Supervised Exercises Seem to Work for Kneecap Pain

Knee pain often presents as pain at the front of the kneecap during or after exercise; this is sometimes called the patellofemoral pain syndrome.  There are numerous possible causes, and examination shows the patella to be the source of the pain.  Rest during periods of pain, with avoidance of pain-provoking activity, is the usual medical advice.

Researchers in the Netherlands have studied the effectiveness of supervised physical therapy in the management of the syndrome, and published their findings online in the British Medical Journal.

There were 131 patients in the study, aged 14 to 40.  They were randomly assigned to a supervised exercise program or ‘usual care’ (see above).  The exercises were tailored to individual performance, and supervised by a physical therapist;  after 6 weeks, these patients were instructed to practice the tailored exercises for 3 months. Both groups were given written information about the syndrome and instructions for home exercise, and advice to avoid painful activities.

After 3 months, the subjects in the supervised exercise group had better outcomes than the control group with respect to pain at rest, pain on activity, and function.  After 12 months, the exercise patients continued to do better than the controls with respect to pain at rest and on activity, but not with regard to function.  More patients in the exercise group reported recovery (42% vs. 35% at 3 months, and 62% vs. 51% at 12 months), but the differences were not statistically significant, i.e. they could have occurred by chance alone. 

This last finding was disappointing; what use is a treatment if the patient doesn’t feel better?  Maybe supervision should have been continued beyond the first 6 weeks?