Article Text

The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning
  1. Christian John Barton1,2,3,4,
  2. Simon Lack1,
  3. Steph Hemmings1,
  4. Saad Tufail1,
  5. Dylan Morrissey1,5
  1. 1Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK
  2. 2Complete Sports Care, Melbourne, Australia
  3. 3Pure Sports Medicine, London, UK
  4. 4Lower Extremity Gait Studies, La Trobe University, Melbourne, Australia
  5. 5Physiotherapy 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} twitter @DrDylanM


Importance Patellofemoral pain (PFP) is both chronic and prevalent; it has complex aetiology and many conservative treatment options.

Objective Develop a comprehensive contemporary guide to conservative management of PFP outlining key considerations for clinicians to follow.

Design Mixed methods.

Methods We synthesised the findings from six high-quality systematic reviews to September 2013 with the opinions of 17 experts obtained via semistructured interviews. Experts had at least 5 years clinical experience with PFP as a specialist focus, were actively involved in PFP research and contributed to specialist international meetings. The interviews covered clinical reasoning, perception of current evidence and research priorities.

Results Multimodal intervention including exercise to strengthen the gluteal and quadriceps musculature, manual therapy and taping possessed the strongest evidence. Evidence also supports use of foot orthoses and acupuncture. Interview transcript analysis identified 23 themes and 58 subthemes. Four key over-arching principles to ensure effective management included—(1) PFP is a multifactorial condition requiring an individually tailored multimodal approach. (2) Immediate pain relief should be a priority to gain patient trust. (3) Patient empowerment by emphasising active over passive interventions is important. (4) Good patient education and activity modification is essential. Future research priorities include identifying risk factors, testing effective prevention, developing education strategies, evaluating the influence of psychosocial factors on treatment outcomes and how to address them, evaluating the efficacy of movement pattern retraining and improving clinicians’ assessment skills to facilitate optimal individual prescription.

Conclusions and relevance Effective management of PFP requires consideration of a number of proven conservative interventions. An individually tailored multimodal intervention programme including gluteal and quadriceps strengthening, patellar taping and an emphasis on education and activity modification should be prescribed for patients with PFP. We provide a ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’ outlining key considerations.

  • Lowever extremity
  • Knee
  • Sports physiotherapy

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