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Cited by 185Lower Extremity Biomechanics and PathologiesTendon Structure and TreatmentMusculoskeletal pain and rehabilitation

Exercise for treating patellofemoral pain syndrome

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van der Heijden, Rianne A, Lankhorst, Nienke E, van Linschoten, Robbart, Bierma-Zeinstra, Sita MA, van Middelkoop, Marienke·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd010387.pub2PMC PMC10898323
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Abstract

BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common knee problem, which particularly affects adolescents and young adults. PFPS, which is characterised by retropatellar (behind the kneecap) or peripatellar (around the kneecap) pain, is often referred to as anterior knee pain. The pain mostly occurs when load is put on the knee extensor mechanism when climbing stairs, squatting, running, cycling or sitting with flexed knees. Exercise therapy is often prescribed for this condition. OBJECTIVES: 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. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 4), MEDLINE (1946 to May 2014), EMBASE (1980 to 2014 Week 20), PEDro (to June 2014), CINAHL (1982 to May 2014) and AMED (1985 to May 2014), trial registers (to June 2014) and conference abstracts. SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the effect of exercise therapy on pain, function and recovery in adolescents and adults with patellofemoral pain syndrome. We included comparisons of exercise therapy versus control (e.g. no treatment) or versus another non-surgical therapy; or of different exercises or exercise programmes. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Where appropriate, we pooled data using either fixed-effect or random-effects methods. We selected the following seven outcomes for summarising the available evidence: 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). MAIN RESULTS: In total, 31 heterogeneous trials including 1690 participants with patellofemoral pain are included in this review. There was considerable between-study variation in patient characteristics (e.g. activity level) and diagnostic criteria for study inclusion (e.g. minimum duration of symptoms) and exercise therapy. Eight trials, six of which were quasi-randomised, were at high risk of selection bias. We assessed most trials as being at high risk of performance bias and detection bias, which resulted from lack of blinding.The included studies, some of which contributed to more than one comparison, provided evidence for the following comparisons: exercise therapy versus control (10 trials); exercise therapy versus other conservative interventions (e.g. taping; eight trials evaluating different interventions); and different exercises or exercise programmes. The latter group comprised: supervised versus home exercises (two trials); closed kinetic chain (KC) versus open KC exercises (four trials); variants of closed KC exercises (two trials making different comparisons); other comparisons of other types of KC or miscellaneous exercises (five trials evaluating different interventions); hip and knee versus knee exercises (seven trials); hip versus knee exercises (two studies); and high- versus low-intensity exercises (one study). There were no trials testing exercise medium (land versus water) or duration of exercises. Where available, the evidence for each of seven main outcomes for all comparisons was of very low quality, generally due to serious flaws in design and small numbers of participants. This means that we are very unsure about the estimates. The evidence for the two largest comparisons is summarised here. Exercise versus control. Pooled data from five studies (375 participants) for pain during activity (short-term) favoured exercise therapy: mean difference (MD) -1.46, 95% confidence interval (CI) -2.39 to -0.54. The CI included the minimal clinically important difference (MCID) of 1.3 (scale 0 to 10), indicating the possibility of a clinically important reduction in pain. The same finding applied for usual pain (short-term; two studies, 41 participants), pain during activity (long-term; two studies, 180 participants) and usual pain (long-term; one study, 94 participants). Pooled data from seven studies (483 participants) for functional ability (short-term) also favoured exercise therapy; standardised mean difference (SMD) 1.10, 95% CI 0.58 to 1.63. Re-expressed in terms of the Anterior Knee Pain Score (AKPS; 0 to 100), this result (estimated MD 12.21 higher, 95% CI 6.44 to 18.09 higher) included the MCID of 10.0, indicating the possibility of a clinically important improvement in function. The same finding applied for functional ability (long-term; three studies, 274 participants). Pooled data (two studies, 166 participants) indicated that, based on the 'recovery' of 250 per 1000 in the control group, 88 more (95% CI 2 fewer to 210 more) participants per 1000 rec

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  • The overview authors report that the van der Heijden 2015 review did not perform subgroup analysis by pain duration (acute, subacute, chronic), which made it difficult for the overview to extract appropriate data.

    “No subgroup analysis to differentiate between acute, subacute, and chronic pain made it difficult to extract appropriate data for this review”

    From Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews (2017) · cites this paper as van der Heijden 2015

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Authors
van der Heijden, R. A., Lankhorst, N. E., van Linschoten, R., Bierma-Zeinstra, S. M., & van Middelkoop, M.
Affiliations
  • Erasmus Medical Center; Department of General Practice; Burg Jacobplein 51 Rotterdam Netherlands 3015CA
  • Erasmus MC (NL)
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-01-20
Volume
2015
Issue
1
Pages
CD010387-CD010387
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd010387.pub2
PMC
PMC10898323
OpenAlex
W1948989148
Cited by
185
References
95
Citations by year
2026: 7 · 2025: 21 · 2024: 11 · 2023: 21 · 2022: 11 · 2021: 14 · 2020: 17 · 2019: 23 · 2018: 19 · 2017: 19 · 2016: 8 · 2015: 13 · 2013: 1
FWCI
1.52
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
patellofemoral pain, exercise therapy, knee pain, knee function, anterior knee pain, adolescents, young adults, functional capacity, recovery, exercise programmes, knee extensor mechanism, conservative treatment
MeSH terms
Adult, Exercise Therapy, Humans, Selection Bias, Randomized Controlled Trials as Topic, Patellofemoral Pain Syndrome

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