Patellofemoral Pain Syndrome and its Association with Balance and Proprioception: A Cross-Sectional Study

Main Article Content

Hira Wahab
Amina Rahat
Azmat Khan
Farhan Haleem
Zohaib Khalid



Background: Patellofemoral Pain Syndrome (PFPS) is a prevalent condition characterized by anterior knee pain, significantly affecting individuals' balance and proprioception. Despite its commonality, the relationship between PFPS and these functional impairments remains inadequately explored. Previous studies have suggested a link, but comprehensive analyses incorporating balance, proprioception, and PFPS are scarce.

Objective: This study aimed to investigate the association between PFPS and deficits in balance and proprioception, emphasizing the potential for rehabilitation focused on these areas to improve patient outcomes.

Methods: A cross-sectional study was conducted with 103 participants diagnosed with PFPS, utilizing non-probability convenience sampling at the Out-Patient Department of Physical Therapy, Akbar Medical Complex, Mardan, Pakistan. Participants underwent assessments for balance (using static and dynamic balance tests) and proprioception (via joint position sense testing). Data analysis was performed using SPSS version 22, with chi-square tests to assess statistical associations between PFPS and the measured variables.

Results: Among the participants, 60.2% were males, and 39.8% were females, with an injured limb distribution of 30.1% for both the left and right legs and 39.8% for both legs. The duration of symptoms varied, with 51.5% experiencing symptoms for 1-3 months. Proprioception degree angles showed mean values of 37.5728 (SD=3.76933) for the right limb and 38.4272 (SD=5.81681) for the left limb. Chi-square tests revealed significant impairments in balance and proprioception among individuals with PFPS (p < 0.05).

Conclusion: The study confirmed a significant association between PFPS and impairments in balance and proprioception. These findings support the integration of balance and proprioceptive training into rehabilitation programs for PFPS patients, potentially improving symptoms and functional outcomes.

Article Details

How to Cite
Wahab, H., Gulalai, Rahat, A., Khan, A., Haleem, F., & Khalid, Z. (2024). Patellofemoral Pain Syndrome and its Association with Balance and Proprioception: A Cross-Sectional Study. Journal of Health and Rehabilitation Research, 4(1), 1012–1017.
Author Biographies

Hira Wahab, Mardan Medical Complex MTI-MMC Mardan Pakistan.

Physical Therapist.

Gulalai, Center of Excellence for Special Children with Autism Peshawar (SWD) Pakistan.

Occupational Therapist, Occupational Therapy Department.

Amina Rahat, University of Peshawar Pakistan.

Assistant Professor, Department of Food and Nutrition.

Azmat Khan, Mardan Medical Complex MTI-MMC Mardan Pakistan.

Manager Physiotherapy Department.

Farhan Haleem, LLH Hospital Musaffah Abu Dhabi UAE.

Physiotherapist, Department of Physiotherapy and Rehabilitation.

Zohaib Khalid, Active Health Clinic New Zealand.



Collado H, Fredericson M. Patellofemoral pain syndrome. Clinics in sports medicine. 2010;29(3):379-98.

Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann G-P, et al. Patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy. 2014;22:2264-74.

Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral pain syndrome. American family physician. 2019;99(2):88-94.

Dixit S, Difiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. American family physician. 2007;75(2):194-202.

Boling MC, Padua DA, Marshall SW, Guskiewicz K, Pyne S, Beutler A. A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) cohort. The American journal of sports medicine. 2009;37(11):2108-16.

Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, et al. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PloS one. 2018;13(1):e0190892.

Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic medicine. 2008;7(1):1-14.

Esculier J-F, Maggs K, Maggs E, Dubois B. A contemporary approach to patellofemoral pain in runners. Journal of Athletic Training. 2020;55(12):1206-14.

. !!! INVALID CITATION !!! (6, 9).

Motealleh A, Mohamadi M, Moghadam MB, Nejati N, Arjang N, Ebrahimi N. Effects of core neuromuscular training on pain, balance, and functional performance in women with patellofemoral pain syndrome: a clinical trial. Journal of chiropractic medicine. 2019;18(1):9-18.

Dutton RA, Khadavi MJ, Fredericson M. Patellofemoral pain. Physical Medicine and Rehabilitation Clinics. 2016;27(1):31-52.

Cheung RT, Zhang Z, Ngai SP. Different relationships between the level of patellofemoral pain and quality of life in professional and amateur athletes. PM&R. 2013;5(7):568-72.

Crossley KM, van Middelkoop M, Barton CJ, Culvenor AG. Rethinking patellofemoral pain: prevention, management and long-term consequences. Best Practice & Research Clinical Rheumatology. 2019;33(1):48-65.

Nunes GS, Stapait EL, Kirsten MH, de Noronha M, Santos GM. Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. Physical Therapy in Sport. 2013;14(1):54-9.

