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Another major win for physiotherapy — curing patellofemoral pain
  1. Karim M Khan
  1. Dr Karim M Khan, Professor UBC, Centre for Hip Health and Mobility, Suite 320 - 5950 University Blvd, Vancouver V6T 1Z3, Canada; karim.khan{at}

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Thanks for the positive feedback about BJSM’s recent articles – particularly the January ( and February ( issues edited by Professor Steven Blair. Many emails supported the claims that physical activity is the most powerful single medical intervention.1 The downside is that Neville Owen has made me feel guilty if I sit for a mere 12 hours.2 The result? Ageing BJSM editor shuffling around the streets of Vancouver at 10 pm getting his “fix” in 3°C temperatures. The voices of Steven Blair and Art Kramer in my head3 penetrating the usual cacophony, “30–60 minutes a day keeps dementia at bay”. “Too late!” you say?


Coincidentally with this month’s cover story, we learn that Jenny McConnell received Australia’s highest honour — the Order of Australia Medal (OAM) — for her “service to physiotherapy as a practitioner and researcher, particularly through the development of innovative musculoskeletal pain management and treatment”. Her cataclysmic 1986 paper4 timestamps the revolution in managing patellofemoral pain with a focused exercise programme. Young clinicians will have trouble imagining patients hobbled with chronic anterior knee pain being told to “retire” (the 1970s panacea for musculoskeletal pain). The more “enlightened” solution was referral for surgeries ranging from “lateral release” to the gruesome “Macquet procedure”. Most unfortunately, one unsatisfied surgical patient actually shot a medical receptionist, ostensibly because of the frustration of chronic knee pain. I apologise for resurrecting painful memories but do so neither flippantly nor gratuitously. I underscore the serious nature of our clinical work and the importance of innovations that improve patients' quality of life.

By providing solutions, physiotherapists, and subsequently enlightened physicians, have reframed patellofemoral pain from a static, degenerative condition to one that results from dynamic “malalignment” or “timing failure”. I see parallels with Paul Hodges’ and others changing our perception of the spine from being a “structural stack” to a finely tuned cylinder and much more.5

This month, BJSM shares Collins and colleagues’ paper from the BMJ (see page 169),6 which investigated a common clinical combination — exercise prescription plus orthoses — for patellofemoral pain. And on the subject of orthoses, please see the evidence-based guide to prescribing running shoes (see page 159).7


The scourge of preventable ACL injuries remains ever-present.7 If your daughter’s basketball or soccer team is not engaged in preventive programmes,7 8 speak to the coach and if that doesn’t work call your Member of Parliament. Still no good? Consider the World Court (officially known as the International Court of Justice — This is serious. You wouldn’t send your kid out cross-country skiing mid-winter in a bikini. Prevention is based on understanding mechanisms and this month we learn about knee joint laxity and its changes during phases of the menstrual cycle from the renowned McCaig Centre at the University of Calgary (see page 174).9 And in keeping with Obama’s potentiating stem cell research in the US, (see pages 195 and 221)10 11 we examine exercise influences on multipotential stem cells (the MSCs above). Physical activity influences everything!

You’ll love the I-test — BJSM’s new imaging feature (see pages 172 and 173).12 13 It vivifies BJSM’s commitment to (a) innovation (research), (b) education (I-test and e-learning) and (c) knowledge translation — highlighting programmes that work. I thank editor colleague Dr Babette Pluim (The Netherlands) and Professor Bruce Forster (Canada) for giving BJSM readers superb educational value. (see page 158); The questions and answers are on different pages to facilitate your placing friendly bets.


This month’s cover pays homage to Da Vinci’s Vitruvian Man (AD 1487) and ( maintains the thread of our virtual theme issue (articles every month) on groin pain. Last month we launched the 3-part “3G” series — groins, gluteals and the greater trochanter as a novel clinical approach to chronic groin pain.14 15 Does that pathoanatomical approach simplify it for you? Or are you an advocate of Holmich’s tests,16 17 or the Bradshaw camp?18 Let’s hope that advances for patients soon match up to those we have seen for patellofemoral pain. And next month? Guest editor Dr Jill Cook brings you BJSM’s tendinopathy issue. Please see the new-look homepage and blog for more news! (


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  • Competing interests: None declared.

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