Sports Health. Acta Orthop Traumatol Turc. Identification of individuals with patellofemoral pain whose symptoms improved after a combined program of foot orthosis use and modified activity: a preliminary investigation. At 60°/s and 180°/s for the concentric quadriceps-to-concentric hamstrings ratio, the limb with PFP had mean ± SD ratios of 1.18 ± 0.21 and 1.02 ± 0.44, respectively, and the control limb had ratios of 1.36 ± 0.57 and 1.35 ± 0.32, respectively. J Foot Ankle Res. While acupuncture is not practiced by physical therapists in the United States, it is practiced by physical therapists in other countries, such as the United Kingdom and Australia. It was originally designed for patients following knee ligament surgery but has been studied in other populations, including patients with PFP.101 Psychometric properties of the Lysholm scale are reported in the Systematic Reviews section under Esculier et al.101, The Lysholm scale has been translated and cross-culturally adapted into Turkish, with psychometric evidence to support its use.46. https://doi.org/10.1016/j.jbmt.2017.06.005, Günay E, Sarıkaya S, Özdolap Ş, Büyükuysal Ç. https://doi.org/10.1016/S0003-9993(97)90005-8, Bonacci J, Hall M, Saunders N, Vicenzino B. Gait retraining versus foot orthoses for patellofemoral pain: a pilot randomised clinical trial. 2015;16:215–221. Phys Med Rehabil Clin N Am. Clinicians may include specific patient education on load management, body-weight management when appropriate, the importance of adherence to active treatments like exercise therapy, biomechanics that may contribute to relative overload of the PFJ, the evidence for various treatment options, and kinesiophobia. The patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF): development and validation using the COSMIN checklist. A quadriceps index is calculated as a strength test score after testing is completed: (involved-side maximum force/uninvolved-side maximum force) × 100. pThe individual assumes a supine position on a mat table, with the hip of the tested leg flexed to 90° and the contralateral limb flush on the mat table. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. The Patellofemoral Pain Syndrome Severity Scale (PSS) is a 10-item VAS questionnaire for knee pain severity during various activities in persons with AKP, scored out of 100, with higher scores indicating less disability. https://doi.org/10.1589/jpts.29.1341, Khayambashi K, Fallah A, Movahedi A, Bagwell J, Powers C. Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial. Med Sci Monit. https://doi.org/10.2519/jospt.1985.7.3.115. 1994;159:421–426. J Orthop Sports Phys Ther. Patellofemoral pain: an enigma explained by homeostasis and common sense. The effects of joint mobilization on individuals with patellofemoral pain: a systematic review. Crepitus is a first indication of patellofemoral osteoarthritis (and not of tibiofemoral osteoarthritis). https://doi.org/10.1177/0363546513489284, Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Clin Biomech (Bristol, Avon). Knee Surg Sports Traumatol Arthrosc. bThe individual is supine, with knees extended. Differential diagnosis, The tibial tubercle–trochlear groove distance is greater in patients with patellofemoral pain: implications for the origin of pain and clinical interventions, Trainees with displaced hip fractures present to physical therapy with primary complaint of knee pain, Translation and cultural adaptation of the Turkish Lysholm knee scale: ease of use, validity, and reliability, Validation of outcome measures in patients with patellofemoral syndrome, Chinese adaptation and validation of the Patellofemoral Pain Severity Scale, Chinese translation and validation of the Kujala scale for patients with patellofemoral pain, A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture, Hip pain and mobility deficits—hip osteoarthritis: revision 2017, Hip pain and mobility deficits — hip osteoarthritis, Physiotherapy for anterior knee pain: a randomised controlled trial, Effectiveness of exercise therapy in treatment of patients with patellofemoral pain syndrome: systematic review and meta-analysis, Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial, 2018 consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017, Prognostic factors for patellofemoral pain: a multicentre observational analysis, Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials, Pain during prolonged sitting is a common problem in persons with patellofemoral pain, Adolescent knee pain and patellar dislocations are associated with patellofemoral osteoarthritis in adulthood: a case control study, Diagnostic accuracy and association to disability of clinical test findings associated with patellofemoral pain syndrome, Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review, Reliability of the modified Foot Posture Index, Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome, Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. They reported no differences in peak torque (isometric strength) and total work (endurance) for the hip abductors, external rotators, and internal rotators. Exercise therapies consist of knee- and/or hip-targeted exercises performed in weight-bearing or non–weight-bearing positions, or both. E-mail: Clinical Practice Guidelines: Patellofemoral Pain, Strength testing with a portable dynamometer: reliability for upper and lower extremities, Carryover effect of hip and knee exercises program on functional performance in individuals with patellofemoral pain syndrome, Reliability and validity of the Hip Stability Isometric Test (HipSIT): a new method to assess hip posterolateral muscle strength, Relationship between frontal plane projection angle of the knee and hip and trunk strength in women with and without patellofemoral pain, Cross-cultural adaptation and psychometric properties testing of the Arabic Anterior Knee Pain Scale. Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. https://doi.org/10.2519/jospt.2010.0304, Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges JJ. J Orthop Sports Phys Ther. 2014;9:564–582. Crossley et al73 developed and evaluated a new KOOS subscale, the patellofemoral pain and osteoarthritis subscale (KOOS-PF). Abbreviations: COSMIN, COnsensus-based Standards for the selection of health status Measurement INstruments; CS, can't say; N, no; Y, yes. The influence of patellofemoral pain on lower limb loading during gait. Only 25% of adolescents and 23% of adults reported functional recovery at 1 year. 2004;22:267–274. J Sport Rehabil. A systematic literature review with meta-analysis, Validation and cultural adaptation of “Kujala Score” in Spanish, Physical activity levels in individuals with and without patellofemoral pain, Demographic and epidemiological trends in patellofemoral pain, Trunk and lower extremity segment kinematics and their relationship to pain following movement instruction during a single-leg squat in females with dynamic knee valgus and patellofemoral pain, Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: a systematic review, The role of foot orthoses as an intervention for patellofemoral pain, Effectiveness of the kinesiotaping in the patellofemoral pain syndrome, Correlation between quadriceps to hamstring ratio and functional outcomes in patellofemoral pain, Two-dimensional frontal plane projection angle can identify subgroups of patellofemoral pain patients who demonstrate dynamic knee valgus, Patellofemoral pain syndrome: validity of clinical and radiological features, Patellofemoral pain syndrome managed by ischemic compression to the trigger points located in the peri-patellar and retro-patellar areas: a randomized clinical trial, Patellofemoral pain in athletes: clinical perspectives, Sport specialization's association with an increased risk of developing anterior knee pain in adolescent female athletes, Individuals with patellofemoral pain have less hip flexibility than controls regardless of treatment outcome, Classification of lower extremity movement patterns based on visual assessment: reliability and correlation with 2-dimensional video analysis. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. They prospectively followed the runners and reported that 17 participants developed PFP. Reliability of measures of impairments associated with patellofemoral pain syndrome. Am J Prev Med. J Am Acad Orthop Surg. Multiple biomechanical and neuromusculoskeletal factors related to the knee, hip, ankle, and trunk/pelvis have been reported to be associated with PFP.19,20,172,206,241,286 Similar to low back pain, clinicians recognize that PFP is not a homogeneous condition, and response to intervention varies.18,311 As a result, several classification systems with subcategories of PFP have been proposed for nonsurgical management of patients. 10 Hypothesis: Treatment designed according to subgroups improves clinical outcomes in 11 patients unresponsive to multimodal treatment. Correlation between quadriceps to hamstring ratio and functional outcomes in patellofemoral pain. Foot and ankle characteristics in patellofemoral pain syndrome: a case control and reliability study. https://doi.org/10.1007/s40279-016-0545-6. A prospective study. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. ; (16) For continuous scores: Were correlations between change scores, or the area under the ROC calculated? Clinicians should also use perfor-mance of other functional activities that load the patellofemoral joint (PFJ) in a flexed position, such as stair climbing or descent, as diagnostic tests for PFP. Knee pain and mobility impairments: meniscal and articular cartilage lesions revision 2018. The cited evidence to support high-volume exercise is from a single cohort and lacked a control group of wait and see. https://doi.org/10.1093/ptj/84.1.49, Swart NM, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M. The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review. Magn Reson Imaging Clin N Am. 2015;46:147–157. 2006;451:223–228. Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password, Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. Int J Sports Phys Ther. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association, 23 September 2020 | Journal of Foot and Ankle Research, Vol. 2013;29:531–535. The NPRS has evidence for responsiveness to change. https://doi.org/10.2519/jospt.2017.0301, Cibulka MT, White DM, Woehrle J, et al. Clinicians may use the patellar tilt test with the presence of hypomobility to support the diagnosis of PFP. A pathoanatomical/medical diagnosis of PFP can provide valuable information in describing tissue pathology and may assist in nonoperative planning and prognosis. J Orthop Sports Phys Ther. Continuous Quality Improvement in a Pandemic: Supporting innovation and resiliency during COVID-19 (Session 1 of 2) - Registration Required 2013;99:126–131. 2012;34:2259–2263. https://doi.org/10.1053/apmr.2001.26253, Lake DA, Wofford NH. Arch Phys Med Rehabil. The Cochrane review noted the very low quality of evidence and heterogeneity of the types of braces (knee brace, sleeve, and strap) across the various studies.267. Ghourbanpour A, Talebi GA, Hosseinzadeh S, Janmohammadi N, Taghipour M. Effects of patellar taping on knee pain, functional disability, and patellar alignments in patients with patellofemoral pain syndrome: a randomized clinical trial. Physiotherapy. ; (6) Was the percentage of missing items given? https://doi.org/10.7547/0980007, Décary S, Frémont P, Pelletier B, et al. Psychological stress negatively influences recovery. 2017;29:1341–1347. 2017;63:299–306. 2018;21:123–128. Int J Athl Ther Train. Only 19.2% of people could sit without pain.61 Pain with prolonged sitting had low to moderate diagnostic accuracy in an earlier systematic review.64, A systematic review of reviews concluded that AKP produced by functional tasks such as squatting, stair climbing, and sitting with flexed knees is currently the best diagnostic indicator of PFP.222. https://doi.org/10.3109/09638288.2012.683480, Papadopoulos C, Constantinou A, Cheimonidou AZ, Stasinopoulos D. Greek cultural adaption and validation of the Kujala anterior knee pain scale in patients with patellofemoral pain syndrome. ; (9) Was the translation reviewed by a committee (eg, original developers)? An injury prevention program had no effect on PFP or other lower extremity overuse injuries in military recruits.38 Brushøj et al38 developed a prevention program to address common impairments (eg, gluteal and quadriceps muscle weakness, quadriceps tightness, and increased knee valgus during squatting and lunging tasks) for military recruits prior to beginning a 3-month basic training program. Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? 2014;19:517–526. 80 The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged … https://doi.org/10.1016/j.ptsp.2012.11.003, Peat G, Bergknut C, Frobell R, Jöud A, Englund M. Population-wide incidence estimates for soft tissue knee injuries presenting to healthcare in southern Sweden: data from the Skåne Healthcare Register. 2004;85:815–822. ‖High-quality prevalence study is a cross-sectional study that uses a local and current random sample or censuses. The authors propose a classification system for PFP, with subcategories named according to the primary impairments. ; (5) Was a list of studies (included and excluded) provided? Objective Develop a comprehensive contemporary guide to conservative management of PFP outlining key considerations for clinicians to follow. The KOS-ADLS was deemed more reliable than the IKDC. J Orthop Sports Phys Ther. Arch Phys Med Rehabil. Interventions to consider combining with exercise therapy include foot orthoses, patellar taping, patellar mobilizations, and lower-limb stretching. The FIQ median change score could discriminate between those who improved and those who were worse or stayed the same.70 The treatment effect size was 0.49.70 The FIQ had an MCID of 2 points or 13% of the total score.70, Selfe et al259,260 investigated the reliability and validity of the modified FIQ in 77 participants (66.2% female). The stationary arm of the goniometer is aligned with the fibular head. Frontal plane knee and hip kinematics during sit-to-stand and proximal lower extremity strength in persons with patellofemoral osteoarthritis: a pilot study. https://doi.org/10.2519/jospt.2015.5987, Mauro CS, Irrgang JJ, Williams BA, Harner CD. 2009;44:7–13. Clinicians should combine physical therapy interventions for the treatment of patients with PFP, which results in superior outcomes compared with no treatment, flat shoe inserts, or foot orthoses alone in the short and medium term. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made based on clinician experience and expertise in light of the clinical presentation of the patient, the available evidence, available diagnostic and treatment options, and the patient's values, expectations, and preferences. Trunk and lower extremity segment kinematics and their relationship to pain following movement instruction during a single-leg squat in females with dynamic knee valgus and patellofemoral pain. 2010;40:736–742. 13, No. ; (5) Was the expertise of the people involved in the translation process adequately described? https://doi.org/10.2165/11594460-000000000-00000. https://doi.org/10.1016/j.apmr.2017.10.014, Décary S, Ouellet P, Vendittoli PA, Desmeules F. Reliability of physical examination tests for the diagnosis of knee disorders: evidence from a systematic review. Clipboard, Search History, and several other advanced features are temporarily unavailable. The patellofemoral joint (PFJ) comprises the articulation between the patella and the trochlear groove of the femur. 