ChiroACCESS Clinical Review

Patellofemoral Pain Syndrome: Therapy

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.


How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)

Published on

June 18, 2009

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The difficulty with patellofemoral pain syndrome (PFPS) is not arriving at a proper diagnosis; the challenge is choosing a treatment that best addresses the etiology of the problem. Treatment can be aimed at strengthening the quadriceps, reducing foot pronation, lengthening the iliotibial tract or reducing ankle eversion, to name a few. Any of these biomechanical faults, plus many more, have been implicated in the etiology of PFPS although the evidence has not been conclusive as to their validity. The most effective interventions for PFPS must be specifically tailored for the individual patient.

The reader should note there is no treatment option that has clearly demonstrated efficacy through rigorous clinical trials.

Although it is presented as a case series, a comprehensive treatment protocol with very good outcomes was reported by Lowry et al. in 2008. Their study included many of the treatment options mentioned below with excellent descriptions as well as pictures of the interventions (1).

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Lowry CD, Cleland JA, Dyke K. Management of patients with patellofemoral pain syndrome using a multimodal approach: a case series. J Orthop Sports Phys Ther 2008 Nov;38(11):691-702.

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Messier SP, Davis SE, Curl WW, Lowery RB, Pack RJ. Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc 1991 Sep;23(9):1008-15.


Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev 2003;(4):CD003472.


Hazneci B, Yildiz Y, Sekir U, Aydin T, Kalyon TA. Efficacy of isokinetic exercise on joint position sense and muscle strength in patellofemoral pain syndrome. Am J Phys Med Rehabil 2005 Jul;84(7):521-7.


Nakagawa TH, Muniz TB, Baldon RM, Dias MC, de Menezes Reiff RB, Serrao FV. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clin Rehabil 2008 Dec;22(12):1051-60.


Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG. Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome. Arch Phys Med Rehabil 2006 Nov;87(11):1428-35.


Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Vanden Berghe L, Cerulli G. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc 2005 Mar;13(2):122-30.


Juhn MS. Patellofemoral pain syndrome: a review and guidelines for treatment. Am Fam Physician 1999 Nov 1;60(7):2012-22.


Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician 2007 Jan 15;75(2):194-202.


Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med 2002 Nov;30(6):857-65.


Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 2005 Jul;(436):100-10.


Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med 2008 Dec 3.


Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ 2008;337:a1735.


Johnston LB, Gross MT. Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther 2004 Aug;34(8):440-8.


McKenzie DC, Clement DB, Taunton JE. Running shoes, orthotics, and injuries. Sports Med 1985 Sep;2(5):334-47.


Lun V, Meeuwisse WH, Stergiou P, Stefanyshyn D. Relation between running injury and static lower limb alignment in recreational runners. Br J Sports Med 2004 Oct;38(5):576-80.


Crossley K, Bennell K, Green S, McConnell J. A systematic review of physical interventions for patellofemoral pain syndrome. Clin J Sport Med 2001 Apr;11(2):103-10.


Aminaka N, Gribble PA. A systematic review of the effects of therapeutic taping on patellofemoral pain syndrome. J Athl Train 2005 Oct;40(4):341-51.


Wilson T, Carter N, Thomas G. A multicenter, single-masked study of medial, neutral, and lateral patellar taping in individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther 2003 Aug;33(8):437-43.


Whittingham M, Palmer S, Macmillan F. Effects of taping on pain and function in patellofemoral pain syndrome: a randomized controlled trial. J Orthop Sports Phys Ther 2004 Sep;34(9):504-10.


Denton J, Willson JD, Ballantyne BT, Davis IS. The addition of the Protonics brace system to a rehabilitation protocol to address patellofemoral joint syndrome. J Orthop Sports Phys Ther 2005 Apr;35(4):210-9.


Lun VM, Wiley JP, Meeuwisse WH, Yanagawa TL. Effectiveness of patellar bracing for treatment of patellofemoral pain syndrome. Clin J Sport Med 2005 Jul;15(4):235-40.


Chew KT, Lew HL, Date E, Fredericson M. Current evidence and clinical applications of therapeutic knee braces. Am J Phys Med Rehabil 2007 Aug;86(8):678-86.


Roostayi MM, Bagheri H, Moghaddam ST, Firooznia K, Razi M, Hosseini M, et al. The effects of vacuumic bracing system on the patellofemoral articulation in patients with patellofemoral pain syndrome. Complement Ther Clin Pract 2009 Feb;15(1):29-34.


Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W. Manipulative therapy for lower extremity conditions: expansion of literature review. J Manipulative Physiol Ther 2009 Jan;32(1):53-71.


Iverson CA, Sutlive TG, Crowell MS, Morrell RL, Perkins MW, Garber MB, et al. Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule. J Orthop Sports Phys Ther 2008 Jun;38(6):297-312.


Rowlands BW, Brantingham JW. The Efficacy of Patella Mobilization in Patients Suffering from Patellofemoral Pain Syndrome. Journal of the Neuromusculoskeletal System 1999;7(4):142-9.


Callaghan MJ, Oldham JA. Electric muscle stimulation of the quadriceps in the treatment of patellofemoral pain. Arch Phys Med Rehabil 2004 Jun;85(6):956-62.


Crossley K, Bennell K, Green S, McConnell J. A systematic review of physical interventions for patellofemoral pain syndrome. Clin J Sport Med 2001 Apr;11(2):103-10.