Supervised exercise therapy improves knee pain

Patellofemoral pain is a common knee problem prevalent in young, active men and women. The condition causes pain under and around the kneecap and can get worse by vigorous activity or when one sits for a long time.

The exact cause of patellofemoral pain is not known. It probably has to do with the way the kneecap (patella) moves on the groove of the thigh bone (femur).

Robbart van Linschoten, M.D., of Erasmus University Medical Centre in Rotterdam, Netherlands and his colleagues conducted a study to assess the effectiveness of supervised exercise therapy as opposed to general care.

They recruited 131 participants aged 14 to 40 years and split them into two groups with 65 forming the intervention group and 66 the control group.

All the subjects were bothered by at least three of the following pains: soreness when walking up or down stairs, squatting, cycling, sitting for a long time with their knees bent, and grinding of the patella.

People with arthritis, previous knee injuries, or those who had undergone knee surgery were excluded from the study.

Supervised exercise therapy versus usual care
The intervention group was assigned a tailored exercise program supervised by a physical therapist. The group had nine sessions over 6 weeks monitored by an expert. This was followed by a three-month period of exercises to be done at home.

The regime for the control group was customary care comprising of a “wait-and-see” approach. They were advised rest when in pain and to refrain from activities that induced pain. All the participants were permitted the use of ice packs, insoles, bandages and other analgesics.

Main outcome of the study
The researchers tracked the subjects at 6 weeks and 3, 6, 9 and 12 months. Patients rated their recovery as pain at rest, pain on activity and function, at the onset of the study and then at three and 12 months.

The researchers noted that after three months, the intervention group reported less pain and better function than the control group. Even at 12 months, the intervention group demonstrated improvement in pain at rest and activity as compared to the control group.

According to the researchers, a higher proportion of the patients who had exercise therapy admitted recovery as opposed to those assigned usual care (42 percent v 35 percent at three months and 62 percent v 51 percent at 12 months).

The researchers concluded, "This study provides evidence that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for the outcome parameters pain at rest, pain on activity, and function at three and 12 months.

"However, supervised exercise therapy had no effect on perceived recovery. Further research should aim to elucidate the mechanisms whereby exercise therapy results in better outcome."

The study has been reported in the British Medical Journal.