise therapy and it is unknown whether this result would apply to all people with PFPS. There is some very low quality evidence that hip plus knee exercises may be more effective in reducing pain than knee exercise alone.

Van der Heijden, R., Lankhorst, N., Van Linschoten, R., Bierma-Zeinstra, S., & Van Middelkoop, M. (2015). Exercise for treating patellofemoral pain syndrome (Review). Cochrane Database of Systematic Reviews, (1), 199. https://doi.org/10.1002/14651858.CD010387.pub2.www.cochranelibrary.com

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