Cook C, Mabry L, Reiman MP, Hegedus EJ. Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review. Physiotherapy. 2012;98(2):93-100.

. !!! INVALID CITATION !!! (17).

Nijs J, Van Geel C, Van de Velde B. Diagnostic value of five clinical tests in patellofemoral pain syndrome. Manual therapy. 2006;11(1):69-77.

Cowan SM, Bennell KL, Crossley KM, Hodges PW, McConnell J. Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Medicine & Science in Sports & Exercise. 2002;34(12):1879-85.

Kooiker L, Van De Port IG, Weir A, Moen MH. Effects of physical therapist–guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: a systematic review. journal of orthopaedic & sports physical therapy. 2014;44(6):391-402.

Espí-López GV, Arnal-Gómez A, Balasch-Bernat M, Inglés M. Effectiveness of manual therapy combined with physical therapy in treatment of patellofemoral pain syndrome: systematic review. Journal of chiropractic medicine. 2017;16(2):139-46.

Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clinical Orthopaedics and Related Research®. 2005;436:100-10.

Vora M, Curry E, Chipman A, Matzkin E, Li X. Patellofemoral pain syndrome in female athletes: a review of diagnoses, etiology and treatment options. Orthopedic reviews. 2017;9(4).

Petersen W, Rembitzki I, Liebau C. Patellofemoral pain in athletes. Open access journal of sports medicine. 2017:143-54.

Selfe J, Callaghan M, McHenry A, Richards J, Oldham J. An investigation into the effect of number of trials during proprioceptive testing in patients with patellofemoral pain syndrome. Journal of Orthopaedic Research. 2006;24(6):1218-24.

. !!! INVALID CITATION !!! (28, 29).

Briani RV, Pazzinatto MF, Silva DDO, Azevedo FM. Different pain responses to distinct levels of physical activity in women with patellofemoral pain. Brazilian Journal of Physical Therapy. 2017;21(2):138-43.

Khayambashi K, Mohammadkhani Z, Ghaznavi K, Lyle MA, Powers CM. The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial. journal of orthopaedic & sports physical therapy. 2012;42(1):22-9.

Willson JD, Kernozek TW, Arndt RL, Reznichek DA, Straker JS. Gluteal muscle activation during running in females with and without patellofemoral pain syndrome. Clinical biomechanics. 2011;26(7):735-40.

Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Vanden Berghe L, Cerulli G. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surgery, Sports Traumatology, Arthroscopy. 2005;13:122-30.

Zeinalzadeh A, Talebian S, Naghdi S, Salavati M, Nazary-Moghadam S, Zeynalzadeh Ghoochani B. Effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome. Physiotherapy theory and practice. 2018;34(4):276-85.

Nouri F, Raeissadat SA, Eliaspour D, Rayegani SM, Rahimi MS, Movahedi B. Efficacy of high-power laser in alleviating pain and improving function of patients with patellofemoral pain syndrome: A single-blind randomized controlled trial. Journal of lasers in medical sciences. 2019;10(1):37.

Guney H, Yuksel I, Kaya D, Doral MN. The relationship between quadriceps strength and joint position sense, functional outcome and painful activities in patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24:2966-72.

Kaya D, Citaker S, Kerimoglu U, Atay OA, Nyland J, Callaghan M, et al. Women with patellofemoral pain syndrome have quadriceps femoris volume and strength deficiency. Knee Surgery, Sports Traumatology, Arthroscopy. 2011;19:242-7.

Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. Journal of orthopaedic & sports physical therapy. 2012;42(2):81-94.

Tállay A, Kynsburg A, Tóth S, Szendi P, Pavlik A, Balogh E, et al. Prevalence of patellofemoral pain syndrome. Evaluation of the role of biomechanical malalignments and the role of sport activity. Orvosi Hetilap. 2004;145(41):2093-101.

Elsayed S, Ammar T, Tolba A, Elgeidi A, editors. Manual ischemic compression in patients with patellofemoral pain syndrome. The 18th international Scientific Conference Faculty of Physical Therapy, Cairo, Egypt; 2017.

Nascimento L, Teixeira-Salmela L, Souza R. Combined Hip & Knee Strengthening for Patellofemoral Pain–Systematic Review. Journal of Orthopaedic & Sports Physical Therapy. 2018;48(1):19-31.

Souza RB, Powers CM. Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. Journal of orthopaedic & sports physical therapy. 2009;39(1):12-9.

Bennell K, Bartam S, Crossley K, Green S. Outcome measures in patellofemoral pain syndrome: test retest reliability and inter-relationships. Physical Therapy in Sport. 2000;1(2):32-41.

Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. The American journal of sports medicine. 2002;30(6):857-65.