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Conservative Management of Anterior Knee Pain: The McConnell Program

  • Jenny McConnell
  • Kim Bennell
Chapter

Abstract

Traditionally, conservative management of patellofemoral pain syndrome (PFPS) involved pain-relieving techniques and standard quadriceps strengthening in non-weight bearing positions. In 1986, an Australian physiotherapist, Jenny McConnell, proposed an innovative management program based on the premise that abnormal patellar tracking plays a key role in the etiology of PFPS.63Passive, active, and neural factors predisposing to abnormal patellar tracking were to be identified via a thorough assessment of the patient. Based on the assessment findings, the treatment program aimed first to unload abnormally stressed soft tissue around the patellofemoral joint by optimizing the patellar position and second, to improve the lower limb mechanics. The program included vastus medialis obliquus (VMO) retraining in functional weight-­bearing positions combined with patellar taping, patellar mobilization, correction of foot and lower limb mechanics, and stretching to reduce pain and enhance VMO activation. This chapter will focus on the McConnell program for conservatively managing PFPS. It will describe factors predisposing to PFPS as a theoretical rationale for the program and include details of assessment and treatment.

Keywords

Vastus Lateralis Subtalar Joint Iliotibial Band Lateral Patellar Femoral Anteversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1.  1.
    Handfield T, Kramer J. Effect of McConnell taping on perceived pain and knee extensor torques during isokinetic exercise performed by pateients with patellofemoral pain. Physioth Can. 2000; Winter:39-44.Google Scholar
  2.  2.
    Ahmed A, Shi S, Hyder A, et al. The effect of quadriceps tension characteristics on the patellar tracking pattern. Transactions of the 34th Orthopaedic Research Society; 1988; Atlanta:280.Google Scholar
  3.  3.
    Bennell K, Duncan M, Cowan S. Effect of patellar taping on vasti onset timing, knee kinematics, and kinetics in asymptomatic individuals with a delayed onset of vastus medialis oblique. J Orthop Res. 2006;24:1854-1860.PubMedGoogle Scholar
  4.  4.
    Bennell K, Hodges P, Mellor R, et al. The nature of anterior knee pain following injection of hypertonic saline into the infrapatellar fat pad. J Orthop Res. 2004;22:116-121.PubMedGoogle Scholar
  5.  5.
    Bockrath K, Wooden C, Worrell T, et al. Effects of patella taping on patella position and perceived pain. Med Sci Sports Exerc. 1993;25:989-992.PubMedGoogle Scholar
  6.  6.
    Brandt K. Pathogenesis of osteoarthritis. In: Kelley WN, Harris ED, Ruddy S, Sledge CB, eds. Textbook of Rheumatology. Philadelphia: W.B. Saunders Co; 1981.Google Scholar
  7.  7.
    Buchbinder R, Naparo N, Bizzo E. The relationship of abnormal pronation to chondromalacia patellae in distance runners. J Am Podiatry Assoc. 1979;69:159-161.PubMedGoogle Scholar
  8.  8.
    Burnham RS, Bell G, Olenik L, et al. Shoulder abduction strength measurement in football players: reliability and validity of two field tests. Clin J Sport Med. 1995;5:90-94.PubMedGoogle Scholar
  9.  9.
    Cerny K. Vastus medialis oblique/vastus lateralis muscle activity ratios for selected exercises in persons with and without patellofemoral pain syndrome. Phys Ther. 1995; 75:672-683.PubMedGoogle Scholar
  10. 10.
    Christou EA. Patellar taping increases vastus medialis oblique activity in the presence of patellofemoral pain. J Electromyogr Kinesiol. 2004;14:495-504.PubMedGoogle Scholar
  11. 11.
    Clark DI, Downing N, Mitchell J, et al. Physiotherapy for anterior knee pain: a randomised controlled trial. Ann Rheum Dis. 2000;59:700-704.PubMedGoogle Scholar
  12. 12.
    Collins N, Crossley K, Beller E, et al. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ. 2008;337:a1735.PubMedGoogle Scholar
  13. 13.
    Conway A, Malone T, Conway P. Patellar alignment/ tracking alteration: effect on force output and perceived pain. Isokinet Exerc Sci. 1992;2:9-17.Google Scholar
  14. 14.
    Cowan SM, Bennell KL, Crossley KM, et al. Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Med Sci Sports Exerc. 2002;34:1879-1885.PubMedGoogle Scholar
  15. 15.
    Cowan SM, Bennell KL, Hodges PW. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome. Clin J Sport Med. 2002;12:339-347.PubMedGoogle Scholar
  16. 16.
