TableĀ 1

Best Practice Guide to Conservative Management of Patellofemoral Pain

EducationActive rehabilitationPassive interventions
  1. Ensure the patients understands potential contributing factors to their condition and treatment options

  2. Advise of appropriate activity modification

  3. Manage the patients expectations regarding rehabilitation

  4. Encourage and emphasise the importance of participation in active rehabilitation

  1. Give preference to CKC exercises to replicate function

  2. Consider OKC exercises in early stages of rehabilitation to target specific strength deficits and movements

  3. Provide adequate supervision in the early stages to ensure correct exercise techniques, but progress to independence as soon as possible

  4. When independent, limit the number of exercises to 3 or 4 to aid compliance

  5. Use biofeedback such as mirrors and videos to improve exercise quality

  1. Incorporate quadriceps and gluteal strengthening

  2. Target distal and core muscles where deficits exist

  3. Consider stretching, particularly of the calf and hamstrings, based on assessment findings

  4. Incorporate movement pattern retraining, particularly of the hip

Pain reduction
  1. Provide tailored patellar taping to reduce pain in the immediate term

  2. Provide PFJ braces where taping is inappropriate (e.g. skin irritation)

  3. Consider foot orthoses

Optimising biomechanics
  1. Consider foot orthoses based on assessment findings (i.e. presence of excessive dynamic pronation)

  2. Consider massage and acupuncture/dry needling to improve the flexibility of tight muscle and fasciae structures, particularly laterally

  3. Consider PFJ mobilisation but only in the presence of hypo-mobility

  4. Consider mobilisation of the ankle and first ray in the presence of sagittal plane joint restriction

  • [Italics] = based on expert opinion without supporting Level 1 evidence.