Knee Isometric Exercises for Patellofemoral Pain Syndrome

Overseen By Haley Goble, MHA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: The Methodist Hospital Research Institute

Disqualifiers: Neurological, Degenerative musculoskeletal, Surgical, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 4-8 weeks

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Knee Isometric Program (KIP) for Patellofemoral Pain Syndrome?

Research shows that isometric quadriceps strengthening exercises can reduce knee pain in patients with patellofemoral pain syndrome, as seen in a study where both adolescents and adults experienced pain relief with a structured exercise program. ^{1 2 3 4 5}

Is the Knee Isometric Exercise Program safe for humans?

The research articles provided do not contain specific safety data for the Knee Isometric Exercise Program or similar treatments for patellofemoral pain syndrome. ^{1 2 3 6 7}

How is the Knee Isometric Program (KIP) treatment different from other treatments for patellofemoral pain syndrome?

The Knee Isometric Program (KIP) is unique because it focuses on isometric exercises, which involve holding a position without moving, to strengthen the knee muscles. This contrasts with other treatments that often use isotonic exercises, which involve movement, or combine hip and knee exercises to address patellofemoral pain syndrome. ^{1 2 3 5 6}

What is the purpose of this trial?

The purpose of this study is to evaluate the efficacy of a knee isometric program (KIP) as compared to the current gold standard treatment for anterior knee pain (Patellofemoral Clinical Practice Guideline \[CPG\] - Academy of Orthopedic Physical Therapy).

Eligibility Criteria

This trial is for individuals experiencing anterior knee pain, known as Patellofemoral Pain Syndrome. Specific eligibility criteria are not provided, but typically participants would need to meet certain health conditions and agree to follow the study's procedures.

Inclusion Criteria

I have had front knee pain for 4 weeks to 12 months.

I have been referred for knee physical therapy by the study's doctor.

Accept all provisions of the study and agree to complete the program in its entirety

Exclusion Criteria

I have a nerve or muscle condition affecting my legs.

I have not had surgery or broken a bone in the affected limb(s) in the past year.

I am willing to follow the study rules and accept being assigned to a random group.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a knee isometric program or standard physical therapy regimen over 4-8 weeks with 1-2 visits per week, supplemented by home exercise programs.

4-8 weeks

1-2 visits per week (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at baseline, 6 weeks, and 12 weeks.

6 weeks

1 visit (in-person) at 12 weeks

Long-term maintenance

Participants continue with a refined comprehensive home exercise program after discharge from formal physical therapy.

Treatment Details

Interventions

• Knee Isometric Program (KIP)

Trial Overview The study is testing a Knee Isometric Program (KIP) against the current standard treatment recommended by the Academy of Orthopedic Physical Therapy. The goal is to see if KIP can effectively reduce knee pain.

Participant Groups

Group I: Knee Isometric Program (KIP) - Intervention Experimental Treatment 1 Intervention

This group will incorporate the KIP protocol, which is a modified physical therapy regimen that is less time-intensive than the gold standard counterpart. Typical structured/skilled physical therapy occurs over the course of 4-8 weeks with 1-2 visits per week to establish improved lower extremity muscle strength, education, and improve gross function. Home exercise programs (HEP) are utilized in tandem with physical therapy visits so that patients are completing interventions 4-5 days per week. Long-term maintenance is generally provided via a refined comprehensive HEP on completion and discharge from formal physical therapy.

Group II: Patellofemoral Clinical Practice Guideline (CPG) - Control Active Control 1 Intervention

This group will incorporate the standard of care physical therapy regimen which includes a specific and structured combination of quadriceps and gluteal strengthening as defined in the patellofemoral pain clinical practice guideline. Typical structured/skilled physical therapy occurs over the course of 4-8 weeks with 1-2 visits per week to establish improved lower extremity muscle strength, education, and improve gross function. Home exercise programs (HEP) are utilized in tandem with physical therapy visits so that patients are completing interventions 4-5 days per week. Long-term maintenance is generally provided via a refined comprehensive HEP on completion and discharge from formal physical therapy.

Who Is Running the Clinical Trial?

The Methodist Hospital Research Institute

Lead Sponsor

Trials

299

Recruited

82,500+

Findings from Research

A comprehensive treatment approach for patellofemoral pain syndrome in 40 young women led to significant reductions in pain and improvements in muscle function and physical activity after 12 weeks, with 85% of participants able to engage in sports pain-free at the 12-month follow-up.