    Cowan SM, Bennell KL, Hodges PW, et al. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001;82:183-189.PubMedGoogle Scholar
  17. 17.
    Cowan SM, Bennell KL, Hodges PW, et al. Simultaneous feedforward recruitment of the vasti in untrained postural tasks can be restored by physical therapy. J Orthop Res. 2003;21:553-558.PubMedGoogle Scholar
  18. 18.
    Cowan SM, Hodges PW, Bennell KL, et al. Altered vastii recruitment when people with patellofemoral pain syndrome complete a postural task. Arch Phys Med Rehabil. 2002;83:989-995.PubMedGoogle Scholar
  19. 19.
    Cowan SM, Hodges PW, Crossley KM, et al. Patellar taping does not change the amplitude of electromyographic activity of the vasti in a stair stepping task. Br J Sports Med. 2006;40:30-34.PubMedGoogle Scholar
  20. 20.
    Crossley KM, Bennell KL, Cowan SM, et al. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil. 2004;85:815-822.PubMedGoogle Scholar
  21. 21.
    Crossley K, Bennell K, Green S, et al. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30:857-865.PubMedGoogle Scholar
  22. 22.
    Crossley KM, Cowan SM, Bennell KL, et al. Knee flexion during stair ambulation is altered in individuals with patellofemoral pain. J Orthop Res. 2004;22:267-274.PubMedGoogle Scholar
  23. 23.
    Deandrade JR, Grant C, Dixon AS. Joint distension and reflex muscle inhibition in the knee. J Bone Joint Surg Am. 1965;47:313-322.PubMedGoogle Scholar
  24. 24.
    Dierks TA, Manal KT, Hamill J, et al. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther. 2008;38:448-456.PubMedGoogle Scholar
  25. 25.
    Dillon PZ, Updyke WF, Allen WC. Gait analysis with reference to chondromalacia patellae. J Orthop Sports Phys Ther. 1983;5:127-131.PubMedGoogle Scholar
  26. 26.
    Doucette SA, Child DD. The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. J Orthop Sports Phys Ther. 1996;23:104-110.PubMedGoogle Scholar
  27. 27.
    Dursun N, Dursun E, Kilic Z. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001;82:1692-1695.PubMedGoogle Scholar
  28. 28.
    Dye SF. The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop Relat Res. 1996; 325:10-18.PubMedGoogle Scholar
  29. 29.
    Eburne J, Bannister G. The McConnell regimen versus isometric quadriceps exercises in the management of anterior knee pain. A randomised prospective controlled trial. Knee. 1996;3:151-153.Google Scholar
  30. 30.
    Ernst GP, Kawaguchi J, Saliba E. Effect of patellar taping on knee kinetics of patients with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 1999;29:661-667.PubMedGoogle Scholar
  31. 31.
    Frankel VH, Nordin M. Basic Biomechanics of the Skeletal System. Philadelphia: Lea and Febiger; 1980.Google Scholar
  32. 32.
    Fucentese SF, von Roll A, Koch PP, et al. The patella morphology in trochlear dysplasia – a comparative MRI study. Knee. 2006;13:145-150.PubMedGoogle Scholar
  33. 33.
    Fulkerson JP. Awareness of the retinaculum in evaluating patellofemoral pain. Am J Sports Med. 1982;10:147-149.PubMedGoogle Scholar
  34. 34.
    Fulkerson J, Hungerford D. Disorders of the Patellofemoral Joint. 2nd ed. Baltimore: Williams & Wilkins; 1990.Google Scholar
  35. 35.
    Gilleard W, McConnell J, Parsons D. The effect of patellar taping on the onset of vastus medialis obliquus and vastus lateralis muscle activity in persons with patellofemoral pain. Phys Ther. 1998;78:25-32.PubMedGoogle Scholar
  36. 36.
    Grabiner MD, Koh TJ, Draganich LF. Neuromechanics of the patellofemoral joint. Med Sci Sports Exerc. 1994;26:10-21.PubMedGoogle Scholar
  37. 37.
    Greenwald AE, Bagley AM, France EP, et al. A biomechanical and clinical evaluation of a patellofemoral knee brace. Clin Orthop Relat Res. 1996;324:187-195.PubMedGoogle Scholar
  38. 38.
    Harrison EL, Sheppard MS, McQuarrie AM. A randomized controlled trial of physical therapy treatment programs in patellofemoral pain syndrome. Physiother Can. 1999; Spring:93-106.Google Scholar
  39. 39.
    Helminen H, Kiviranta I, Tammi M, et al. Joint Loading: Biology and Health of Articular Structures. London: Butterworth & Co Ltd; 1987.Google Scholar
  40. 40.
