title: The Effects of a Multimodal Rehabilitation Program on Symptoms and Ground-Reaction Forces in Runners With Patellofemoral Pain Syndrome.
abstract: Patellofemoral pain (PFP) is one of the most frequent running-related injuries. However, few interventions taking into consideration the specificity of running have been shown to be effective in runners with PFP.
  
  
  
  To evaluate the effects of a multimodal rehabilitation program including lower-limb-strengthening/ motor-control exercises, advice on running biomechanics, and symptoms management on symptoms, strength, and ground-reaction forces in runners with PFP.
  
  
  
  Pre- to post- quasi-experimental.
  
  
  
  Gait-analysis laboratory and private physical therapy clinic.
  
  
  
  21 runners with PFP (34.1 ± 6.0 y old, symptoms duration 38.1 ± 45.5 mo).
  
  
  
  An 8-wk multimodal rehabilitation program including lower-limb- and core-strengthening and motor-control exercises, as well as advice on running gait and symptoms management.
  
  
  
  The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) questionnaire and visual analog scales for usual pain (VAS-U), worst pain (VAS-W), and pain during running (VAS-R) were used to assess changes in symptoms and function. Vertical ground-reaction forces (VGRF) during running and lower-limb isometric strength were also measured.
  
  
  
  Statistically and clinically significant improvements (P < .001) were reported on KOS-ADLS (+17.8 pts), VAS-U (-19.2 pts), VAS-W (-28.7 pts), and VAS-R (-32.2 pts) after the intervention. No significant changes in isometric strength were observed. The instantaneous vertical loading rate was decreased after the intervention (P = .002), and this reduction was correlated with changes in KOS-ADLS scores (P = .028).
  
  
  
  This multimodal intervention was successful in reducing pain and improving function of runners with PFP. However, no significant changes in lower-limb strength were observed. It appears that changes in VGRF combined with appropriate training advice could explain the clinical outcomes.
authors.affiliation: Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Esculier
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Bouyer
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Roy
mesh_terms: D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D003131:Combined Modality Therapy; D037001:Directive Counseling; D026241:Exercise Movement Techniques; D005081:Exercise Therapy / Q000379:methods*; D005528:Foot / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength; D059352:Musculoskeletal Pain / Q000209:etiology; D010147:Pain Measurement; D046788:Patellofemoral Pain Syndrome / Q000150:complications / Q000534:rehabilitation*; D052097:Quadriceps Muscle / Q000502:physiology; D055070:Resistance Training; D012420:Running / Q000293:injuries* / Q000502:physiology*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D016474:Weight-Bearing; D055815:Young Adult