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Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized controlled trials have, to our knowledge, directly compared HIP and KNEE programs. To compare PFP pain, function, hip- and knee-muscle strength, and core endurance between KNEE and HIP protocols after 6 weeks of rehabilitation. We hypothesized greater improvements in (1) pain and function, (2) hip strength and core endurance for patients with PFP involved in the HIP protocol, and (3) knee strength for patients involved in the KNEE protocol. Randomized controlled clinical trial. Four clinical research laboratories in Calgary, Alberta; Chicago, Illinois; Milwaukee, Wisconsin; and Augusta, Georgia. Of 721 patients with PFP screened, 199 (27.6%) met the inclusion criteria (66 men [31.2%], 133 women [66.8%], age = 29.0 ± 7.1 years, height = 170.4 ± 9.4 cm, weight = 67.6 ± 13.5 kg). Patients with PFP were randomly assigned to a 6-week KNEE or HIP protocol. Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures, which were conducted weekly. Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks. Compared with baseline, both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocols (P < .001), but the visual analog scale scores for those in the HIP protocol were reduced 1 week earlier than in the KNEE group. Both groups increased in strength (P < .001), but those in the HIP protocol gained more in hip-abductor (P = .01) and -extensor (P = .01) strength and posterior core endurance (P = .05) compared with the KNEE group. Both the HIP and KNEE rehabilitation protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol.

Background Rear-foot eversion increases the patellofemoral joint stress through the mechanism of lower extremity coupling. Therefore, the present clinical trial aimed to evaluate the effects of altering walking foot strike pattern in combination with lower extremity strengthening on lower limb alignment in females with patellofemoral pain (PFP). Methods Forty women with PFP were randomly assigned to experimental (n = 20) and control groups (n = 20). For 8 weeks, the experimental group received the forefoot strike pattern combined with foot-knee strengthening exercises. Versus, the control group during 8 weeks did not receive any intervention aimed at treating PFP. The primary outcome was self-reported pain. The secondary outcome was rear-foot eversion, dynamic knee valgus (DKV), pelvic drop, hip extensor, hip abductor, and knee extensor muscle strength, which were measured before and after 8 weeks. Covariance analysis was used to compare the results between the two groups. Results A significant difference was observed in reduced pain ( P  < 0.001, η 2  = 0.884), rear-foot eversion ( P  < 0.001, η 2  = 0.880), DKV ( P  < 0.001, η 2  = 0.740), and pelvic drop ( P  < 0.001, η 2  = 0.540). In addition, a significant difference was observed in the increase in the muscle strength of the hip extensor ( P  < 0.001, η 2  = 0.743), hip abductor ( P  < 0.001, η 2  = 0.770), and knee extensor ( P  < 0.001, η 2  = 0.811). Conclusion Eight weeks the lower limb strengthening and changes in foot strike during walking can have clinical importance in reducing self-reported pain, rear-foot eversion, DKV, and pelvic drop during a single leg squat.

