Best Management of PFPS in Runners

A runner with right knee patella-femoral pain syndrome (PFPS) consults you. What should you do? Training modification education? Specific lower extremity strengthening exercises? Or running gait retraining?


This RCT involved runners diagnosed with PFPS who were randomly assigned to one of three intervention groups:


Group 1: Education on training modifications & symptoms management


  1. Avoid downhill & stairs running
  2. Apply run-walk intervals
  3. Maintain pain level at 2 or less (out of 10)
  4. Pain must return to pre-training level within 1 hr
  5. Increase running frequency but decrease the distance and speed of each training session
  6. Running distance can be increased based on symptoms and then followed by adding speed & hills


Group 2: Progressive strengthening exercise program in addition to education


  1. Hip abduction in side-lying
  2. Single leg bridging
  3. Step ups
  4. Single leg ¼ squats
  5. Eccentric step downs
  6. Side & forward planks


Group 3: Running gait modification in addition to education

  1. Runners were asked to run softer and to adopt more of a mid-foot or forefoot strike
  2. Runners were also asked to increase their cadence by 10% (e.g. increase cadence from 165 to 180 steps per minute)


After 4, 8 and 12 weeks all three groups showed similar improvements in their pain and functional scores.

However, the runners in the exercise group showed the greatest improvement in knee extension strength but it was not associated with pain reduction.
The runners who received gait training had 25% reduction in their vertical loading rate but again not associated with pain reduction.

Clinical application:
A runner with PFPS consults you. What should you do?

Take the time to discuss and teach your runner training modification and symptom management. Based on this RCT, the six running tips that the patients in Group 1 received may be the most effective management strategy.


Reference: Esculier JF et al. Is combining gait retraining or an exercise programme with education better than educationalone in treating runners with patellofemoral pain?A randomised clinical trial. Br J Sports Med. 2017 May 5.


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