An Individualized Kinetic-Chain–Based Physiotherapy Protocol for Patellofemoral Pain: A Prospective Interventional Study
Authors
Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India (India)
Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India (India)
Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India (India)
Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India (India)
Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India (India)
Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India (India)
Article Information
DOI: 10.51584/IJRIAS.2026.110200093
Subject Category: Social science
Volume/Issue: 11/2 | Page No: 1071-1076
Publication Timeline
Submitted: 2026-02-21
Accepted: 2026-02-28
Published: 2026-03-14
Abstract
Background: Patellofemoral pain (PFP) is one of the most common causes of anterior knee pain in physically active individuals and young adults. Altered lower-limb biomechanics, proximal muscle weakness, poor neuromuscular control, and faulty movement patterns along the kinetic chain contribute to abnormal patellofemoral joint loading. Conventional physiotherapy approaches focusing solely on the knee may fail to address these contributing factors.
Objective: To evaluate the effectiveness of an individualized kinetic-chain–based physiotherapy protocol on pain intensity, functional capacity, and movement quality in individuals with patellofemoral pain.
Methods: A prospective interventional study was conducted on 40 participants aged 18–35 years diagnosed with patellofemoral pain. Participants underwent a 6-week individualized kinetic-chain–based physiotherapy protocol focusing on hip and trunk strengthening, lower-limb alignment, movement retraining, and patellar loading control. Outcome measures included the Numerical Pain Rating Scale (NPRS), Kujala Anterior Knee Pain Scale (AKPS), and single-leg squat quality assessment. Pre- and post-intervention scores were analyzed using paired statistical tests.
Results: A significant reduction in pain intensity (NPRS) and improvement in functional outcomes (AKPS) were observed post-intervention (p < 0.05). Movement quality during single-leg tasks showed marked improvement, with reduced dynamic knee valgus and better trunk control.
Conclusion: An individualized kinetic-chain–based physiotherapy protocol is effective in reducing pain and improving function and movement quality in individuals with patellofemoral pain. Addressing proximal and distal contributors within the kinetic chain enhances rehabilitation outcomes beyond knee-focused interventions alone.
Keywords
Patellofemoral pain, kinetic chain, physiotherapy
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References
1. Nakagawa TH, Maciel CD, Serrão FV. Trunk biomechanics and its association with hip and knee kinematics in patients with and without patellofemoral pain. Man Ther. 2015 Feb;20(1):189–93. doi:10.1016/j.math.2014.08.013 PubMed PMID: 25261089. [Google Scholar] [Crossref]
2. Dill KE, Begalle RL, Frank BS, Zinder SM, Padua DA. Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion. J Athl Train. 2014;49(6):723–32. doi:10.4085/1062-6050-49.3.29 PubMed PMID: 25144599; PubMed Central PMCID: PMC4264643. [Google Scholar] [Crossref]
3. Xie P, István B, Liang M. The Relationship between Patellofemoral Pain Syndrome and Hip Biomechanics: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022 Dec 28;11(1):99. doi:10.3390/healthcare11010099 PubMed PMID: 36611559; PubMed Central PMCID: PMC9818693. [Google Scholar] [Crossref]
