What is the evidence for treating knee pain?

Kooiker, L., Van De Pert, I, G, L,  Weir, A., Moen, M, H., (2014) Effects of Physical Therapist-Guided quadriceps-Strengthening Exercises for the treatment of Patellofemoral Pain Syndrome. A Systematic Review.  Journal of Orthopadic and Sports Physical Therapy.


The purpose of this study was to analyze and summarize the current literature and evidence for quadriceps strengthening exercise that is used in the treatment of patellofemoral pain (PFP). Due to Quadriceps strength work being used regularly for the treatment and exercise prescription in PJP it is important to determine what exercise is most beneficial and if quadriceps exercise actually helps. A similar review was undertaken in 2003 that found only limited evidence thus the authors felt that over a 10 year period a similar study should be performed



The study was a systematic review where they underwent a literature review and searched Randomized Controlled Trials comparing quadriceps strengthening exercise and other interventions or placebo. A total of 304 studies were identified that was reduced to 7 for the review due to inclusion and exclusion criteria. They excluded non randomised studies, use of braces, same population groups and control groups in studies receiving treatment within 7 days. The results demonstrated strong evidence for quadriceps strengthening exercises is effective in reducing pain with PFP.



The study was a systematic review thus has a strong level of evidence with regards to the indications given. The study was undertaken with specific inclusion and exclusion criteria and the methodological quality of the studies was also assessed creating a stronger evidence base from the literature used.



One weakness was that they only used 7 studies. The studies were also not able to demonstrate one quadriceps strengthen exercise over another, however this does not necessarily mean it is a weakness as it can indicate that a combination of exercise can improve PFP and a patients pain levels. They could give no clear indication of change between one and closed chain rehabilitation however this was not their goal.


Food for thought

Due to a systematic review being one of the highest levels of research it gives strong evidence that Quadriceps strengthening will aid in reduced Patella femoral pain. It is demonstrated that isolated quadriceps exercises performed three imes per week have been shown to be effective. From a clinical perspective it is not something that is new as quadriceps strengthening is undertaken regularly for  PFP however it does support and give increased evidence prescribing this kind of exercise. When assessing knee pain we will be assessing the entire lower limb looking at alignment, movement control, balance and strength.  The strength of the hips is also an important part of treating knee pain and as such we will always be assessing your hip strength and if required providing you with exercises to strengthen the weak areas.

thanks for reading and feel free to email me at stuart.mailer@kenphysio.com should you have any questions.



Stuart Mailer

Senior Physiotherapist


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