Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review

Abstract

Objectives: Current best evidence has reported that therapeutic exercise programs that are designed to treat patellofemoral pain (PFP) should include both hip and knee specific exercises.The purpose of this review was to 1) examine the quality/comprehensiveness of exercise reporting in this field; 2) quantify the extent to which individual exercises comprised task-specific elements (single limb stance; eccentric control of the hip; rotational z-axis control) most likely to address key pathomechanics associated with PFP. Design: Systematic review: a systematic survey of RCTs Methods: PubMed, CINAHL, Medline, Physiotherapy Evidence Database (PEDro) and SPORT Discus databases were searched for randomized controlled trials that addressed PFP utilizing a proximal control hip focused rehabilitation paradigm. The therapeutic exercise programs were evaluated, and each individual exercise was extracted for analysis. Quality assessments included the PEDro Scale and the Consensus on Exercise Reporting Template (CERT) was utilized to score the reporting of the interventions.Results: 19 studies were included in the final analysis. 178 total exercises were extracted from the proximal hip and knee rehabilitation programs. The exercises were analyzed for the inclusion of elements that align with reported underlying biomechanical mechanisms. Conclusions:The vast majority of the exercises were sagittal plane, concentric, non-weight bearing exercises, whereas multiplanar exercises, single limb weightbearing, and exercises where loading was directed around the longitudinal z-axis, were considerably under-represented.Current exercises for PFP utilize simplistic frameworks that lack progression into more task specific exercise, and are not reflective of the complex injury etiology.

If exercise is medicine, why don’t we know the dose? An overview of systematic reviews assessing reporting quality of exercise interventions in health and disease

“…We identified 7804 studies and included 28 systematic reviews18–20 22 24 34 35 37–57 (figure 1). These 28 reviews included 1467 studies comprised of 1724 interventions.…”

“…A list of the studies excluded during full-text assessment, with reasons, is provided in online supplemental appendix 5. Ten reviews only used CERT,35 38 41 42 44 48 52–54 56 11 reviews only used TIDieR,18–20 24 39 45–47 50 51 55 and 6 reviews22 34 37 40 43 57 used both CERT and TIDieR (table 2). One review38 used a hybrid tool comprised of items 1–5, 7, and 9–12 from TIDieR, complemented and expanded upon by items 6 and 8 of CERT.…”

“…The median number of interventions included in the reviews was 24 (range 3–287, IQR 67). Twelve reviews assessed quality of reporting in musculoskeletal conditions,19 34 35 37 38 40–42 45 48 56 57 four in neurological conditions,39 47 51 53 six in cardiovascular conditions,18 20 22 24 49 55 one in cancer50 and five in ‘other’ conditions including urinary dysfunction (n=1),44 pelvic organ prolapse (n=1)43 organ transplant patients (n=2),46 52 and older adults (n=1) 54. See table 2 for all characteristics of included reviews.…”

Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review

“…Exercises incorporating components of multiplanar movement, single limb weight-bearing, and a flight phase, were most reflective of injury etiology, and therefore presented the highest level of challenge to the patient. A priori definitions, developed from recent scoping reviews by Dischiavi et al [13][14][15] were used to categorize each exercise element.…”

“…This classification could have been subjective; but to minimise this, we aligned our methods and definitions to three previous reviews. [13][14][15] We must also acknowledge that our classification criteria is informed primarily by mechanical constructs relevant to the injury inciting event. This reductionist approach of discussing only biomechanical effects of rehabilitation exercises deviates from the original biopsychosocial model.…”