National Athletic Trainers' Association Position Statement: Management of Individuals With Patellofemoral Pain

This NATA position statement, led by Lori Bolgla, gives athletic trainers and other health care providers evidence-graded recommendations on risk factors for, and management of, patellofemoral pain. Its risk-factor recommendations draw only on prospective studies.

It identifies altered hip and knee mechanics during running and landing and quadriceps weakness as risk factors, while finding that static alignment measures such as the Q-angle do not predict the condition. It recommends tracking pain and function with validated scales and patient-reported outcome measures.

For treatment, it gives its strongest grades to a multimodal plan built on gluteal and quadriceps strengthening with education and activity modification, trunk-muscle training and movement retraining with feedback. Patellar taping and foot orthoses are presented as useful adjuncts; neuromuscular electrical stimulation added little over exercise alone, and therapeutic ultrasound and low-level laser showed limited effectiveness. Surgery is reserved for specific structural problems after thorough rehabilitation has failed.