Individualized Physiotherapy in the Treatment of Patellofemoral Pain

Patellofemoral pain (PFP) is related to a wide range of local and global physical factors possibly contributing to pain and therefore necessitates detailed assessment and individualized treatment. However, no cohort study was found that assessed the value of individualized physiotherapy, probably because this approach lends itself to clinical practice but not to scientific research. Most studies focus on a ‘knee’ or ‘hip’ treatment approach irrespective of individual global differences in lower limb alignment, movement patterns and muscle tightness. Therefore, this study had the objective of determining the effectiveness of supplementing local treatment of PFP with individualized treatment targeting global contributing factors. Secondarily it aimed to subgroup the patients according to variations in lower limb alignment/laxity, movement patterns, biarticular muscle tightness and joint degeneration. Forty-one patients (60 knees) with PFP who had followed a programme of local quadriceps strengthening, quadriceps stretching and taping for one fortnight were prescribed an individualized programme based on assessment. This global assessment included lower limb postural alignment, movement patterns, muscle tightness and range of motion. Another fortnights treatment was prescribed accordingly and included specific, individualized postural and movement retraining, stretching and functional weight-bearing, strengthening exercises. Seven outcome measures, namely four pain measures, isokinetic quadriceps strength, quadriceps length and eccentric knee control, assessed improvement. All outcome measures exhibited further significant improvement after individualized treatment (p < 0.03). Patients fell into four broad physical subgroups: hypermobility (often with malalignment), hypomobility (with three of four tight muscle groups), faulty movement patterns (mostly dynamic knee valgus) and patellofemoral osteoarthritis.

The study showed that individualized treatment augmenting local standard physiotherapy for PFP leads to further significant improvement over 2 weeks. This study highlights the importance of assessing patients globally so that treatment and ongoing improvement may optimized. Recognition of different subgroups may guide treatment that should include both local and deficit-targeted global treatment.