Patellofemoral Pain: Consensus Statement From the 2013 IPFRR
Patellofemoral pain (PFP) is often seen in physically active individuals and may account for 25–40% of all knee problems seen in a sports injury clinic. Patellofemoral-related problems occur more frequently in women than in men. PFP is characterised by diffuse pain over the anterior aspect of the knee and aggravated by activities that increase patellofemoral joint (PFJ) compressive forces, such as squatting, ascending and descending stairs and prolonged sitting, as well as repetitive activities such as running. It, therefore, has a debilitating effect on sufferers' daily lives by reducing their ability to perform sporting and work-related activities pain free. Dye has described PFP as an orthopaedic enigma, and it is one of the most challenging pathologies to manage. Alarmingly, a high number of individuals with PFP have recurrent or chronic pain. While physiotherapy interventions for PFP have proven effective compared with sham treatments, treatment results can be disappointing in a proportion of patients. This variability in treatment results may be due to the fact that the underlying factors that contribute to the development of PFP are not being addressed, or are not the same for all patients with PFP. The mission of the 3rd International Patellofemoral Research Retreat was to improve our understanding concerning the factors that contribute to the development and consequently to the treatment of PFP.
The 3rd International Patellofemoral Research Retreat was held in Vancouver, Canada, in September 2013, for 3 days: from 18 September to 21 September. After peer-review for scientific merit and relevance to the retreat, 58 abstracts were accepted for the retreat (39 podiums, 8 posters and 11 thematic posters). The podium and poster presentations were grouped into three categories: (1) natural history of PFP and local factors that influence PFP, (2) trunk and distal factors that influence PFP and (3) innovations in rehabilitation of PFP. Presentations in the Natural history and local factors category focused on the prevalence of PFP in different age groups, the relationship between PFP and patellofemoral osteoarthritis (PFOA) and the contribution of surrounding tissues to PFP. Presentations in the Trunk and distal factors category focused on understanding how different factors from different regions (trunk, pelvis, hip and foot and ankle) may contribute to PFJ dysfunction. Presentations in the Innovation in rehabilitation category were dedicated to evaluating outcomes of new treatment options for PFP.
Two keynote speakers were chosen for their scientific contribution in the area of physiotherapy in general, and PFP specifically. Professor Irene Davis from the Harvard Medical School, USA spoke on 'Alignment and loading: global indicators for patellofemoral pain'. Professor Paul Hodges from the University of Queensland, Australia, addressed the question 'Pain and motor control: what have we learnt?'
As with our past two International Patellofemoral Research Retreats, we developed a consensus statement addressing each of the three presentation categories outlined above. This paper is a revision and update of the previous consensus statements published after the first and second international research retreat on PFP in Baltimore 2009, USA. and Ghent, Belgium in 2011. Six category consensus leaders facilitated the development of consensus for three specific areas: (1) natural history of PFP and local (knee region) factors that influence PFP (MJC and JJS), (2) trunk and distal factors that influence PFP (BN and DB-J) and (3) innovations in rehabilitation for PFP (JDW and JEE-B).
On the third day of the retreat, participants elected to join one of the three groups, where they discussed and summarised the evidence in their category. Each group was asked to consider two questions: 'What have we learned? ' and 'What are the future advances required to understand PFP and its treatment'. Consensus statements were presented for discussion with the entire group, and then refined by the authors of the paper with input from participants.
We present here the 3rd Patellofemoral Pain Consensus Statement. These statements represent the contemporary status of knowledge in the field of PFP, and hence will change over time. This document is developed by researchers for researchers, to stimulate novel studies that will evolve our knowledge of PFP. But in addition to that, we aim to provide clinicians with updated knowledge of PFP, thus enabling them to integrate this knowledge into their clinical practice.
Abstract and Introduction
Introduction
Patellofemoral pain (PFP) is often seen in physically active individuals and may account for 25–40% of all knee problems seen in a sports injury clinic. Patellofemoral-related problems occur more frequently in women than in men. PFP is characterised by diffuse pain over the anterior aspect of the knee and aggravated by activities that increase patellofemoral joint (PFJ) compressive forces, such as squatting, ascending and descending stairs and prolonged sitting, as well as repetitive activities such as running. It, therefore, has a debilitating effect on sufferers' daily lives by reducing their ability to perform sporting and work-related activities pain free. Dye has described PFP as an orthopaedic enigma, and it is one of the most challenging pathologies to manage. Alarmingly, a high number of individuals with PFP have recurrent or chronic pain. While physiotherapy interventions for PFP have proven effective compared with sham treatments, treatment results can be disappointing in a proportion of patients. This variability in treatment results may be due to the fact that the underlying factors that contribute to the development of PFP are not being addressed, or are not the same for all patients with PFP. The mission of the 3rd International Patellofemoral Research Retreat was to improve our understanding concerning the factors that contribute to the development and consequently to the treatment of PFP.
The 3rd International Patellofemoral Research Retreat was held in Vancouver, Canada, in September 2013, for 3 days: from 18 September to 21 September. After peer-review for scientific merit and relevance to the retreat, 58 abstracts were accepted for the retreat (39 podiums, 8 posters and 11 thematic posters). The podium and poster presentations were grouped into three categories: (1) natural history of PFP and local factors that influence PFP, (2) trunk and distal factors that influence PFP and (3) innovations in rehabilitation of PFP. Presentations in the Natural history and local factors category focused on the prevalence of PFP in different age groups, the relationship between PFP and patellofemoral osteoarthritis (PFOA) and the contribution of surrounding tissues to PFP. Presentations in the Trunk and distal factors category focused on understanding how different factors from different regions (trunk, pelvis, hip and foot and ankle) may contribute to PFJ dysfunction. Presentations in the Innovation in rehabilitation category were dedicated to evaluating outcomes of new treatment options for PFP.
Two keynote speakers were chosen for their scientific contribution in the area of physiotherapy in general, and PFP specifically. Professor Irene Davis from the Harvard Medical School, USA spoke on 'Alignment and loading: global indicators for patellofemoral pain'. Professor Paul Hodges from the University of Queensland, Australia, addressed the question 'Pain and motor control: what have we learnt?'
Consensus Development Process
As with our past two International Patellofemoral Research Retreats, we developed a consensus statement addressing each of the three presentation categories outlined above. This paper is a revision and update of the previous consensus statements published after the first and second international research retreat on PFP in Baltimore 2009, USA. and Ghent, Belgium in 2011. Six category consensus leaders facilitated the development of consensus for three specific areas: (1) natural history of PFP and local (knee region) factors that influence PFP (MJC and JJS), (2) trunk and distal factors that influence PFP (BN and DB-J) and (3) innovations in rehabilitation for PFP (JDW and JEE-B).
On the third day of the retreat, participants elected to join one of the three groups, where they discussed and summarised the evidence in their category. Each group was asked to consider two questions: 'What have we learned? ' and 'What are the future advances required to understand PFP and its treatment'. Consensus statements were presented for discussion with the entire group, and then refined by the authors of the paper with input from participants.
We present here the 3rd Patellofemoral Pain Consensus Statement. These statements represent the contemporary status of knowledge in the field of PFP, and hence will change over time. This document is developed by researchers for researchers, to stimulate novel studies that will evolve our knowledge of PFP. But in addition to that, we aim to provide clinicians with updated knowledge of PFP, thus enabling them to integrate this knowledge into their clinical practice.
Source...