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Long-term effects of treatment are questionable and have not been studied well

Patellofemoral pain syndrome (PFPS)-sometimes referred to as runner's knee-is a painful condition that's particularly common in physically active individuals. Patients with PFPS typically experience a dull ache behind or around the kneecap that gets worse with running or going up or down stairs. The initial treatment for PFPS is usually conservative (non-surgical) and may consist of a physical therapy program with various exercises that target the quadriceps muscles in the front of the thigh. While many studies have shown that this type of treatment is effective in the short term, long-term results are not as clearly understood. One reason for this is a lack of long-term studies that evaluate the potential benefits of conservative treatment. With this in mind, researchers conducted a follow-up study to investigate if improvements from a one-month physical therapy program in patients with PFPS were maintained three years later.

Participants are assessed at five different time points over three years

In the original study, 41 patients who had PFPS for at least one month were randomly assigned to one of four treatment programs: 1) quadriceps strengthening, 2) quadriceps stretching, 3) taping beneath the kneecap and 4) control, which did not receive any treatment. The total length of the intervention was one month, with the first week including specific exercises based on the groups participants were assigned to, and the second week consisting of a combination treatment of quadriceps strengthening, quadriceps stretching and kneecap taping. In the final two weeks, treatments were individualized to each patient and focused on aligning posture, correcting faulty movement patterns, improving knee and hip strength, stretching tight muscles and restoring flexibility. Patients were also given a home-exercise program with similar exercises to perform during these four weeks, and after completing this intervention, they were told to perform one quadriceps stretching and one quadriceps strengthening exercise daily for the next three years. All participants were assessed in seven categories at five different time points: before the intervention began, and then after one week, after two weeks, at the end of the intervention and three years later.

Majority of patients maintain their initial improvements and stick with exercise programs

Of the 41 original patients, 37 were available for the follow-up three years later. Overall, the measurements taken at this time were very similar to those taken at the completion of the intervention, which shows that patients maintained most of their improvements. In particular, all patients reported an improvement in knee pain scores when performing various physical activities, and 73% of them experienced no pain during the testing protocol. In addition, 28 of 34 patients (82%) were able to resume the sport that they had to stop because of PFPS, while three patients never played a sport in the first place. It was also found that 33 patients (89%) were continuing to do some of the exercises prescribed after completing the intervention, which probably helped improve their outcomes. The one measurement in which scores did decline was quadriceps strength, but this may simply be due to the fact that patients gained significant strength during the intervention. Nonetheless, these scores were still higher than those at the start of the study. These findings very clearly show that a physical therapy program for patients with PFPS leads to various improvements immediately after the intervention, and that these benefits appear to last for up to three years. Patients dealing with knee pain that may be related to PFPS are therefore encouraged to seek out treatment from physical therapist and to stick with their home-exercise program for the best chances of a successful long-term outcome.

-As reported in the May '16 issue of the Clinical Journal of Sports Medicine