REF-917 · Esculier et al., 2017 · British Journal of Sports Medicine, Vol. · Paper · PubMed

Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? A randomised clinical trial

B+moderate evidenceMeasured on recreational to trained athletesWritten before October 2026, being re-checked

Runners with patellofemoral pain (PFP) were randomised to one of three 8-week rehabilitation programmes: education on symptoms management and training modifications; an exercise programme added to that education; or gait retraining added to that education. Symptoms and functional limitations improved similarly in all three groups at 4, 8 and 20 weeks.

The exercise group alone gained knee extension strength and the gait retraining group alone raised step rate and lowered vertical loading rate, but neither addition gave extra benefit on symptoms or function. The authors conclude that appropriate education on symptoms and management of training loads should be a primary component of treatment in runners with PFP.

Participants

Sixty-nine runners with PFP, randomly assigned to three groups. Sex, age, running volume and group sizes are not given in the abstract.

Protocol

Education: education on symptoms management and training modifications.
Exercises: an exercise programme in addition to education.
Gait retraining: gait retraining in addition to education.
Each programme ran for 8 weeks; outcomes were measured at baseline (T0) and at weeks 4, 8 and 20 (T4, T8, T20).
Outcomes: the KOS-ADLS (Knee Outcome Survey, Activities of Daily Living Scale) and VASs (visual analogue scales) rating usual pain, worst pain and running pain. At T0 and T8 also: running kinematics and kinetics of the lower limb, and isometric strength.
Two-way analysis of variance. Trial registration NCT02352909.

Key Results

No significant group × time interactions (p<0.447) for KOS-ADLS and the VASs.
Relative to T0, every group improved by a similar amount at T4, T8 and T20 (p<0.05).
Only the exercises group increased knee extension strength (group × time: p<0.001).
Only the gait retraining group increased step rate (+7.0%) and decreased average vertical loading rate (-25.4%) (group × time: p<0.001).
The abstract gives no KOS-ADLS or pain scores, so the size of the improvement is not available here.

Practical Application

In sixty-nine runners with patellofemoral pain randomised to education alone, education plus exercises, or education plus gait retraining for 8 weeks, all three groups improved similarly at 4, 8 and 20 weeks; adding exercises or gait retraining changed strength and running mechanics but gave no extra benefit on symptoms or function. To "my clinician says it is patellofemoral pain — do I need a strength programme or a new running style?": in this trial, education on managing symptoms and training load did as well as education with either addition.
The additions did what they target: knee extension strength rose only with exercises, and step rate rose (+7.0%) and vertical loading rate fell (-25.4%) only with gait retraining. They simply did not add to the symptom result within 20 weeks.
The abstract does not describe what the education contained beyond "symptoms management and training modifications"; the base cannot quote its rules.
Not from this paper; the base's own practice: the assistant does not name a diagnosis from a description of knee pain; it uses a clinician's diagnosis as given, and the triage, substitution and return rules are in SYNTH-73.

Limitations

No untreated or wait-list control: the similar improvement in all groups cannot be separated from natural recovery.
Group sizes, participant characteristics and the outcome scores are not given in the abstract.
Follow-up ended at 20 weeks; recurrence and longer-term outcome are unknown.
Single-blind; participants in an exercise or gait intervention cannot be blinded.
Written from the abstract and record metadata only (full text not read).
How this entry was checked and changed
Why this level

three-arm parallel RCT, n=69 in total split three ways (group sizes not given in the abstract), so no pairwise comparison reaches the rubric's well-powered bar; the main result is the absence of a between-group difference