Both isometric and eccentric training programs were effective, showing no significant differences in outcomes, suggesting that the overall treatment strategy, including education and gradual progression, played a key role in recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comprehensive treatment approach for patellofemoral pain syndrome in young women. Thomeé, R.[2022]

In a pilot study involving 20 patients with patellofemoral pain syndrome, isotonic eccentric training of the quadriceps significantly reduced pain and improved functional status, as measured by various outcome scales.

All outcome measures, including the SF-36 Health questionnaire and patellofemoral pain severity scale, showed significant improvements, indicating that this type of training can be an effective treatment option for managing symptoms of patellofemoral pain syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of eccentric isotonic quadriceps muscle exercises on patellofemoral pain syndrome: an exploratory pilot study. Eapen, C., Nayak, CD., Pazhyaottyil Zulfeequer, C.[2021]

In a study of 55 young female patients with patellofemoral pain syndrome, those who performed hip-and-knee exercises showed significantly greater improvements in pain relief and functional gain compared to those who only did knee exercises after 12 weeks.

The study suggests that incorporating hip-strengthening exercises into rehabilitation programs can enhance outcomes for patients suffering from patellofemoral pain syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of hip and knee exercises on pain, function, and strength in patientswith patellofemoral pain syndrome: a randomized controlled trial. Şahin, M., Ayhan, FF., Borman, P., et al.[2022]

In a study of 30 patients with patellofemoral pain, a structured isometric quadriceps strengthening program significantly reduced knee pain in both skeletally immature individuals and adults, demonstrating its efficacy as an initial treatment.

Skeletally immature patients showed not only pain reduction but also improved knee alignment, with 8 out of 13 showing significant changes in congruence angles, while adults had less radiographic improvement and some had to limit their activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patellofemoral stress. A prospective analysis of exercise treatment in adolescents and adults. O'Neill, DB., Micheli, LJ., Warner, JP.[2017]

An isokinetic exercise program significantly improved functional capacity and reduced pain scores in 22 patients with patellofemoral pain syndrome over a 6-week treatment period.

The exercise program helped prevent loss of extensor power, but the improvements in functional capacity were not directly linked to the increase in power, indicating a complex relationship between strength and function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of isokinetic exercise on functional capacity and pain in patellofemoral pain syndrome. Alaca, R., Yilmaz, B., Goktepe, AS., et al.[2022]

A systematic review of 19 randomized controlled trials found that most therapeutic exercises for patellofemoral pain (PFP) primarily focused on simple, non-weight bearing movements, which may not effectively address the complex mechanics of the injury.

The analysis revealed a significant lack of task-specific exercises, such as multiplanar and single limb weight-bearing activities, suggesting that current rehabilitation programs may need to evolve to better target the underlying biomechanical issues associated with PFP.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review. Dischiavi, SL., Wright, AA., Tarara, DT., et al.[2021]

Patients with patellofemoral pain syndrome exhibited a significant reduction in quadriceps torque (30% to 40%) compared to healthy individuals, indicating a potential impairment in muscle function associated with this condition.

The torque reduction was consistent across different speeds and modes of contraction, suggesting that the impact of patellofemoral pain syndrome on muscle strength is not influenced by these factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Concentric and eccentric torque variations of the quadriceps femoris in patellofemoral pain syndrome. Dvir, Z., Shklar, A., Halperin, N., et al.[2013]

References

1. United States pubmed.ncbi.nlm.nih.gov

A comprehensive treatment approach for patellofemoral pain syndrome in young women. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Effect of eccentric isotonic quadriceps muscle exercises on patellofemoral pain syndrome: an exploratory pilot study. [2021]

3. Turkey pubmed.ncbi.nlm.nih.gov

The effect of hip and knee exercises on pain, function, and strength in patientswith patellofemoral pain syndrome: a randomized controlled trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Patellofemoral stress. A prospective analysis of exercise treatment in adolescents and adults. [2017]

5. United States pubmed.ncbi.nlm.nih.gov

Efficacy of isokinetic exercise on functional capacity and pain in patellofemoral pain syndrome. [2022]

6. Australia pubmed.ncbi.nlm.nih.gov

Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Concentric and eccentric torque variations of the quadriceps femoris in patellofemoral pain syndrome. [2013]