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Am J Sports Med. 2019 Jun;47(7):1629-1637. doi: 10.1177/0363546519843915. Epub 2019 May 16.

Activity Modification and Load Management of Adolescents With Patellofemoral Pain: A Prospective Intervention Study Including 151 Adolescents.

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SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.



Patellofemoral pain (PFP) affects 7% of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted.


To investigate the effects of a treatment strategy for adolescents that focuses on activity modification and load management.


Cohort study; Level of evidence, 2.


Adolescents aged 10 to 14 years with PFP were included (N = 151). The 12-week intervention included 4 supervised sessions with a physical therapist, which adolescents and parents were required to attend. The intervention included activity modification (weeks 1-4) to reduce loading of the patellofemoral joint via an activity ladder and pain monitoring, home-based exercises (weeks 5-8), and return-to-sport guidance (weeks 9-12). Primary outcome was a 7-point global rating of change, ranging from "much improved" to "much worse." Adolescents were considered to have a successful outcome if they reported "much improved" or "improved." The primary endpoint was at 12 weeks, with additional follow-up at 4, 24, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), hip and knee torque, sports participation, satisfaction with treatment, and use of painkillers.


At 12 weeks, 87% completed the full questionnaire, of which 86% reported a successful outcome, as compared with 77% (95% CI, 68%-83%) at 6 months and 81% (95% CI, 73%-88%) at 12 months. There were large clinically relevant improvements in 3 KOOS subscales: Pain, Sport/Recreation, and Quality of Life (13-24 points). Hip and knee torque increased by 20% to 33%. In total, 68% were back playing sport after 3 months, which increased to 79% at 6 months and 81% at 12 months. The majority were satisfied with the treatment (90%) and would recommend it to a friend (95%). No specific patient characteristics were associated with prognosis.


A treatment strategy focusing on activity modification and load management was associated with high rates of successful outcome among adolescents with PFP at 12 and 52 weeks. These short- and longer-term outcomes were supported by improvements in symptoms and objective measures of hip and knee torque.


NCT02402673 ( identifier).


anterior knee pain; education; knee pain; youth


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