Adding neuromuscular training to a strengthening program did not produce additional improvement in clinical or kinematic outcomes in women with patellofemoral pain: A blinded randomised controlled trial

Background: Patellofemoral pain (PFP) is a knee pain condition with multifactorial aetiology, twice common in women. The recommended conservative treatment is based on strengthening of the core, hip, and knee mus-culatures. Addition of neuromuscular training to a strengthening protocol might provide further benefits on pain, function, and kinematics in PFP individuals. However, evidence for the effectiveness of this protocol is lacking.Objective: To investigate whether adding neuromuscular training to strengthening program could provide any additional improvements of pain, function, and kinematics in PFP women.Methods: 71 PFP women were randomly into two groups and submitted to different interventions for 12 weeks. The strengthening group (SG) performed strengthening exercises for the trunk, hip, and knee muscles, while the neuromuscular training group (NMTG) performed the same exercises as SG, plus neuromuscular training from the 4th week onwards. The primary outcomes were pain intensity, function, and 2-D kinematics of the trunk and lower limb. The secondary outcomes were isometric muscle strength and patient satisfaction level. All outcomes were evaluated at 12 weeks, immediately post-treatment.Results: At 12 weeks, there was no evidence of between-group differences for any outcome, but both in-terventions provided clinically significant improvements for pain intensity (SG: mean difference-3.9, 95% confidence interval [CI]-5.0,-2.9; NMTG: mean difference-3.1, 95% CI-4.1,-2.0) and function (SG: mean difference 15.3, 95% CI 11.5, 19.2; NMTG: mean difference 16.9, 95% CI 13.2, 20.7).Conclusion: Neuromuscular training did not produce any additional benefits for pain, function, or kinematics at 12 weeks of treatment.