Healthy Perspective by Chris Fissel


Effects of Exercise on Decreasing Pain and Improving Function in Patellofemoral Knee Pain by Chris Fissel

Patellofemoral pain is the most common condition in individuals under 50 with knee complaints, with higher incidence in women.  Approximately 25% of sports participants and 40% of military trainees will experience the symptoms.  Typically described as pain under or around the kneecap (patella), symptoms increase after prolonged sitting, squatting, kneeling, running or climbing stairs.  Muscle imbalances, particularly quadriceps weakness, may be the primary risk factor.  Patellar malalignment, overuse, joint defects, and biomechanical abnormalities of the hip/pelvis and ankle are also proposed causes.

If symptoms are not alleviated with rest alone, exercise prescription may be indicated as a conservative measure.  Multiple studies have shown reduction in pain, as measured by a visual analog scale, and improved function, as measured by national outcomes forms, with exercise intervention.  However, over time, if the  intensity of the exercise wanes, so does the functional outcome, so consistency is key.  Positive treatment effect was also only noted in individuals who were provided exercise instruction and guidelines, as compared to those who were simply told to "exercise more".

So which exercises are the most effective?  Growing empirical evidence is indicating that impaired control of the hip musculature can affect patellofemoral joint mechanics.  As such, hip strengthening has been advocated as appropriate intervention in addressing knee pain.  Randomized control studies ( the go-to in evidence-based medicine) have looked at the effects of quadriceps strengthening, general lower extremity strengthening, patellar taping techniques and foot orthotics, with good outcomes noted in programs that included hip strengthening, whether in totality or combined with other therapies.  Specifically, the combination of hip abductor, hip external rotator and knee extensor strengthening was more effective in decreasing perceived pain and improving outcomes function than quadriceps strengthening alone.  Interventions of 4-8 weeks were necessary to show a statistically significant measurable change.  Chris Fissel, Physical Therapist and Personal Trainer.  Learn more about Chis

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