    Herbert R. Preventing and treating stiff joints. In: Crosbie J, McConnell J, eds. Key issues in Musculoskeletal Physio­therapy. Oxford: Butterworth – Heinemann; 1993.Google Scholar
  41. 41.
    Herrington L. The effect of corrective taping of the patella on patella position as defined by MRI. Res Sports Med. 2006;14:215-223.PubMedGoogle Scholar
  42. 42.
    Herrington L, Payton CJ. Effects of corrective taping of the patella on patients with patellofemoral pain. Physiotherapy. 1997;83:566-572.Google Scholar
  43. 43.
    Hodges PW, Mellor R, Crossley K, et al. Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles. Arthritis Rheum. 2009;61:70-77.PubMedGoogle Scholar
  44. 44.
    Hooley CJ, McCrum NG, Cohen RE. The viscoelastic deformation of tendon. J Biomech. 1980;13:521-528.PubMedGoogle Scholar
  45. 45.
    Hoppenfeld S. Physical Examination of the Spine and Extremities. New York: Appleton; 1976.Google Scholar
  46. 46.
    Howard JD, Enoka RM. Maximum bilateral contractions are modified by neurally mediated interlimb effects. J Appl Physiol. 1991;70:306-316.PubMedGoogle Scholar
  47. 47.
    Hudson Z, Darthuy E. Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Man Ther. 2009;14:147-151.PubMedGoogle Scholar
  48. 48.
    Insall J. “Chondromalacia patellae”: patellar malalignment syndrome. Orthop Clin North Am. 1979;10:117-127.PubMedGoogle Scholar
  49. 49.
    Karst GM, Willett GM. Onset timing of electromyographic activity in the vastus medialis oblique and vastus lateralis muscles in subjects with and without patellofemoral pain syndrome. Phys Ther. 1995;75:813-823.PubMedGoogle Scholar
  50. 50.
    Kendall HD, Kendall FP, Boynton DA. Posture and Pain. Baltimore: Williams & Wilkinson Co; 1952.Google Scholar
  51. 51.
    Kendall F, McCreary L. Muscle Testing and Function. Baltimore: Williams & Wilkins; 1983.Google Scholar
  52. 52.
    Keser S, Savranlar A, Bayar A, et al. Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. 2008;16:911-915.PubMedGoogle Scholar
  53. 53.
    Koh TJ, Grabiner MD, De Swart RJ. In vivo tracking of the human patella. J Biomech. 1992;25:637-643.PubMedGoogle Scholar
  54. 54.
    Kramer PG. Patella malalignment syndrome: rationale to reduce excessive lateral pressure. J Orthop Sports Phys Ther. 1986;8:301-309.PubMedGoogle Scholar
  55. 55.
    Larsen B, Andreasen E, Urfer A, et al. Patellar taping: a radiographic examination of the medial glide technique. Am J Sports Med. 1995;23:465-471.PubMedGoogle Scholar
  56. 56.
    Levinger P, Gilleard W. Tibia and rearfoot motion and ground reaction forces in subjects with patellofemoral pain syndrome during walking. Gait Posture. 2007;25:2-8.PubMedGoogle Scholar
  57. 57.
    Lutter LD. The knee and running. Clin Sports Med. 1985; 4:685-698.PubMedGoogle Scholar
  58. 58.
    Lyon LK, Benz LN, Johnson KK, et al. Q-angle: a factor in peak torque occurrence in isokinetic knee extension. J Orthop Sports Phys Ther. 1988;9:250-253.PubMedGoogle Scholar
  59. 59.
    MacKay-Lyons M. Low-load, prolonged stretch in treatment of elbow flexion contractures secondary to head trauma: a case report. Phys Ther. 1989;69:292-296.PubMedGoogle Scholar
  60. 60.
    Maitland GD. Vertebral Manipulation. London: Butter­worths; 1986.Google Scholar
  61. 61.
    Malek MM, Mangine RE. Patellofemoral pain syndromes: a comprehensive and conservative approach. J Orthop Sports Phys Ther. 1981;2:108-116.PubMedGoogle Scholar
  62. 62.
    Mariani PP, Caruso I. An electromyographic investigation of subluxation of the patella. J Bone Joint Surg Br. 1979;61:169-171.PubMedGoogle Scholar
  63. 63.
    McConnell J. The management of chondromalacia patellae: a long term solution. Aust J Physiother. 1986;32:215-223.Google Scholar
  64. 64.
    McConnell J. Fat pad irritation: a mistaken patellar tendonitis. Sport Health. 1991;9:79.Google Scholar
  65. 65.
