Nonoperative Treatment of Patellofemoral Problems: The Role of Physical Medicine and Rehabilitation

Abstract

Patellofemoral pain syndrome (PFPS) is a common cause of knee pain. It affects young active people, and its treatment is difficult, partly because its exact etiopathogenic mechanism is not completely known. The mainstay of treatment for PFPS is nonoperative management, which should be carried out by an interdisciplinary team. Before prescribing the different techniques for conservative treatment of PFPS, a full clinical and functional evaluation must be performed. The option with the best evidence is the combination of physical exercise (strengthening, flexibilization, proprioceptive, gait retraining) with other therapies. Exercise prescribed should include both the knee and the hip. The training programs offering the best clinical results are those that combine close kinetic chain and open kinetic chain exercises. Adding weight-bearing exercises and strengthening exercises with blood flow restriction may be clinically useful. There are numerous treatment options that can be used as adjuncts to therapeutic exercise. Among them, magnetotherapy, manual medicine, shoe insoles, and patellar taping can be recommended. Other treatment options like thermotherapy (both superficial and diathermy), electrotherapy (TENS, neuromuscular electrostimulation, biofeedback via EMG), ultrasound, laser, and knee orthoses (knee sleeve, knee brace, and knee strap) have not shown to be clinically effective. More studies with adequate methodological quality are recommended to better prescribe the conservative treatment of patients with PFPS.