Patellofemoral pain syndrome (PFPS) is the most common knee problem that affects the knee in adulthood. It is more common in females twice than in males. It has a multifactorial etiology. The effect of the combination of manual therapy and hip and knee exercises is unconfirmed till now. Therefore, the aim of this study is to investigate the effect of adding manual therapy to knee and hip exercises on pain intensity, self-reported and objective knee function, hip abductors, hip external rotators, and knee extensor strength in addition to calf, and hamstring flexibility in patients with PFPS. This was a double-blind study. Fifty-nine adult patients with PFPS matched with eligibility criteria were sequentially recruited from an outpatient clinic, and faculty students were enrolled in this study and randomized by a generated Excel sheet into two groups either control (30 patients) or manual therapy (29 patients) group. The control group received stretch and open and closed kinetic chain strength exercises, while the manual therapy group received the same exercises as the control plus patellar mobilization, iliotibial band release, and deep friction massage of lateral retinacula. This treatment was performed in the outpatient clinic for 12 sessions in 4 weeks. Fifty-three patients had only been analyzed at the end of treatment. The primary outcomes were knee pain intensity and self-reported knee function. The secondary outcomes were hip and knee muscle strength, calf and hamstring flexibility, and a step-down test. All outcomes were measured before and after 4 weeks of treatment immediately by a blind assessor. Comparing between and within groups were performed using the Multivariate analysis of variance (MANOVA) test. The mean age was 22.64 ± 3.71 years for control group, 21.92 ± 2.39 years for manual therapy group. Both treatment protocols showed significant reduction of pain (ascending ( p  < 0.001; CI: (14.85–39.44)), descending ( p  < 0.001; CI: (15.95–30.62)), squatting ( p  < 0.001; CI: (15.00-38.07)) and sitting ( p  < 0.001; CI: (13.49–37.87))) for control group, while (ascending ( p  < 0.001; CI: (20.37–39.07)), descending ( p  < 0.001; CI: (12.72–32.80)), squatting ( p  < 0.001; CI: (28.98–51.66)) and sitting ( p  < 0.001; CI: (16.72–42.24))) for manual therapy group, improvement in knee function (Kujala: ( p  < 0.001; CI: (-17.02—8.76))) for control group while (Kujala: ( p  < 0.001; CI: (-21.32—12.19))) for manual therapy group, hip and knee muscle strength and flexibility ( p  < 0.05). However, there were non-significant differences between groups in all dependent variables ( p  > 0.05). Manual therapy added to hip and knee exercises may have the same effect as hip and knee exercises without superiority to one of them. Manual therapy improved patients’ clinical outcomes, including pain and function disability, with a higher percentage of change than exercises only. Clinical trial registration : www.clinicaltrials.gov (NCT05665452). Date: 27/12/2022 .

The purpose was to determine whether the benefits of a muscle strength and power training program are superior to those achieved with muscle strength training alone in people with patellofemoral pain (PFP). Thirty-seven individuals with PFP (25.86 ± 7.62 years) were randomly assigned to a strength and power training group ( n  = 18) or strength training group ( n  = 19). Primary outcomes were pain intensity and physical functioning. Secondary outcomes were kinesiophobia, quality of life, maximal isometric torque and rate of torque development of the hip and knee and self-perception of recovery. Primary outcomes were measured at baseline, after six weeks, after 12 weeks and at three, six- and 12-months follow-ups. Secondary outcomes were measured at baseline and after 12 weeks. The significance level was 0.05. After interventions, no significant differences were found between groups for primary or secondary outcomes. No difference between groups were found for pain or physical functioning at the other assessment times. Results of this study indicated that addition of power exercises to strength training for hip and knee muscles did not result in superior benefits compared to strength training alone.

To determine the effect of a combination of a minimalist shoe and increased cadence on measures of patellofemoral joint loading during running in individuals with patellofemoral pain. Within-participant repeated measures with four conditions presented in random order: (1) control shoe at preferred cadence; (2) control shoe with +10% cadence; (3) minimalist shoe at preferred cadence; (4) minimalist shoe with +10% cadence. Fifteen recreational runners with patellofemoral pain ran on an instrumented treadmill while three-dimensional motion capture data were acquired. Peak patellofemoral joint stress, joint reaction force, knee extensor moment and knee joint angle during the stance phase of running were calculated. One-way repeated measures ANOVA was used to compare the control condition (1) to the three experimental conditions (2–4). Running in a minimalist shoe at an increased cadence reduced patellofemoral stress and joint reaction force on average by approximately 29% (p<0.001) compared to the control condition. Running in a minimalist shoe at preferred cadence reduced patellofemoral joint stress by 15% and joint reaction force by 17% (p<0.001), compared to the control condition. Running in control shoes at an increased cadence reduced patellofemoral joint stress and joint reaction force by 16% and 19% (p<0.001), respectively, compared to the control condition. In individuals with patellofemoral pain, running in a minimalist shoe at an increased cadence had the greatest reduction in patellofemoral joint loading compared to a control shoe at preferred cadence. This may be an effective intervention to modulate biomechanical factors related to patellofemoral pain.

