What are Effective Treatments for Patellofemoral Pain?
The recent paper, by Winters et al, on effective treatments for PFP is a living systematic review with network meta-analysis, meaning it analyses multiple studies and will be updated annually for at least 5 years. Its aim was to compare the effectiveness of all available treatments at 3 and 12 months’ post onset of PFP.
They used a reference group containing 7 PFP patients to decide which outcome measures were most relevant. The reference group selected the global rating of change (GROC) scale as the primary measure and pain scales as the secondary measure.
What Treatments did the Patellofemoral Pain Study Look at:
- Education Education, exercise, patella taping/mobilisation
- Education and foot orthoses
- Education, exercises, patella taping/ mobilisation and orthoses
- Wait and see
Education included information and advice on PFP pain and activity/exercise management of symptoms. Exercise was performed against resistance of either weights, bands or bodyweight with the aim of strengthening the lower limb and trunk. The orthoses were described as “prefabricated orthotics to be placed under the foot in the shoe to support the arch”.
The study looked at the results of the network meta-analysis and comparison of treatments based on the primary (GROC scale) and secondary outcome measures (pain scales), both at 3 and 12 months. 22 RCTs were included in the analysis, and this equated to 1472 patients with PFP symptoms for more than 6 weeks.
All the treatments discussed were better than “wait and see” for the GROC scale outcome measure at 3 months. With education and exercise being the most effective short term intervention. At 12 months using the primary outcome measure education or education, exercise, orthosis/patella taping/mobilisation showed similar rates of improvement.
From the secondary outcome measure analysis no treatment was superior to any other or to wait and see. The outcomes from education, exercise, patella taping/mobilisation were superior to education, exercises, patella taping/ mobilisation and orthoses at 12 months. Both of these treatment pathways were superior to education alone.
What about Load Management with Patellofemoral Pain?
Unfortunately load management was not included in the study. However, it is important that patients are educated on this to help them progress as smoothly as possible back to full fitness. Usually making sure exercise level is controlled within pain limits and that pain levels do not increase after rest.