Abstract
BackgroundStrong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and it remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles comprising power and strength exercises are greater than those of a program consisting of strength exercises only.MethodThis study will be a randomized controlled trial that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after 6 weeks, 12 weeks, 3 months, 6 months, and 1 year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation.DiscussionThis randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP.Trial registrationClinicalTrials.gov NCT 03985254. Registered on 26 August 2019.
Highlights
Patellofemoral pain (PFP) is characterized by retropatellar and/or peripatellar pain that is aggravated during activities that increase patellofemoral joint loading [1], with an annual prevalence in the general population of around 22.7% [2]
This randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for patellofemoral pain (PFP) rehabilitation
Other parameters of hip and knee muscle capacity seem to be altered in people with PFP, such as rate of force development (RFD) and power [12,13,14,15]
Summary
Patellofemoral pain (PFP) is characterized by retropatellar and/or peripatellar pain that is aggravated during activities that increase patellofemoral joint loading (e.g., squatting and ascending/descending stairs) [1], with an annual prevalence in the general population of around 22.7% [2]. Previous studies reported that people with PFP have decreased strength in hip [8, 9] and knee muscles [10, 11]. Some studies reported the effects of rehabilitation programs for PFP patients focused on proximal muscles combined with quadriceps strengthening [16,17,18,19,20,21,22,23]. The combination of hip and knee muscles exercises presents the best level of evidence for pain reduction and physical function improvement during PFP rehabilitation [26]. People with PFP have power deficits in hip and knee muscles and it remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. This study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles comprising power and strength exercises are greater than those of a program consisting of strength exercises only
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