Objectives Describe proportions of individuals with patellofemoral pain (PFP) with an unfavourable recovery over 12 months; identify clinical predictors of poor recovery at 3 and 12 months; and determine baseline values of predictors that identify those with poor 12-month prognosis. Methods An observational analysis utilised data from 310 individuals with PFP enrolled in two randomised clinical trials. Thirteen baseline variables (participant, PFP, study characteristics) were investigated for their prognostic ability. Pain, function and global recovery were measured at 3 and 12 months. Multivariate backward stepwise regression analyses (treatment-adjusted, p<0.10) were performed for each follow-up measure. Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months. Results 55% and 40% of participants had an unfavourable recovery at 3 and 12 months, respectively. Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity (β 11.36 to 24.94), Anterior Knee Pain (AKP) Scale (−4.44 to −11.33) and global recovery (OR: 2.32 to 6.11). Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures (p<0.05). Baseline duration >2 months and AKP Scale score <70/100 were associated with unfavourable 12-month recovery. Conclusions A substantial number of individuals with PFP have an unfavourable recovery over 12 months, irrespective of intervention. Knee pain duration >2 months is the most consistent prognostic indicator, followed by AKP Scale score <70. Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP, and promote early intervention to maximise prognosis. Trial registration Australian study: Australian Clinical Trials Registry (ACTRN012605000463673), ClinicalTrials.gov (NCT00118521); Dutch study: International Standard Randomised Controlled Trial Number Register (ISRCTN83938749)

Background Patellofemoral pain is a prevalent knee condition affecting up to 40% of individuals, especially females aged teens to 50 s. Standard treatments, including exercise therapy, often yield insufficient long-term results, partly due to low compliance and psychological factors like depression and catastrophizing of pain. A digital therapeutics “MORA Cure PFP,” which combines structured progressive exercise and cognitive behavioral therapy via an app, offers a solution to overcome the limitations of conventional treatment for patellofemoral pain patients. Methods To evaluate the safety and efficacy of MORA Cure PFP, a two-arm controlled trial will enroll 216 patients diagnosed with patellofemoral pain randomly assigned in a 1:1 ratio to treatment and control groups. The treatment group will use the app, while the control group will perform self-guided exercises using educational materials. This trial aims to determine if the treatment group shows greater reduction in usual pain intensity scores at 8 weeks compared to the control group. Additional assessments include worst pain, knee function, depression, and pain catastrophizing levels. Discussion Key design elements of the clinical trial, such as control group selection, inclusion/exclusion criteria, number of patients, and primary endpoint, were designed with consideration for not only medical perspectives but also regulatory aspects of software as a medical device, including device approval and health technology assessment. Trial registration ClinicalTrials.gov., NCT06260865, registered 15th February 2024.

ObjectivesTo test (i) if greater foot pronation (measured as midfoot width mobility) is associated with better outcomes with foot orthoses treatment, compared with hip exercises and (ii) if hip exercises are superior to foot orthoses, irrespective of midfoot width mobility.MethodsA two-arm parallel, randomised superiority clinical trial was conducted in Australia and Denmark. Participants (18–40 years) were included who reported an insidious onset of knee pain (≥6 weeks duration); ≥3/10 numerical pain rating, that was aggravated by activities (eg, stairs, squatting, running). Participants were stratified by midfoot width mobility (high ≥11 mm change in midfoot width) and site, randomised to foot orthoses or hip exercises and blinded to objectives and stratification. Success was defined a priori as much better or better on a patient-perceived 7-point scale at 12 weeks.ResultsOf 218 stratified and randomised participants, 192 completed 12-week follow-up. This study found no difference in success rates between foot orthoses versus hip exercises in those with high (6/21 vs 9/20; 29% vs 45%, respectively) or low (42/79 vs 37/72; 53% vs 51%) midfoot width mobility. There was no association between midfoot width mobility and treatment outcome (Interaction effect p=0.19). This study found no difference in success rate between foot orthoses versus hip exercises (48/100 vs 46/92; 48% vs 50%).ConclusionMidfoot width mobility should not be used to help clinicians decide which patient with patellofemoral pain might benefit most from foot orthoses. Clinicians and patients may consider either foot orthoses or hip exercises in managing patellofemoral pain.Trial registration numberACTRN12614000260628.

