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Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain?A randomised clinical trial
  1. Jean-Francois Esculier1,2,3,
  2. Laurent Julien Bouyer1,2,
  3. Blaise Dubois1,3,
  4. Pierre Fremont1,
  5. Lynne Moore1,
  6. Bradford McFadyen1,2,
  7. Jean-Sébastien Roy1,2
  1. 1 Faculty of Medicine, Laval University, Quebec, Canada
  2. 2 Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec, Canada
  3. 3 The Running Clinic, Quebec, Canada
  1. Correspondence to Dr Jean-Sébastien Roy, Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, 525, Boulevard Wilfrid Hamel, Quebec G1M 2S8, Canada; jean-sebastien.roy{at}


Design Single-blind randomised clinical trial.

Objective To compare the effects of three 8-week rehabilitation programmes on symptoms and functional limitations of runners with patellofemoral pain (PFP).

Methods Sixty-nine runners with PFP were randomly assigned to one of three intervention groups: (1) education on symptoms management and training modifications (education); (2) exercise programme in addition to education (exercises); (3) gait retraining in addition to education (gait retraining). Symptoms and functional limitations were assessed at baseline (T0), and after 4, 8 and 20 weeks (T4, T8 and T20) using the Knee Outcome Survey of the Activities of Daily Living Scale (KOS-ADLS) and visual analogue scales (VASs) for usual pain, worst pain and pain during running. Lower limb kinematics and kinetics during running, and isometric strength were also evaluated at T0 and T8. The effects of rehabilitation programmes were assessed using two-way analysis of variance.

Results No significant group × time interactions (p<0.447) were found for KOS-ADLS and VASs. All three groups showed similar improvements at T4, T8 and T20 compared with T0 (p<0.05). Only the exercises group increased knee extension strength following rehabilitation (group × time: p<0.001) and only the gait retraining group (group × time: p<0.001) increased step rate (+7.0%) and decreased average vertical loading rate (−25.4%).

Conclusion Even though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations. Appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP.

Trial registration number (NCT02352909).

  • Knee pain
  • Running
  • Exercise

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  • Contributors JFE, LJB, BD, PF, LM and JSR designed the study. JFE, LJB, BD, PF and JSR created the study protocol. LM is the statistician. BM contributed to laboratory data analysis. JFE and JSR directed the publication. All authors contributed to writing and approved the final version of the manuscript.

  • Funding JFE received scholarships from Canadian Institutes for Health Research (CIHR) and Fonds de recherche du Québec – Santé (FRQ-S). JSR was supported by a salary award from the CIHR and FRQ-S. This study was funded by the Réseau Provincial de Recherche en Adaptation/Réadaptation – Fonds de Recherche du Québec – Santé (REPAR/FRQ-S), Ordre Professionnel de la Physiothérapie du Québec (OPPQ), Physiotherapy Foundation of Canada (PFC) and Canadian Academy of Sport and Exercise Medicine (CASEM). The funding agencies had no role in the study design, analysis of results, writing of the manuscript or in the decision to submit for publication.

  • Competing interests None declared.

  • Ethics approval Quebec Rehabilitation Institute research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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