A Randomized Controlled Trial of Physical Therapy Treatment Programs in Patellofemoral Pain Syndrome.

A Randomized Controlled Trial of Physical Therapy Treatment Programs in Patellofemoral Pain Syndrome Harrison EL, Sheppard MS, McQuarrie AM (School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada), Physiotherapy Canada. Spring 1999: 93-100.

Although physical therapy is a common component in the management of patellofemoral pain syndrome (PFPS), few prospective studies have evaluated the efficacy of different physical therapy approaches to managing PFPS. Therefore, the purpose of this study was to evaluate the efficacy of 3 physical therapy treatment approaches for PFPS.

One hundred thirteen subjects (68 women, 45 men) between the ages of 12 and 35 years (mean age=22.2 [+ or -] 8.2 years) participated in this study, and 52% of these subjects completed the study. Each subject presented with at least 2 of the following criteria: patellar pain with manual compression of the patella against the femur, patellar tenderness with palpation of the posteromedial and posterolateral borders of the patella, patellar pain during resisted dynamic knee extension, or patellar pain with manual compression of the patella against the femur during an isometric knee extension contraction.

Subjects were randomly assigned to 1 of 3 treatment groups. Group 1 received one session of education and instruction in a home exercise program of lower-extremity stretching and strengthening. Group 2 was instructed in the same program as group 1; however, their program was supervised by a physical therapist and carried out in a clinical setting 3 times a week for 4 weeks. Group 3 carried out a physical therapist-directed program in a clinical setting 3 times a week for 4 weeks, which was based on the biomechanical evaluation of the patella and lower extremity. The program consisted of lower-extremity stretching and strengthening exercises, biofeedback, patellar taping, and education.

The stretching programs in this study were based on the assessment of the following lower-extremity muscles: quadriceps femoris, tensor fasciae latae, hamstrings, and ankle plantar flexors. The strengthening programs for groups 1 and 2 included resisted hip adduction, a step down exercise, and terminal knee extension exercises that were progressed to weighted straight-leg raises. The strengthening program for group 3 focused on training the vastus medialis muscle through various exercises with biofeedback. Hip adduction strengthening was performed if a physical therapist determined that it was necessary.

Subjects were assessed at the initial evaluation and at 1-, 3-, 6-, and 12-month intervals by an investigator who was unaware of the group assignments. The following outcome measures were used: the Functional Index Questionnaire, a visual analog scale (VAS) for pain, a measure of clinical change (ie, condition worse, no improvement, some improvement, substantial improvement), a patellofemoral scale, and a step test.

No significant differences were noted between the 3 groups for sex, age, or onset of symptoms. Activity levels were similar for the 3 groups. Furthermore, at the time of initial assessment, no significant differences were noted between the 3 groups for the Functional Index Questionnaire scores or VAS scores for pain.

Over the study period, all groups had decreased pain, as well as significant improvements in Functional Index Questionnaire and patellofemoral scale scores. At the 1-month assessment, the number of subjects in group 3 who indicated higher function and substantial improvement was significantly greater than group 2. Subjects in group 3 also had significantly lower VAS scores for pain than subjects in group 2 at the 1-month assessment. No significant long-term differences, however, were noted among the 3 groups.

Although all 3 groups showed considerable improvement over the course of the study, the authors noted no long-term differences among the groups. According to these results, the authors believed that a more comprehensive program that includes biofeedback and patellar taping may produce faster improvement in patients with PFPS. In the long term, however, they thought that a home exercise program with regular follow-up may be just as effective in the treatment of PFPS as more time-and resource-intensive interventions.

Michael Ross, PT, OCS United States Air Force Academy Colorado Springs, Colo