title: Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis.
abstract: BACKGROUND
  Proximal muscle rehabilitation is commonly prescribed to address muscle strength and function deficits in individuals with patellofemoral pain (PFP). This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP; (2) compares the efficacy of various rehabilitation protocols; and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group.
  
  
  METHODS
  Web of Knowledge, CINAHL, EMBASE and Medline databases were searched in December 2014 for randomised clinical trials and cohort studies evaluating proximal rehabilitation for PFP. Quality assessment was performed by two independent reviewers. Effect size calculations using standard mean differences and 95% CIs were calculated for each comparison.
  
  
  RESULTS
  14 studies were identified, seven of high quality. Strong evidence indicated proximal combined with quadriceps rehabilitation decreased pain and improved function in the short term, with moderate evidence for medium-term outcomes. Moderate evidence indicated that proximal when compared with quadriceps rehabilitation decreased pain in the short-term and medium-term, and improved function in the medium term. Limited evidence indicated proximal combined with quadriceps rehabilitation decreased pain more than quadriceps rehabilitation in the long term. Very limited short-term mechanistic evidence indicated proximal rehabilitation compared with no intervention decreased pain, improved function, increased isometric hip strength and decreased knee valgum variability while running.
  
  
  CONCLUSIONS
  A robust body of work shows proximal rehabilitation for PFP should be included in conservative management. Importantly, greater pain reduction and improved function at 1 year highlight the long-term value of proximal combined with quadriceps rehabilitation for PFP.
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Lack
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, UK Complete Sports Care, Melbourne, Australia Pure Sports Medicine, London, UK Lower Extremity Gait Studies, Health Sciences, La Trobe University, Bundoora, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Barton
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Sohan
authors.affiliation: School of Health and Rehabilitation Sciences, University of Queensland, Brisbance, Queensland, Australia.
authors.forename: Kay
authors.initials: K
authors.lastname: Crossley
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, UK Physiotherapy Department, Bart's Health NHS Trust, London, UK.
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
mesh_terms: D015331:Cohort Studies; D006801:Humans; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D010147:Pain Measurement / Q000379:methods; D046788:Patellofemoral Pain Syndrome / Q000503:physiopathology / Q000534:rehabilitation*; D052097:Quadriceps Muscle / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D055070:Resistance Training / Q000379:methods*; D016896:Treatment Outcome
keywords: Exercises; Knee; Rehabilitation