Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK Complete Sports Care, Melbourne, Australia Pure Sports Medicine, London, UK Lower Extremity Gait Studies, La Trobe University, Melbourne, Australia.
Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK.
Br J Sports Med. 2015 Jul;49(14):923-34. doi: 10.1136/bjsports-2014-093637. Epub 2015 Feb 25.
Patellofemoral pain (PFP) is both chronic and prevalent; it has complex aetiology and many conservative treatment options.
Develop a comprehensive contemporary guide to conservative management of PFP outlining key considerations for clinicians to follow.
Mixed methods.
We synthesised the findings from six high-quality systematic reviews to September 2013 with the opinions of 17 experts obtained via semistructured interviews. Experts had at least 5 years clinical experience with PFP as a specialist focus, were actively involved in PFP research and contributed to specialist international meetings. The interviews covered clinical reasoning, perception of current evidence and research priorities.
Multimodal intervention including exercise to strengthen the gluteal and quadriceps musculature, manual therapy and taping possessed the strongest evidence. Evidence also supports use of foot orthoses and acupuncture. Interview transcript analysis identified 23 themes and 58 subthemes. Four key over-arching principles to ensure effective management included-(1) PFP is a multifactorial condition requiring an individually tailored multimodal approach. (2) Immediate pain relief should be a priority to gain patient trust. (3) Patient empowerment by emphasising active over passive interventions is important. (4) Good patient education and activity modification is essential. Future research priorities include identifying risk factors, testing effective prevention, developing education strategies, evaluating the influence of psychosocial factors on treatment outcomes and how to address them, evaluating the efficacy of movement pattern retraining and improving clinicians' assessment skills to facilitate optimal individual prescription.
Effective management of PFP requires consideration of a number of proven conservative interventions. An individually tailored multimodal intervention programme including gluteal and quadriceps strengthening, patellar taping and an emphasis on education and activity modification should be prescribed for patients with PFP. We provide a 'Best Practice Guide to Conservative Management of Patellofemoral Pain' outlining key considerations.
髌股疼痛（PFP）是慢性和普遍的；它的病因复杂，有许多保守治疗方法。
制定髌股疼痛保守治疗的综合当代指南，概述临床医生需要遵循的关键考虑因素。
混合方法。
我们综合了截至 2013 年 9 月的 6 项高质量系统评价的结果，并通过半结构化访谈获得了 17 名专家的意见。专家们在 PFP 方面至少有 5 年的临床经验，是 PFP 的专家，积极参与 PFP 研究，并为国际专家会议做出贡献。访谈涵盖了临床推理、对当前证据的看法和研究重点。
包括加强臀肌和股四头肌的运动疗法、手法治疗和贴扎等综合干预措施具有最强的证据。有证据支持使用足矫形器和针灸。访谈记录分析确定了 23 个主题和 58 个子主题。确保有效管理的四项关键总体原则包括-(1) PFP 是一种多因素疾病，需要个体化的综合治疗方法。(2) 立即缓解疼痛是获得患者信任的首要任务。(3) 通过强调主动干预而不是被动干预来增强患者的能力非常重要。(4) 良好的患者教育和活动调整是必不可少的。未来的研究重点包括确定危险因素、测试有效的预防方法、制定教育策略、评估心理社会因素对治疗结果的影响以及如何解决这些问题、评估运动模式再训练的效果以及提高临床医生的评估技能，以促进最佳的个体化处方。
PFP 的有效管理需要考虑一些经过验证的保守干预措施。对于 PFP 患者，应制定个体化的综合治疗方案，包括臀肌和股四头肌强化、髌腱贴扎以及强调教育和活动调整。我们提供了一份“髌股疼痛保守治疗的最佳实践指南”，概述了关键的考虑因素。