    McConnell J. Training the vastus medialis oblique in the management of patellofemoral pain. In: Tenth Congress of the World Confederation for Physical Therapy; 1987; Sydney.Google Scholar
  66. 66.
    Merican AM, Amis AA. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomech. 2009;42: 1539-1546.PubMedGoogle Scholar
  67. 67.
    Micheli LJ, Slater JA, Woods E, et al. Patella alta and the adolescent growth spurt. Clin Orthop Relat Res. 1986;213:159-162.PubMedGoogle Scholar
  68. 68.
    Mizuno Y, Kumagai M, Mattessich SM, et al. Q-angle influences tibiofemoral and patellofemoral kinematics. J Orthop Res. 2001;19:834-840.PubMedGoogle Scholar
  69. 69.
    Mow VC, Lai WM, Eisenfeld J, et al. Some surface characteristics of articular cartilage. II. On the stability of articular surface and a possible biomechanical factor in etiology of chondrodegeneration. J Biomech. 1974;7:457-468.PubMedGoogle Scholar
  70. 70.
    Nadler SF, DePrince ML, Hauesien N, et al. Portable dynamometer anchoring station for measuring strength of the hip extensors and abductors. Arch Phys Med Rehabil. 2000;81:1072-1076.PubMedGoogle Scholar
  71. 71.
    Nakagawa TH, Muniz TB, Baldon Rde M, et al. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clin Rehabil. 2008;22: 1051-1060.PubMedGoogle Scholar
  72. 72.
    Ng GY, Cheng JM. The effects of patellar taping on pain and neuromuscular performance in subjects with patellofemoral pain syndrome. Clin Rehabil. 2002;16:821-827.PubMedGoogle Scholar
  73. 73.
    On AY, Uludag B, Taskiran E, et al. Differential corticomotor control of a muscle adjacent to a painful joint. Neurorehabil Neural Repair. 2004;18:127-133.PubMedGoogle Scholar
  74. 74.
    Owings TM, Grabiner MD. Motor control of the vastus medialis oblique and vastus lateralis muscles is disrupted during eccentric contractions in subjects with patellofemoral pain. Am J Sports Med. 2002;30:483-487.PubMedGoogle Scholar
  75. 75.
    Pfeiffer RP, DeBeliso M, Shea KG, et al. Kinematic MRI assessment of McConnell taping before and after exercise. Am J Sports Med. 2004;32:621-628.PubMedGoogle Scholar
  76. 76.
    Powers CM, Landel R, Perry J. Timing and intensity of vastus muscle activity during functional activities in subjects with and without patellofemoral pain. Phys Ther. 1996; 76:946-955; discussion 956-967.PubMedGoogle Scholar
  77. 77.
    Powers CM, Landel R, Sosnick T, et al. The effects of patellar taping on stride characteristics and joint motion in subjects with patellofemoral pain. J Orthop Sports Phys Ther. 1997;26:286-291.PubMedGoogle Scholar
  78. 78.
    Powers CM, Mortenson S, Nishimoto D, et al. Criterion-related validity of a clinical measurement to determine the medial/lateral component of patellar orientation. J Orthop Sports Phys Ther. 1999;29:372-377.PubMedGoogle Scholar
  79. 79.
    Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55:9-15.PubMedGoogle Scholar
  80. 80.
    Radin EL. A rational approach to the treatment of ­patellofemoral pain. Clin Orthop Relat Res. 1979;144:107-109.PubMedGoogle Scholar
  81. 81.
    Roberts JM. The effect of taping on patellofemoral alignment a radiological pilot study. In: Sixth Biennial Conference of the Manipulative Therapists Association of Australia. 1989:146-151.Google Scholar
  82. 82.
    Root M, Orien W, Weed J. Clinical Biomechanics, vol. II. Los Angeles: Clinical Biomechanics Corp; 1977.Google Scholar
  83. 83.
    Sale D, MacDougall D. Specificity in strength training: a review for the coach and athlete. Can J Appl Sport Sci. 1981;6:87-92.PubMedGoogle Scholar
  84. 84.
    Salsich GB, Brechter JH, Farwell D, et al. The effects of patellar taping on knee kinetics, kinematics, and vastus lateralis muscle activity during stair ambulation in individuals with patellofemoral pain. J Orthop Sports Phys Ther. 2002; 32:3-10.PubMedGoogle Scholar
  85. 85.
    Scott DA, Bond EQ, Sisto SA, et al. The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station. Arch Phys Med Rehabil. 2004;85:598-603.PubMedGoogle Scholar
  86. 86.
