Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning.

Patellofemoral pain, the ache around and behind the kneecap that often flares with running, squatting, or stairs, has been treated in many different ways over the years, with clinicians and patients often unsure which approach deserves priority. This paper tried to settle that question by combining three sources of evidence: a meta-analysis of high-quality randomised trials, interviews with people living with the condition, and interviews and focus groups with experienced clinicians. Bringing these together, the authors concluded that exercise therapy targeting the knee and sometimes the hip, paired with education about the condition, should form the core of care, with other options like foot orthoses, manual therapy, movement or running retraining, or taping added only when they suit an individual's specific presentation.

The strength here lies in triangulating clinical trial data with real patient and expert perspectives rather than relying on numbers alone. The main limitation is that even strong evidence for a treatment package does not tell us which individual ingredient, or combination, matters most for any one person.

If you've dealt with kneecap pain, especially the kind that shows up with running, squats, or stairs, you know there's no shortage of suggested fixes: exercises, orthotics, taping, gait retraining, and more. This study pulled together the best available research trials, conversations with people who've experienced this pain, and interviews with experienced clinicians to work out what actually deserves top priority.

The consistent answer was that exercises focused on the knee, sometimes combined with hip exercises, along with clear education about the condition, should come first. Other treatments like shoe inserts, hands-on therapy, changes to running technique, or taping weren't dismissed, but the evidence suggests they work best when chosen to fit a person's particular situation rather than applied to everyone the same way. It's reassuring that this recommendation comes from combining research data with what patients and clinicians actually experience, not just numbers in isolation.

That said, this doesn't tell you exactly how much any single approach will help your own knee, since people's pain and physical findings vary quite a bit.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This mixed-methods synthesis combined meta-analysed data from 65 high-quality randomised controlled trials (3796 participants, 11 meta-analyses) with thematic analysis of interviews from 12 patients with patellofemoral pain and 19 clinical experts, refined through three expert focus groups. Convergence across these three data streams supported six interventions for best practice, with knee-targeted exercise therapy, with or without hip-targeted exercise, delivered alongside education, forming the primary recommended approach based on the strongest agreement across data sources. Supporting interventions, including prefabricated foot orthoses, manual therapy, movement or running retraining, and taping, were recommended as adjuncts rather than standalone treatments, to be selected according to individual risk factors, symptom presentation, and physical impairments identified through assessment.

The trial-level evidence pool, while restricted to PEDro-quality studies above 7, still reflects a heterogeneous condition and intervention set, and the synthesis does not establish comparative superiority between the supporting interventions themselves. Clinicians should note this is a best practice guide derived from convergent evidence rather than a single definitive trial, and individual intervention effect sizes from the meta-analyses are not detailed in the abstract, limiting precise quantification of expected benefit for any one component.