title: Patellofemoral stress. A prospective analysis of exercise treatment in adolescents and adults.
abstract: Thirty patients, 13 skeletally immature individuals and 17 adults, participated in a prospective study designed to evaluate the effect of isometric quadriceps strengthening exercises on patellofemoral pain. Of the 30 patients with anatomically normal lower extremity alignment and no history of previous knee trauma or surgery, there were 34 knees that had a decrease in peripatellar knee pain with a structured exercise program. One additional patient had a decrease in pain after an arthroscopic lateral release and with continued exercises. An equal number of skeletally immature patients and adults had a decrease in peripatellar knee pain. However, 5 of the 17 adults had to limit their activities, while no adolescent patient had to limit activity. Additionally, eight skeletally immature knees had greater than 5 degrees change in their congruence angles, as measured on Merchant tangential radiographs, over the year-long course of this study. Only one adult knee had a similar radiographic improvement. We recommend immediate action to alleviate patellofemoral pain syndrome, even when extremity alignment is normal. An isometric, progressive resistance quadriceps program with iliotibial band and hamstring stretching exercises is the preferred initial treatment.
authors.affiliation: Department of Orthopaedics, Children's Hospital Medical Center, Boston, Massachusetts.
authors.forename: D B
authors.initials: DB
authors.lastname: O'Neill
authors.forename: L J
authors.initials: LJ
authors.lastname: Micheli
authors.forename: J P
authors.initials: JP
authors.lastname: Warner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001182:Arthroscopy; D002648:Child; D005081:Exercise Therapy; D005260:Female; D005269:Femur / Q000502:physiology; D006801:Humans; D008297:Male; D010146:Pain / Q000601:surgery; D059408:Pain Management; D010329:Patella / Q000502:physiology; D011446:Prospective Studies