Patello-femoral pain syndrome: is spinal manipulation favourable over local exercise therapy?

Patello-femoral pain syndrome (PFPS) is a chronic musculoskeletal condition characterised by pain behind the knee cap, usually worsened during weightbearing activities. Activities such as walking, running, jumping, stair climbing, and prolongued sitting and kneeling usually increase symptoms. Most patients with PFPS report knee stiffness on bending the knee joint.

As with many injuries, PFPS is multifactorial and can be due to:-

# knee joint laxity

# poor Quadriceps strength

# poor biomechanics in the lower extremity

# muscle imbalances surrounding the knee and hip joints

Lower back and sacroiliac joint function, and decreased hip range of movement have also been associated with PFPS.

Exercise therapy has always been the choice in the management of PFPS, focusing on strengthening the muscles of the hip and knee joints. This has shown to be effective in reducing pain and improving short, medium and long term recovery. However, about 50% of patients will continue to experience pain and dysfunction in the medium and long term, and ultimately culminate in significant osteoarthritis.

More recently, the use of spinal manipulation has been utilised in the treatment of PFPS. In a research project where two groups either received exercise therapy or lumbar spinal manipulation over a six week period, evidence supported spinal manual therapy to be more effective in the medium term. Spinal manipulation is known to modulate pain pathways, and due to the shared common nerve roots levels of the lumbar spine and hip and knee joints, stimulating these inhibitory systems has proven to be effective in providing a hypoalgesic effect.

Further research is to take place to observe the effects of spinal manipulation and exercise therapy combined in treating PFPS.