    Smith TO, Davies L, Donell ST. The reliability and validity of assessing medio-lateral patellar position: a systematic review. Man Ther. 2009;14:355-362.PubMedGoogle Scholar
  87. 87.
    Smith TO, Hunt NJ, Donell ST. The reliability and validity of the Q-angle: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2008;16:1068-1079.PubMedGoogle Scholar
  88. 88.
    Somes S, Worrell TW, Corey B, et al. Effects of patellar taping on patellar position in the open and closed kinetic chain: a preliminary study. J Sport Rehabil. 1997;6:299-308.Google Scholar
  89. 89.
    Souza DR, Gross MT. Comparison of vastus medialis obliquus: vastus lateralis muscle integrated electromyographic ratios between healthy subjects and patients with patellofemoral pain. Phys Ther. 1991;71(4):310-316; ­discussion 317-320.PubMedGoogle Scholar
  90. 90.
    Souza RB, Powers CM. Predictors of hip internal rotation during running: an evaluation of hip strength and femoral structure in women with and without patellofemoral pain. Am J Sports Med. 2009;37:579-587.PubMedGoogle Scholar
  91. 91.
    Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps reflex inhibition in man. Arch Phys Med Rehabil. 1984;65:171-177.PubMedGoogle Scholar
  92. 92.
    Stokes M, Young A. Investigations of quadriceps inhibition: implications for clinical practice. Physiotherapy. 1984;70: 425-428.Google Scholar
  93.  93.
    Subotnick SI. The foot and its relationship to gait: a series of articles and editorial comments. J Orthop Sports Phys Ther. 1980;2:48-54.PubMedGoogle Scholar
  94.  94.
    Syme G, Rowe P, Martin D, et al. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening. Man Ther. 2009;14:252-263.PubMedGoogle Scholar
  95.  95.
    Tang SF, Chen CK, Hsu R, et al. Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study. Arch Phys Med Rehabil. 2001;82:1441-1445.PubMedGoogle Scholar
  96.  96.
    Taylor DC, Dalton JD Jr, Seaber AV, et al. Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. Am J Sports Med. 1990;18:300-309.PubMedGoogle Scholar
  97.  97.
    Thijs Y, De Clercq D, Roosen P. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. Br J Sports Med. 2008;42:466-471.PubMedGoogle Scholar
  98.  98.
    Townsend PR, Rose RM, Radin EL, et al. The biomechanics of the human patella and its implications for chondromalacia. J Biomech. 1977;10:403-407.PubMedGoogle Scholar
  99.  99.
    Van Tiggelen D, Cowan S, Coorevits P, et al. Delayed vastus medialis obliquus to vastus lateralis onset timing contributes to the development of patellofemoral pain in previously healthy men: a prospective study. Am J Sports Med. 2009;37: 1099-1105.PubMedGoogle Scholar
  100. 100.
    Voight ML, Wieder DL. Comparative reflex response times of vastus medialis obliquus and vastus lateralis in normal subjects and subjects with extensor mechanism dysfunction. An electromyographic study. Am J Sports Med. 1991;19:131-137.PubMedGoogle Scholar
  101. 101.
    Warden SJ, Hinman RS, Watson MA, et al. Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthritis Rheum. 2008; 59:73-83.PubMedGoogle Scholar
  102. 102.
    Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dyn Med. 2008;7:9.PubMedGoogle Scholar
  103. 103.
    Wilson NA, Press JM, Koh JL, et al. In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am. 2009;91:558-566.PubMedGoogle Scholar
  104. 104.
    Wilson NA, Press JM, Zhang LQ. In vivo strain of the medial versus lateral quadriceps tendon in patellofemoral pain syndrome. J Appl Physiol. 2009;107:422-428.PubMedGoogle Scholar
  105. 105.
    Witvrouw E, Sneyers C, Lysens R, et al. Reflex response times of vastus medialis oblique and vastus lateralis in normal subjects and in subjects with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 1996;24:160-165.PubMedGoogle Scholar
  106. 106.
    Yang JF, Winter DA. Electromyography reliability in maximal and submaximal isometric contractions. Arch Phys Med Rehabil. 1983;64:417-420.PubMedGoogle Scholar
  107. 107.
    Yip SL, Ng GY. Biofeedback supplementation to physiotherapy exercise programme for rehabilitation of patellofemoral pain syndrome: a randomized controlled pilot study. Clin Rehabil. 2006;20:1050-1057.PubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Centre for Health, Exercise and Sports Medicine, Physiotherapy, School of Health SciencesThe University of MelbourneVictoriaAustralia

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