Physiotherapy for anterior knee pain: a randomized controlled trial. (City Hospital Nottingham, Nottingham, United Kingdom) Ann Rheum Dis 2000;59:700–704.
Authors: Clark D. I. , Downing N. , Mitchell J. , Coulson L. , Syzpryt E. P. , Doherty: M. 
Published: March 2003

This observer blind, prospective, factorial design randomized controlled trial determined the efficacy of the individual components of physiotherapy in subjects with anterior knee pain. Eighty‐one young adults with anterior knee pain were randomly allocated to one of four treatment groups: (1) exercise, tapping, and education; (2) exercise and education; (3) taping and education; and (4) education alone. Each group received 6 physiotherapist‐led treatments over 3 months. Follow up took place at 3 months using the following outcomes measures: Patient satisfaction; a visual analogue pain score; the WOMAC lower limb function score; the Hospital Anxiety and Depression scale (HAD); and quadriceps strength. At 12 months the WOMAC and HAD were assessed by postal questionnaire. All groups showed significant improvements in WOMAC, visual analogue, and HAD scores; these improvements did not vary significantly between the four groups or between exercising/nonexercising and taped/nontaped patients at 3 and 12 months. However, patients who exercised were significantly more likely to be discharged at 3 months than nonexercising patients. Taping was not significantly associated with discharge. Significantly greater improvements in WOMAC, visual analogue, and the anxiety score were seen in patients who were discharged than in those who were referred. Conclude the proprioceptive muscle stretching and strengthening aspects of physiotherapy have a beneficial effect at 3 months sufficient to permit discharge from physiotherapy. These benefits are maintained at 1 year. Taping does not influence the outcome.

Comment by Phillip S. Sizer Jr., MEd, P.T. The investigators evaluated a total of 81 patients (36 female and 45 male) between the ages of 16 and 40 years with a history of anterior knee pain of more than three months. Patients were evaluated through history, locomotor examination, WOMAC score and Hospital Anxiety and Depression scale (HAD). In addition, isometric quadriceps strength and power were measured before and after treatment. Patients were randomly assigned to one of four different groups: (1) exercise, taping, and education; (2) taping and education; (3) exercise and education; and (4) education alone. Each patient received six treatments over a three‐month period. Through a 2 × 2 factorial analysis design, the investigators discovered that the group participating in exercise were significantly more likely to be discharged than non‐participants. Additionally, they found that taping alone was not significantly associated with discharge. Furthermore, they observed no difference between groups for the WOMAC score and the visual analogue pain score. Finally, they found that education alone resulted in the sufficient improvement of 60% of those subjects without need for other intervention, supporting the value of therapist contact and simple advice. These investigators embarked upon the evaluation of a controversial condition whose etiology is not well understood.1 Recent investigators have revealed alternative explanations for persistent anterior knee pain, including increased patelo‐femoral joint stress2,3 and receptor neuro‐sensitization within the lateral retinaculum.4 These outcomes may reflect the influence of exercise on those factors and support the use of physical therapy in the treatment of anterior knee pain.