2016;37:72–76; quiz 77. https://doi.org/10.1542/pir.2015-0041, Wolf M. Knee pain in children, part III: stress injuries, benign bone tumors, growing pains. An additional cross-sectional study that was not reported in the systematic review also reported no association between Q angle and peak knee abduction moment in healthy runners with PFP.224, A prospective study of college-aged physical education students found an association of decreased quadriceps flexibility, shorter reflex response time of the vastus medialis oblique muscle, reduction of vertical jump height, and higher than normal medial patellar mobility with occurrence of PFP.313. They reported limited evidence for several factors as predictors of pain: frequency of pain, pain catastrophizing, fear avoidance, AKPS scores, quadriceps cross-sectional area, and muscle recruitment. Hip strength is greater in athletes who subsequently develop patellofemoral pain. 2015;45:153–161. 2002;36:95–101. eCollection 2017. https://doi.org/10.3138/physio.62.1.17, Cook C, Mabry L, Reiman MP, Hegedus EJ. Describe evidence-based physical therapy practice, including diagnosis, prognosis, intervention, and assessment of outcome, for musculoskeletal disorders commonly managed by orthopaedic physical therapists, Classify and define common musculoskeletal conditions using the World Health Organization's terminology related to impairments of body function and body structure, activity limitations, and participation restrictions, Identify interventions supported by current best evidence to address impairments of body function and structure, activity limitations, and participation restrictions associated with common musculoskeletal conditions, Identify appropriate outcome measures to assess changes resulting from physical therapy interventions in body function and structure as well as in activity and participation of the individual, Provide a description to policy makers, using internationally accepted terminology, of the practice of orthopaedic physical therapists, Provide information for payers and claims reviewers regarding the practice of orthopaedic physical therapy for common musculoskeletal conditions, Create a reference publication for orthopaedic physical therapy clinicians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of orthopaedic physical therapy, The presence of retropatellar or peripatellar pain, Reproduction of retropatellar or peripatellar pain with squatting, stair climbing, prolonged sitting, or other functional activities loading the PFJ in a flexed position, Exclusion of all other conditions that may cause AKP, including tibiofemoral pathologies. Examination: Physical Impairments/Activity Limitations, COSMIN Systematic Review, Examination: Physical Impairments/Activity Limitations, Level of Evidence. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Phys Ther Rev. The median classification rates were high in both healthy athletes (86%) and in athletes with PFP (99%). A classification system based on symptoms and physical examination findings would be useful to guide the physical therapist's plan of care.258,261,262 Such a classification system would be useful to select interventions for persons with PFP. Thijs et al281 conducted a prospective study of male and female officer cadets entering a military academy and initiated a 6-week intensive physical training program. This may be partly due to the pain generated from the PFJ through arthrogenic inhibition. 1980;60:1410–1415. These PROMs demonstrated moderate to high correlations (r>0.5) in samples including patients with PFP. J Orthop Res. Clinical relevance: https://doi.org/10.1177/0269215506071259, Giles L, Webster KE, McClelland J, Cook JL. Pain with prolonged sitting was found to have low to moderate diagnostic accuracy in an earlier systematic review,64 which suggests that its presence may be a diagnostic indicator for PFP (TABLE 2). In a group of 15 patients with PFP, the GRS was strongly associated with the KOS-ADLS (r = 0.85) and with the KOS-SAS (r = 0.88). https://doi.org/10.1080/09593980600724246, Nijs J, Van Geel C, Van der auwera C, Van de Velde B. The differential diagnosis should also consider conditions local to the knee, for example, ligamentous (cruciate and collateral) injuries, meniscus injuries, articular cartilage injuries, OA, distal iliotibial band syndrome (ITBS), quadriceps and patellar tendinopathies, plica syndrome, patellar (Sinding-Larsen-Johansson lesion) and tibial (Osgood-Schlatter lesion) apophysitis, and patellar subluxation or dislocation (instability). J Orthop Sports Phys Ther. Due to the heterogeneous nature and combination of multiple interventions for the treatment of individuals with PFP, results are often provided based on combined interventions. Cowan SM, Bennell KL, Hodges PW. Van Cant J, Pineux C, Pitance L, Feipel V. Hip muscle strength and endurance in females with patellofemoral pain: a systematic review with meta-analysis. The tibial tubercle–trochlear groove distance is greater in patients with patellofemoral pain: implications for the origin of pain and clinical interventions.