Backgrounds Patellofemoral pain syndrome (PFPS) is one of the most frequent musculoskeletal disorders. Flatfoot and weakness of the hip and core muscles have been introduced as distal and proximal factors associated with this syndrome, respectively. The aim of this study is to investigate the effectiveness of a combination of a proximal strengthening exercise (PSE) program and a foot orthosis (PSEFO) on pain and function in women with PFPS and a pronated foot (PF). Methods In this randomized clinical trial (RCT), 117 female patients aged 18–40 years will be recruited through online announcements on cyberspace as well as those installed in rehabilitation and healthcare centers and gyms. Considering the inclusion criteria, the participants will be randomized into three groups of 39 (group I: practicing PSEs and wearing PSEFO; group II: practicing only PSEs; and group III: control group [CG]). Randomization will be conducted using the sequentially numbered, opaque, sealed envelope (SNOSE) technique. The intervention groups (groups I and II) will perform PSEs at gyms for 2 months at the rate of three sessions per week (each session lasting 45–60 min) under the guidance of a trainer. In addition to the PSE, group I participants will receive prefabricated polyurethane FOs with an 8° varus wedge. They will be asked to wear the orthosis for 2 h a day and then slowly increase their wearing time to a full day. The CG participants will follow their routine lives during this study. Pain, as the primary outcome, will be measured by the visual analog scale before and after the 8-week intervention program. Additionally, quality of life, disability, Q angle, performance, and dynamic balance will be evaluated as secondary outcomes using the 36-item Short Form Health Survey, the Kujala score, a goniometer, the step-down test, the unilateral squat test, the anteromedial lunge test, the bilateral squat test, and the Y-balance test, respectively. Discussion In this RCT, the effectiveness of PSEs focusing on the hip and core muscles, with and without FOs, on pain and performance among women with PFPS and PF will be investigated and compared. Trial registration The present study was approved by the Research Ethics Committee of Guilan University of Medical Sciences, Rasht, Iran (code: IR.GUILAN.REC.1402.021) and registered on the Iranian Registry of Clinical Trials (IRCT, code: IRCT20230604058380N1) at 28 July 2023.

Patellar taping and quadriceps strengthening exercises are commonly used in physiotherapy to manage patellofemoral pain syndrome (PFPS). However, previous research has reported inconsistent findings regarding quadriceps strength gains at specific knee angles during strength training in individuals with PFPS. This study investigated the efficacy of patellar taping and quadriceps isometric strength training (quadriceps-IST) at 60° knee flexion on quadriceps strength, pain, and functional performance in female patients with PFPS. A two-arm, parallel-group, randomized comparative design was employed. Sixty adult females with PFPS were randomly assigned to either the experimental group (  = 30), which received patellar taping combined with quadriceps strength training at 60°, or the control group (  = 30), which received placebo taping with the same training. Both interventions lasted six weeks. Pain intensity, quadriceps muscle strength, and functional performance were assessed using the numeric pain rating scale (NPRS), maximum voluntary isometric contraction (MVIC) at 60° knee flexion, single leg triple hop (SLTH) test, and anterior knee pain scale (AKPS). For within and between groups comparison, a Wilcoxon signed-rank test and a Mann-Whitney U tests was employed, with confidence interval (α) set at 95%. Within-group analysis showed significant improvements in NPRS and MVIC at 60° knee flexion, SLTH, and AKPS scores post-intervention (  < 0.05). Between-group comparisons revealed that the experimental group had significantly greater improvements in all outcomes at six weeks post-intervention. Additionally, the pre-to-post changes ( , mean difference scores) were larger in the experimental group compared to the control group, which confirmed the superiority of the experimental group over the control group. The study demonstrates that patellar taping combined with quadriceps -IST at a 60° knee flexion improves pain, muscle strength, and functional performance compared to placebo taping combined with quadriceps-IST. These findings suggest that incorporating this combined approach may enhance rehabilitation outcomes for patients with PFPS, providing a valuable addition to clinical practice. This study was registered prospectively in the ClinicalTrials.gov PRS under a trial identifier NCT05168332 and last updated date 15/03/2024.