Just exercise those thighs!

Last week I announced a major new edition of the patellofemoral pain book, with new co-author Tony Ingram. Here’s an example of the kind of evidence Tony presented me with, to persuade me that the new edition had to be more positive about exercise. This is just one of many studies cited in the book …

“Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: a systematic review”
Kooiker et al. Journal of Orthopaedic & Sports Physical Therapy. Volume 44, Number 6, 391–B1. Jun 2014.

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 PFPS. Effects sizes were mostly “large” — clinically significant as well as statistically significant (a rare combination). Considering the decent methodological quality of the studies included, it seems the total evidence suggests quad strengthening works for PFPS. Of course, this doesn’t mean it will work for everyone — but it should for many, or 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 vastus medialis specific training. Just exercise those thighs!