A study published today on bmj.com reports that supervised exercise therapy is more effective at reducing pain and improving function than usual care for patients with severe knee pain.

Knee pain is a common reason to visit the doctor. Patellofemoral pain syndrome is a condition in which pain occurs at the front of the knee during or after exercise. Symptoms usually start during adolescence when participation in sporting activities is high. Also, women are more likely to be affected than men.

General medical advice is to rest during periods of pain and to avoid pain provoking activities. This “wait and see” approach is considered as standard care.

The findings of a recent study suggest there is limited evidence on the effectiveness of exercise therapy with respect to pain reduction. There are inconsistent facts with respect to functional improvement.

In order to find out more, researchers based in the Netherlands investigated the effectiveness of supervised exercise therapy. They compared it with usual care in 131 patients aged between 14 and 40 years with patellofemoral pain syndrome.

From the total of 131 participants included in the study, 65 were assigned to a supervised exercise program (intervention group) and 66 to usual care (control group). Both groups received similar written information about the syndrome and similar instructions for home exercises. All participants were instructed to refrain from painful activities.

At the start of the study, patients rated their recovery, pain at rest, pain on activity, and function scores. They did so again after three and twelve months.

After three months, the intervention group reported considerably less pain and better function than the control group. At twelve months, the intervention group continued to show superior outcomes than the control group with regard to pain at rest and pain on activity, but not function.

A higher proportion of patients in the exercise group than in the control group reported recovery (42 percent compared to 35 percent at three months and 62 percent compared to 51 percent at twelve months). However, these results were not considerably different between the two groups.

The authors say that the findings of this study give indication that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for pain at rest, pain on activity, and function at three and twelve months. On the other hand, supervised exercise therapy had no effect on perceived recovery.

They say in closing that further research is necessary in order to understand how exercise therapy results in better outcome.

“Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomized controlled trial”
R van Linschoten, sports physician, M van Middelkoop, researcher, M Y Berger, researcher, general practitioner, E M Heintjes, research associate, J A N Verhaar, professor of orthopaedics, S P Willemsen, statistician, B W Koes, research professor, S M Bierma-Zeinstra, associate research professor
BMJ 2009; 339:b4074

Written by Stephanie Brunner (B.A.)