The aetiology of patellofemoral pain (PFP) is a complex interplay among various anatomical, biomechanical, psychological, social and behavioural influences. Numerous factors associated with PFP have been reported in the literature, but the interaction between these proposed risk factors and the clinical entity of PFP remains unclear (figure 1).



Figure 1 
Schematic overview of potential pathways to elevated patellofemoral joint (PFJ) stress, a proposed contributor to patellofemoral pain.



The goal of this consensus document is to place known associated factors within the context of a pathomechanical model of PFP. An underlying assumption of the proposed pathomechanical model is that PFP is associated with abnormal loading of the patellofemoral joint (elevated joint stress). In this model, abnormal loading could affect the various patellofemoral structures that can contribute to nociception (ie, subchondral bone, infrapatellar fat pad, retinaculum and ligamentous structures); however, the specific tissue sources related to PFP are not known.

The experience of PFP is not just nociception.1 Persons with persistent PFP exhibit abnormal nociceptive processing (ie, widespread mechanical hyperalgesia, impaired pain modulation),2–5 altered somatosensory processing (implying neuropathic pain),6 impaired sensorimotor function (ie, proprioception and balance)7–10 and certain psychological factors (ie, catastrophising and kinesiophobia).11 The amount and quality of research in the non-‘patho-mechanical’ pathways to PFP are evolving, and will be included in future consensus statements emanating from the International Patellofemoral Pain Research Retreats.

At the 4th International Patellofemoral Pain  Research Retreat,12 Dr Christopher Powers presented a draft framework of the pathomechanical model, which was based on prior consensus statements from the three previous Patellofemoral Pain Research Retreats.13–15 At the meeting, all attendees (clinician-researchers and research scientists) participated in a comprehensive discussion of the draft model, and agreed on the overall framework (Figure 1). Following the retreat, the authors conducted a thorough review of pertinent literature related to …

https://bjsm.bmj.com/content/bjsports/51/24/1713.full.pdf

Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3.

Importance Patellofemoral pain (PFP) is both chronic and prevalent; it has complex aetiology and many conservative treatment options. Objective Develop a comprehensive contemporary guide to conservative management of PFP outlining key considerations for clinicians to follow. Design Mixed methods. Methods We synthesised the findings from six high-quality systematic reviews to September 2013 with the opinions of 17 experts obtained via semistructured interviews. Experts had at least 5 years clinical experience with PFP as a specialist focus, were actively involved in PFP research and contributed to specialist international meetings. The interviews covered clinical reasoning, perception of current evidence and research priorities. Results Multimodal intervention including exercise to strengthen the gluteal and quadriceps musculature, manual therapy and taping possessed the strongest evidence. Evidence also supports use of foot orthoses and acupuncture. Interview transcript analysis identified 23 themes and 58 subthemes. Four key over-arching principles to ensure effective management included—(1) PFP is a multifactorial condition requiring an individually tailored multimodal approach. (2) Immediate pain relief should be a priority to gain patient trust. (3) Patient empowerment by emphasising active over passive interventions is important. (4) Good patient education and activity modification is essential. Future research priorities include identifying risk factors, testing effective prevention, developing education strategies, evaluating the influence of psychosocial factors on treatment outcomes and how to address them, evaluating the efficacy of movement pattern retraining and improving clinicians’ assessment skills to facilitate optimal individual prescription. Conclusions and relevance Effective management of PFP requires consideration of a number of proven conservative interventions. An individually tailored multimodal intervention programme including gluteal and quadriceps strengthening, patellar taping and an emphasis on education and activity modification should be prescribed for patients with PFP. We provide a ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’ outlining key considerations.

https://bjsm.bmj.com/content/bjsports/49/14/923.full.pdf

The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': Incorporating level 1 evidence with expert clinical reasoning

The effects of additional kinesio taping over exercise in the treatment of patellofemoral pain syndrome

Published articles on iliotibial band friction syndrome have been reviewed. These articles cover the epidemiology, etiology, anatomy, pathology, prevention, and treatment of the condition. This article describes (1) the various etiological models that have been proposed to explain iliotibial band friction syndrome; (2) some of the imaging methods, research studies, and clinical experiences that support or call into question these various models; (3) commonly proposed treatment methods for iliotibial band friction syndrome; and (4) the rationale behind these methods and the clinical outcome studies that support their efficacy.

/pdf/iliotibial-band-friction-syndrome-2s2q0upq7r.pdf

Iliotibial band friction syndrome

Introduction Exercise programmes are used in the prevention and treatment of adductor-related groin injuries in soccer; however, there is a lack of knowledge concerning the intensity of frequently used exercises. Objective Primarily to investigate muscle activity of adductor longus during six traditional and two new hip adduction exercises. Additionally, to analyse muscle activation of gluteals and abdominals. Materials and methods 40 healthy male elite soccer players, training >5 h a week, participated in the study. Muscle activity using surface electromyography (sEMG) was measured bilaterally for the adductor longus during eight hip adduction strengthening exercises and peak EMG was normalised (nEMG) using an isometric maximal voluntary contraction (MVC) as reference. Furthermore, muscle activation of the gluteus medius, rectus abdominis and the external abdominal obliques was analysed during the exercises. Results There were large differences in peak nEMG of the adductor longus between the exercises, with values ranging from 14% to 108% nEMG (p Conclusions Specific hip adduction exercises can be graded by exercise intensity providing athletes and therapists with the knowledge to select appropriate exercises during different phases of prevention and treatment of groin injuries. The Copenhagen Adduction and the hip adduction with an elastic band are dynamic high-intensity exercises, which can easily be performed at any training facility and could therefore be relevant to include in future prevention and treatment programmes.

/pdf/emg-evaluation-of-hip-adduction-exercises-for-soccer-players-2pk1lglszf.pdf

Emma Darthuy

Papers

Iliotibial band tightness and patellofemoral pain syndrome: a case-control study.

Iliotibial band tightness and patellofemoral pain syndrome a case-control study