Education in runners with patellofemoral pain
The majority of runners develop running-related injuries. Patellofemoral pain (PFP) ranks among the common conditions in individuals with running-related injuries. Education on managing training loads is believed to be a main component for treating runners with PFP. In addition, multimodal interventions are recommended to treat runners with PFP. However to date, the relative contribution of treatment components and the influence on the clinical outcome has not been addressed. Thus, this study compared different rehabilitation approaches in runners with PFP.
23 runners were randomly assigned to either the: 1) Education; 2) Exercises and education; and 3) Running retraining and education group.
The education group included: education on load management and instructions to self-modify running training according to symptoms. Furthermore, the patients were asked to increase the frequency of their weekly trainings, to decrease each session’s duration and speed and to avoid downhill and stairs running. Lastly, the runners were instructed to not exceed VAS 2/10 during the running training and the running distance was increased gradually according to symptoms, before adding speed and hills.
The exercises group received in addition to the education a standardised home exercise programme, including strength, capacity to sustain mechanical load and dynamic control exercises of the lower limbs.
The gait retraining group received besides the education, a personalised advice on running gait modifications. Runners were asked to increase step rate by 7.5%–10% and if necessary, they were instructed to run softer and to adopt a non-rearfoot strike pattern.
All 3 groups significantly benefited of the treatment approaches. However, adding exercises or gait retraining did not provide additional benefits compared with education alone. The gait retraining and exercise group did also not exhibit faster improvements than other groups.
The decreased running speed, avoiding hills and splitting total weekly distance into more frequent but shorter sessions may have allowed runners to maintain patellofemoral joint loads and might have enabled the improvement in symptoms. It could be hypothesized that decreasing running speed may achieve the same purpose as gait retraining approaches aiming for transient decreases in PFJ.
This study showed that exercises or gait retraining did not offer additional benefits in reducing symptoms of runners with PFP over education alone. Neither increased knee extensors strength in the exercises group nor increased step rate and decreased average vertical loading rate in the gait retraining group resulted in improved outcomes. Thus, it could be shown that the treatment of runners with PFP should include an appropriate education on symptoms and management of training loads.
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> From: Esculier et al., Br J Sports Med (2017) (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the online summary.