Knee pain

Academy of Orthopaedic Physical Therapy Develops Guideline for Patellofemoral Pain

The Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association has released a clinical practice guideline on the management of patellofemoral pain (PFP). The guideline includes recommendations on the diagnosis of, classification of, examination of, and intervention for PFP.1

The guideline comes after authors conducted a systematic literature review of articles from 5 databases about PFP that had been published between 1960 and May 2018.


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Among the recommendations based on the review are the following:

  • To diagnose PFP, clinicians should use reproduction of retropatellar or peripatellar pain during squatting as well as the performance of other functional activities that load the patellofemoral joint in a flexed position.
  • To measure pain and function, clinicians should use the Anterior Knee Pain Scale, the patellofemoral pain and osteoarthritis subscale of the Knee Injury and Osteoarthritis Outcome Score, the visual analogue scale for activity, or the Eng and Pierrynowski Questionnaire.
  • To reduce pain, improve patient-reported outcomes, and for better functional performance in the short, medium, and long term, clinicians should include exercise therapy with combined hip- and knee-targeted exercises.
  • The use of biophysical agents, including ultrasonography, cryotherapy, phonophoresis, iontophoresis, electrical stimulation, and therapeutic laser, are not recommended for the treatment of a patient with PFP.


“While it might be tempting to seek quick fixes for knee pain, there is no evidence that nonactive treatments alone, such as electrical stimulation, lumbar manipulations, ultrasound, or dry needling, help persons with PFP,” guideline lead author Richard W. Willy, PT, PhD, said in a press release issued by the University of Montana. “Persons with PFP should seek clinicians who use exercise therapy for the treatment of this injury.”2

—Colleen Murphy


1. Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302.

2. UM physical therapy professor authors new guideline on treating runner’s knee [press release]. Missoula, MT: University of Montana; September 3, 2019. Accessed September 4, 2019.