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Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis
  1. Simon Lack1,
  2. Christian Barton1,2,3,4,
  3. Oliver Sohan1,
  4. Kay Crossley5,
  5. Dylan Morrissey1,6
  1. 1Centre for Sports and Exercise Medicine, Queen Mary University of London, UK
  2. 2Complete Sports Care, Melbourne, Australia
  3. 3Pure Sports Medicine, London, UK
  4. 4Lower Extremity Gait Studies, Health Sciences, La Trobe University, Bundoora, Australia
  5. 5School of Health and Rehabilitation Sciences, University of Queensland, Brisbance, Queensland, Australia
  6. 6Physiotherapy Department, Bart's Health NHS Trust, London, UK
  1. Correspondence to Dr Dylan Morrissey, Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft road, London E1 4DG, UK; d.morrissey{at}qmul.ac.uk

Abstract

Background Proximal muscle rehabilitation is commonly prescribed to address muscle strength and function deficits in individuals with patellofemoral pain (PFP). This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP; (2) compares the efficacy of various rehabilitation protocols; and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group.

Methods Web of Knowledge, CINAHL, EMBASE and Medline databases were searched in December 2014 for randomised clinical trials and cohort studies evaluating proximal rehabilitation for PFP. Quality assessment was performed by two independent reviewers. Effect size calculations using standard mean differences and 95% CIs were calculated for each comparison.

Results 14 studies were identified, seven of high quality. Strong evidence indicated proximal combined with quadriceps rehabilitation decreased pain and improved function in the short term, with moderate evidence for medium-term outcomes. Moderate evidence indicated that proximal when compared with quadriceps rehabilitation decreased pain in the short-term and medium-term, and improved function in the medium term. Limited evidence indicated proximal combined with quadriceps rehabilitation decreased pain more than quadriceps rehabilitation in the long term. Very limited short-term mechanistic evidence indicated proximal rehabilitation compared with no intervention decreased pain, improved function, increased isometric hip strength and decreased knee valgum variability while running.

Conclusions A robust body of work shows proximal rehabilitation for PFP should be included in conservative management. Importantly, greater pain reduction and improved function at 1 year highlight the long-term value of proximal combined with quadriceps rehabilitation for PFP.

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