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Great clinical commentary on patellofemoral pain in runners by @JFEsculier and team.
Key points:
1) patient education on the concepts of load and capacity should be the hallmark clinical approach
1/n https://pubmed.ncbi.nlm.nih.gov/33196837/
Key points:
1) patient education on the concepts of load and capacity should be the hallmark clinical approach
1/n https://pubmed.ncbi.nlm.nih.gov/33196837/
2) length of injury is key.
—more acuity: may just need a temporary shift in load away from PFJ
—more chronic: more permanent shift in load and enhanced focus on psychosocial aspects may be warranted
2/n
—more acuity: may just need a temporary shift in load away from PFJ
—more chronic: more permanent shift in load and enhanced focus on psychosocial aspects may be warranted
2/n
3) it is very likely that your runner w/ PFPS has strength deficits
—but, unless they are in the military it is likely this is the effect and not the cause of their pain.
—so work on hip and quad strength. Most likely works better than quad strengthening alone.
3/n
—but, unless they are in the military it is likely this is the effect and not the cause of their pain.
—so work on hip and quad strength. Most likely works better than quad strengthening alone.
3/n
4) what we say matters. We must move away from saying we know the cause of their pain as that’s usually not true and may 
kinesiophobia and pain catastrophization
— we especially should stop talking about PFP maltracking & other anatomical variants as the cause of pain
4/n
kinesiophobia and pain catastrophization— we especially should stop talking about PFP maltracking & other anatomical variants as the cause of pain
4/n
5)gait retraining, esp step rate manipulation, has evidence for its support but the question of change permanence exists.
—does the shift in load need to be permanent to meet a patient’s needs?
—what side effects are there?
Is the patient educated on the risks/benefits?
5/n
—does the shift in load need to be permanent to meet a patient’s needs?
—what side effects are there?
Is the patient educated on the risks/benefits?
5/n
6) shoes are even trickier. Limited evidence indicates a more minimal shoe 
many PFP mechanical factors associated w/ PFPS. But this change requires time and money and is not usually recommended on its own.
6/n
many PFP mechanical factors associated w/ PFPS. But this change requires time and money and is not usually recommended on its own. 6/n
7) ultimately an individualized, multimodal approach is warranted. Education & strengthening exercises are 2 interventions w/ the most research support. But taking into consideration the whole person & factors like sleep, stress, fear, etc are key to effective physiotherapy
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