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Improve knee pain slightly (without changing biomechanics)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

If you had mild but stubborn kneecap pain, you’d probably be thrilled to be handed the best possible rehab programme that a panel of experts could cook up back in 2016. Nothing too good to be true, no one’s claiming it’s a miracle cure. It consists mostly of exercise, especially hip and knee strengthening.

Twenty-seven people with mild patellofemoral (kneecap) pain did that programme, and their progress was carefully observed (an “observational study,” see Greaves et al). This was not a true test of the programme’s efficacy (which would need a “controlled” trial). Instead, Greaves et al. just watched, measured, and took notes. The point was to learn something about the effect of the programme on running form, strength, function, and pain.

Pain barely improved — despite being minor to begin with. The change was statistically insignificant by one standard way of measuring pain, and just barely by another.

Their function also improved, but also in underwhelming ways. For instance, fear of movement also barely improved, and how much more “functional” can you be that way?

These small wins for pain and function notably came without any improvement at all in running biomechanics and quads strength — and yet those are the main things that most professionals believe are the drivers of improvements in pain and function. This disconnect makes the result a bit of an eyebrow raiser.

One possible implication of this data is that you don’t have to get stronger or “fix” your running biomechanics to make a little progress. Just work out a bit.

Another take-home message: that best-of-breed program really didn’t do much for minor cases! But, again, it wasn’t a proper test. Observational studies are almost like high quality anecdotal evidence: they can provide reasons to study things more carefully, but that’s about it.