Data from a new study, “Is combining gait retraining or an exercise program with education better than education alone in treating runners with patellofemoral pain? A randomized clinical trial” published in the May 2018 issue of the British Journal of Sports Medicine, reinforces the need for education on symptoms management and training modifications as part of treatment for patellofemoral pain in runners.
Study Questions Education’s Role Treating Patellofemoral Pain
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Secondary#patellofemoralpain#gaitretraining#exercises
In their study, the researchers compared the effects of three 8-week rehabilitation programs on symptoms and functional limitations of runners with patellofemoral pain (PFP).
The researchers randomly assigned 69 runners with PFP to one of three intervention groups: (1) education on symptoms management and training modifications (education); (2) exercise program in addition to education (exercises); (3) gait retraining in addition to education (gait retraining). They then assessed symptoms and functional limitations at baseline (T0) and after 4, 8 and 20 weeks (T4, T8 and T20) using the Knee Outcome Survey of the Activities of Daily Living Scale (KOS-ADLS) and Visual Analogue Scales (VASs) for usual pain, worst pain and pain during running.
They also evaluated lower limb kinematics and kinetics during running, and isometric strength at T0 and T8.
According to the analyses, there were no significant group x time interactions (p < 0.44) found for KOS-ADLS and VASs, and all three groups showed similar improvements at T4, T8, and T20 compared with T0 (p < 0.05).
In addition, only the exercises group increased knee extension strength following rehabilitation (group x time: p < 0.001) and only the gait retraining group (group x time: p < 0.00) increased step rate (+7.0%) and decreased average vertical loading rate (-25.4%).
The researchers wrote that “even though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations.”
They emphasized that “appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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