Article

Patellofemoral pain (PFP) is the most prevalent running pathology and associated
with multi-level biomechanical factors. This systematic review aims to guide
treatment and prevention of PFP by synthesising prospective, observational and
intervention studies that measure clinical and biomechanical outcomes in
symptomatic running populations. Medline, Web of Science and CINAHL were searched
from inception to April 2015 for prospective, case-control or intervention
studies in running-related PFP cohorts. Study methodological quality was scored
by two independent raters using the modified Downs and Black or PEDro scales,
with meta-analysis performed where appropriate. 28 studies were included. Very
limited evidence indicates that increased peak hip adduction is a risk factor for
PFP in female runners, supported by moderate evidence of a relationship between
PFP and increased peak hip adduction, internal rotation and contralateral pelvic
drop, as well as reduced peak hip flexion. Limited evidence was also identified
that altered peak force and time to peak at foot level is a risk factor for PFP
development. Limited evidence from intervention studies indicates that both
running retraining and proximal strengthening exercise lead to favourable
outcomes in both pain and function, but only running retraining significantly
reduces peak hip adduction, suggesting a possible kinematic mechanism. Put
together, these findings highlight limited but coherent evidence of altered
biomechanics which interventions can alter with resultant symptom change in
females with PFP. There is a clear need for high quality prospective studies of
intervention efficacy with measurement of explanatory mechanisms.
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