Open Access Highly Accessed Study protocol

Neuromuscular training and muscle strengthening in patients with patellofemoral pain syndrome: a protocol of randomized controlled trial

Nayra Deise dos Anjos Rabelo1, Bruna Lima1, Amir Curcio dos Reis1, André Serra Bley1, Liu Chiao Yi2*, Thiago Yukio Fukuda3, Leonardo Oliveira Pena Costa45 and Paulo Roberto Garcia Lucareli1

Author Affiliations

1 Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil

2 Universidade Federal de São Paulo, Campus Baixada Santista, Avenue Ana Costa, 95 - Santos/SP. CEP: 11060-000, São Paulo, SP, Brazil

3 Irmandade da Santa Casa de Misericórdia, São Paulo, Brazil

4 Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil

5 Musculoskeletal Division, The George Institute for Global Health, Sydney, Australia

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BMC Musculoskeletal Disorders 2014, 15:157  doi:10.1186/1471-2474-15-157

Published: 16 May 2014



Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition, particularly among women. Patients with PFPS usually experience weakness in the gluteal muscles, as well as pain and impaired motor control during activities of daily living. Strengthening the hip muscles is an effective way of treating this disorder. Neuromuscular training has also been identified as a therapeutic tool, although the benefits of this intervention in patients with PFPS patients remain inconclusive.


This is a protocol of randomized controlled trial with a blind assessor. Thirty-four women with a clinical diagnosis of PFPS participated. These participants were allocated into two groups (experimental and control). The experimental group performed twelve sessions to strengthen the knee extensors, hip abductor and lateral rotator muscles in association with neuromuscular training of the trunk and lower extremities. The control group performed the same number of sessions to strengthen the muscles of the hip and knee. The primary outcome was functional capacity (Anterior Knee Pain Scale – AKPS) at 4 weeks. Pain intensity, muscle strength and kinematic changes were also measured during the step down test after four weeks of intervention. Follow up assessments were conducted after three and six months to assess functional capacity and pain. The effects of the treatment (i.e. between-group differences) were calculated using mixed linear models.


The present study was initiated on the 1st of April 2013 and is currently in progress. The results of this study may introduce another effective technique of conservative treatment and could guide physical therapists in the clinical decision-making process for women with PFPS.

Trial registration

Current Controlled Trials NCT01804608.

Biomechanics; Kinematics; Anterior knee pain; Hip; Knee; Neuromuscular