PatelloFemoral Joint Pain - What Works?

Patellofemoral joint pain (PFP), commonly called runner’s knee, is a prevalent musculoskeletal complaint, especially among athletes and active individuals. Effective management is rooted in evidence-based, conservative approaches, typically centred on exercise therapy and patient education.

Best Practice Recommendations

Recent high-quality guidelines and meta-analyses unanimously recommend knee- and hip-targeted exercise therapy as the primary intervention for PFP. Structured programmes focusing on strengthening the quadriceps, hip abductors, and external rotators over at least 6–12 weeks, preferably under clinician supervision, show significant improvements in pain and function. Hip strengthening, in particular, has demonstrated even greater efficacy in pain reduction than knee-directed protocols, likely due to the role of proximal mechanics in patellofemoral alignment and load.

Education and Multimodal Approaches

Education forms a core part of management, ensuring patients understand risk factors, biomechanics, and the importance of regular exercise. Adjuncts such as prefabricated foot orthoses, movement retraining, taping, and manual therapy can be considered on an individual basis; these should be tailored according to symptom severity, physical findings, and patient preference. Taping and bracing may provide short-term symptom relief, and foot orthoses can be beneficial for patients with biomechanical abnormalities.

Role of Osteopathy and Manual Therapy

Osteopathic manipulative treatment (OMT) and manual therapy are increasingly recognised as supportive options for reducing pain and restoring function. Techniques like myofascial release, strain-counterstrain, and muscle energy have been shown to significantly decrease knee pain and improve joint function when combined with exercise therapy. Meta-analyses indicate a meaningful reduction in pain scores with OMT interventions compared to no treatment, though heterogeneity across studies warrants cautious interpretation.

When to Consider Other Treatments

Additional conservative treatments (e.g., medication) should only be considered for severe, refractory pain where exercise therapy is insufficient after a sustained trial. The routine use of imaging, injections, or surgical intervention is not supported unless guided by specific clinical concerns or when non-operative strategies fail. Surgery is reserved for highly selective cases unresponsive to exhaustive conservative measures.