A systematic review of physical interventions for patellofemoral pain syndrome

Objective: Physical interventions (nonpharmacological and nonsurgical) are the mainstay of treatment for patellofemoral pain syndrome (PFPS). Physioth erapy is the most common of all physical interventions and includes specifi c vastus medialis obliquus or general quadriceps strengthening and/or reali gnment procedures (tape, brace, stretching). These treatments appear to be based on sound theoretical rationale and have attained widespread acceptanc e, but evidence for the efficacy of these interventions is not well establi shed. This review will present the available evidence for physical interven tions for PFPS. Data Sources: Computerized bibliographic databases (MEDLINE, Current Conten ts, CINAHL) were searched, including the keywords "patellofemoral," "patell a," and "anterior knee pain," combined with "treatment," "rehabilitation," and limited to clinical trials through October 2000. Study Selection: The critical eligibility criteria used for inclusion were that the study be a controlled trial, that outcome assessments were adequat ely described, and that the treatment was a nonpharmacological, nonsurgical physical intervention. Results: Of the 89 potentially relevant titles, 16 studies were reviewed an d none of these fulfilled all of the requirements for a randomized, control led trial. Physiotherapy interventions were evaluated in eight trials, and the remaining eight trials examined different physical interventions. Signi ficant reductions in PFPS symptoms were found with a corrective foot orthos is and a progressive resistance brace, but there is no evidence to support the use of patellofemoral orthoses, acupuncture, low-level laser, chiroprac tic patellar mobilization, or patellar taping. Overall the physiotherapy in terventions had significant beneficial effects but these interventions were not compared with a placebo control. There is inconclusive evidence to sup port the superiority of one physiotherapy intervention compared with others . Conclusions: The evidence to support the use of physical interventions in t he management of PFPS is limited. There appears to be a consistent improvem ent in short-term pain and function due to physiotherapy treatment, but com parison with a placebo group is required to determine efficacy, and further trials are warranted for the other interventions.