4. da Silva-Júnior FB, Dibai-Filho AV, Barros DCC, dos Reis-Júnior JR, Gonçalves MBS, Soares AR, et al. Anterior Knee Pain Scale (AKPS): structural and criterion validity in Brazilian population with patellofemoral pain. BMC Musculoskelet Disord. 2024 Jan 8;25:39. doi:10.1186/s12891-024-07164-z PubMed PMID: 38191375; PubMed Central PMCID: PMC10773022. [Google Scholar] [Crossref]
5. Jordan CM, Kim S, Glaviano NR. Hip rate of torque development, but not strength, is associated with single-leg squat kinematics in individuals with patellofemoral pain. Physiother Theory Pract. 2025 Apr;41(4):695–703. doi:10.1080/09593985.2024.2360578 PubMed PMID: 38813879. [Google Scholar] [Crossref]
6. Kedroff L, Galea Holmes MN, Amis A, Newham DJ. Effect of patellofemoral pain on foot posture and walking kinematics. Gait Posture. 2019 May;70:361–9. doi:10.1016/j.gaitpost.2019.03.014 PubMed PMID: 30959427. [Google Scholar] [Crossref]
7. Carry PM, Gala R, Worster K, Kanai S, Miller NH, James D, et al. POSTURAL STABILITY AND KINETIC CHANGE IN SUBJECTS WITH PATELLOFEMORAL PAIN AFTER A NINE-WEEK HIP AND CORE STRENGTHENING INTERVENTION. Int J Sports Phys Ther. 2017 Jun;12(3):314–23. PubMed PMID: 28593085; PubMed Central PMCID: PMC5455181. [Google Scholar] [Crossref]
8. 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: Journal of Orthopaedic & Sports Physical Therapy: Vol 49, No 9 [Internet]. [cited 2026 Feb 23]. Available from: https://www.jospt.org/doi/10.2519/jospt.2019.0302?utm_source=chatgpt.com [Google Scholar] [Crossref]
9. Manojlović D, Kozinc Ž, Šarabon N. Trunk, Hip and Knee Exercise Programs for Pain Relief, Functional Performance and Muscle Strength in Patellofemoral Pain: Systematic Review and Meta-Analysis. J Pain Res. 2021;14:1431–49. doi:10.2147/JPR.S301448 PubMed PMID: 34079359; PubMed Central PMCID: PMC8165213. [Google Scholar] [Crossref]
10. Jamaludin NI, Sahabuddin FNA, Rasudin NS, Shaharudin S. The Concurrent Validity and Reliability of Single Leg Squat Among Physically Active Females with and without Dynamic Knee Valgus. Int J Sports Phys Ther. 2022;17(4):574–84. doi:10.26603/001c.35706 PubMed PMID: 35693857; PubMed Central PMCID: PMC9159712. [Google Scholar] [Crossref]
11. Thomson C, Krouwel O, Kuisma R, Hebron C. The outcome of hip exercise in patellofemoral pain: A systematic review. Man Ther. 2016 Dec;26:1–30. doi:10.1016/j.math.2016.06.003 PubMed PMID: 27428378. [Google Scholar] [Crossref]
12. Halabi MH, Alturkistani BA, Abuhadi RH, Garout AN, Almuqbil FB, Alshehri MS. The Efficacy of Hip and Knee Muscles Strengthening Versus Knee Muscle Strengthening Alone in Managing Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis. Musculoskeletal Care. 2025 Mar;23(1):e70059. doi:10.1002/msc.70059 PubMed PMID: 39934098. [Google Scholar] [Crossref]
13. Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007 Jan 15;75(2):194–202. PubMed PMID: 17263214. [Google Scholar] [Crossref]
14. van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SMA, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015 Jan 20;1(1):CD010387. doi:10.1002/14651858.CD010387.pub2 PubMed PMID: 25603546; PubMed Central PMCID: PMC10898323. [Google Scholar] [Crossref]
15. Fadil A, Muaidi QI, Alayat MS, AlMatrafi NA, Subahi MS, Alshehri MA. The Effectiveness of closed kinetic chain exercises in individuals with knee osteoarthritis: A systematic review and meta-analysis. PLoS One. 2025;20(5):e0322475. doi:10.1371/journal.pone.0322475 PubMed PMID: 40315212; PubMed Central PMCID: PMC12047827. [Google Scholar] [Crossref]
16. Pereira PM, Baptista JS, Conceição F, Duarte J, Ferraz J, Costa JT. Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review. Int J Environ Res Public Health. 2022 Jul 28;19(15):9241. doi:10.3390/ijerph19159241 PubMed PMID: 35954598; PubMed Central PMCID: PMC9367913. [Google Scholar] [Crossref]
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