Detailed guides to painful problems, treatments & more

Do strong quadriceps help patellofemoral pain?

PainSci » bibliography » Kooiker et al 2014
Tags: patellar pain, physical therapy, exercise, arthritis, aging, pain problems, knee, leg, limbs, overuse injury, injury, running, self-treatment, treatment, manual therapy

Two articles on PainSci cite Kooiker 2014: 1. The Complete Guide to Patellofemoral Pain Syndrome2. Patellofemoral Pain & the Vastus Medialis Myth

PainSci commentary on Kooiker 2014: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Do quadriceps strengthening exercises help with patellofemoral pain? This 2014 systematic literature review set out to summarize the evidence, sorting through the junk to find 7 of the highest quality studies published at the time.

The conclusion was strongly in favor of quadriceps strengthening being effective for decreasing pain and improving function in patients with patellofemoral pain syndrome. Effect sizes were mostly "large" — clinically significant as well as statistically significant. Considering the decent methodological quality of the studies included, it seems the total evidence suggests quad strengthening works for patellofemoral pain. Of course, this doesn't mean it will work for everyone — but it should for most!

Note that this study also found that pretty much any form of quadricep strengthing is effective, with no superiority found in weight bearing vs non-weight bearing or VMO specific training. Just exercise those thighs!

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

STUDY DESIGN: Systematic literature review.

OBJECTIVE: To summarize the evidence for physical therapist-guided quadriceps-strengthening exercises as a treatment for patellofemoral pain syndrome.

BACKGROUND: Although quadriceps strengthening is often included in the plan of care for patellofemoral pain syndrome, a systematic review published in 2003 found only limited evidence that exercise was more effective than no exercise for this common condition.

METHODS: The PubMed, Embase/MEDLINE, and Cochrane Central Register of Controlled Trials databases, from inception to January 9, 2014, were searched for randomized controlled trials comparing the use of quadriceps-strengthening exercises to interventions consisting of advice/information or a placebo. Outcomes of interest were pain measures and function, as measured with self-report questionnaires. The methodological quality of the randomized controlled trials was assessed with the Physiotherapy Evidence Database scale. Results were summarized using a best-evidence synthesis and graphically illustrated using forest plots without meta-analysis.

RESULTS: Seven studies were included in the literature review. These studies reported strong evidence that isolated quadriceps strengthening is more effective in reducing pain and improving function than advice and information alone. In addition, compared to advice and information or placebo, there was strong evidence that quadriceps-strengthening exercises combined with other interventions may be more effective in reducing pain immediately postintervention and after 12 months, but not in improving function.

CONCLUSION: The literature provides strong evidence for the use of quadriceps-strengthening exercises, with or without other interventions, for the treatment of patellofemoral pain syndrome.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: