Public Release:  Exercise therapy best for knee pain

Research: Supervised exercise therapy vs. usual care for patellofemoral pain syndrome: an open label randomized controlled trial

BMJ-British Medical Journal

For patients with severe knee pain, supervised exercise therapy is more effective at reducing pain and improving function than usual care, finds a study published on bmj.com today.

Patellofemoral pain syndrome is a condition in which pain occurs at the front of the knee during or after exercise and is a common reason to visit the doctor. Women are more likely to be affected than men, and symptoms usually start during adolescence when participation in sporting activities is high.

General advice is to rest during periods of pain and to avoid pain provoking activities. This "wait and see" approach is considered usual care.

A recent study reported only limited evidence for the effectiveness of exercise therapy with respect to pain reduction, while there is conflicting evidence with respect to functional improvement.

So researchers based in the Netherlands investigated the effectiveness of supervised exercise therapy compared with usual care in 131 patients aged between 14 and 40 years with patellofemoral pain syndrome.

A total of 131 participants were included in the study, 65 to a supervised exercise program (intervention group) and 66 to usual care (control group). Both groups received similar written information about the syndrome and similar instructions for home exercises, as well as advice to refrain from painful activities.

Patients rated their recovery, pain at rest, pain on activity, and function scores at the start of the study and again at three and 12 months.

After three months, the intervention group reported significantly less pain and better function than the control group. At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain at rest and pain on activity, but not function.

A higher proportion of patients in the exercise group than in the control group reported recovery (42% v 35% at three months and 62% v 51% at 12 months), but these results were not significantly different between the two groups.

This study provides evidence that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for pain at rest, pain on activity, and function at three and 12 months, say the authors. However, supervised exercise therapy had no effect on perceived recovery.

Further research is needed to understand how exercise therapy results in better outcome, they conclude.

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