Core training for pain management and functional improvement in patients with patellofemoral pain syndrome: a systematic review and meta-analysis.

ABSTRACT

OBJECTIVE: To investigate the effects of core strengthening exercises on pain, mobility, and lower extremity muscle strength in patients with Patellofemoral Pain Syndrome (PFP). DESIGN: Six databases were searched from inception until August 11, 2023. Pain, function and muscle strength related outcomes were extracted and the quality of the studies was assessed using the PEDro scale and the level of evidence was assessed using the GRADE. RESULTS: Nineteen studies involving 1138 patients were included. Very low-grade evidence supported the short-term pain-relieving effect of core training (SMD = -0.60 95% CI [-0.95, -0.25]), high-grade evidence supported the short-term functional improvement effects of core training (WMD = 3.61 95% CI [1.44, 5.78]), which was similarly significant within 3-12 months of follow-up. The results of the subgroup analyses suggested that hip-knee training was most advantageous in relieving pain and enhancing motor function. CONCLUSIONS: Although training that includes trunk core is clearly superior to knee strengthening alone, the effectiveness of hip-knee training, which is also a core training program for pain and function, is more pronounced. The available evidence supports that hip-knee training is the most valuable treatment option for patients with PFP.