Barriers and Facilitators of Loaded Self-Managed Exercises in People with Patellofemoral Pain

Patellofemoral pain (PFP) is common with an estimated prevalence of 23% in the general population. Not all patients who develop PFP and seek physio become pain free, many develop avoidance behaviour and catastrophising thoughts about their pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with PFP. This was achieved through a mixed-methods design using semi-structured interviews after 10 PFP patients took part in a loaded self-management exercise programme (as part of a separate feasability study). 


There were 5 overlapping themes which emerged from the research with locus of control being evident throughout. All participants reported positive engagement with occasional over-dosing of the exercises which did result in some catastrophising about tissue damage. Overall both therapist and participant reported positively about the loaded exercise plan. This is interesting as typical management of PFP in the UK is multi-modal and trial and error in nature rather than adherence to one treatment style.

  1. Locus of Control
  2. Treatment Expectations & Preferences
  3. Belief & Attitude Towards Pain
  4. Engagement with The Loaded Self-Managed Exercises
  5. Physiotherapist’s Development

Clinical Implications

This is probably the biggest bit of learning from this study. That change in culture in general clinical practice is challenging but feasible. Albeit this is a small scale qualitative investigation about one condition which has clear emergent evidence that a loading programme is effective.