PAIN+ CPN

DesignA randomised controlled trial was designed to evaluate the added value of femoral nerve neurodynamic techniques on knee pain and function in patients with patellofemoral pain syndrome.Setting: University Physiotherapy Clinic.Participants: 71 patients with unilateral patellofemoral pain syndrome aged 18-45 years were randomised.Intervention: Patients were assigned to either the treatment group, receiving femoral nerve neurodynamic techniques and standard physiotherapy, or the control group, receiving standard physiotherapy alone, for 10 sessions.Main measures: Outcome measures include visual analogue scales at rest and during activity, functional ability measured with the Kujala patellofemoral score, and the range of hip extension recorded at baseline and immediately post-intervention.ResultsAfter 10 sessions, the combined effect of femoral nerve neurodynamic techniques and standard physiotherapy showed significantly greater improvements in pain scores compared with the standard physiotherapy alone: pain at squat (adjusted mean difference: -6.12, 95% CI: -10.37, -1.87), pain at stair (adjusted mean difference: -7.76, 95% CI: -12.01, -3.53), pain at kneel (adjusted mean difference: -6.57, 95% CI: -9.97, -3.17), and pain at sitting (adjusted mean difference: -5.31, 95% CI: -8.88, -1.74). Additional benefits were observed in knee function (adjusted mean difference: 7.06, 95% CI: 4.56, 9.55) and hip extension (adjusted mean difference: 2.09, 95% CI: 1.27, 2.90).ConclusionsThe combination of femoral nerve neurodynamic techniques with standard physiotherapy demonstrated promising short-term reductions in knee pain and improvements in function among patients with patellofemoral pain syndrome. These findings suggest that femoral nerve neurodynamic techniques may offer additional benefits as an adjunct therapy, although further research with longer follow-up is needed to confirm the durability of these effects.

Physician rater

The study supports a peripheral neuropathic/mechanosensitivity component in a PFPS subgroup of patients. Femoral nerve neurodynamics added to standard physiotherapy decreased movement-related pain but not resting pain. Limitations are: no assessor blinding, no long-term follow-up, a small single-centre sample with sex imbalance, small effect sizes of uncertain clinical relevance, and no sham control, so non-specific manual therapy effects aren't excluded.

Physician rater

This single-blind RCT shows that adding femoral nerve neurodynamics to standard physiotherapy yields statistically significant but clinically modest gains in pain reduction, improved Kujala function, and hip extension. Pain at rest did not differ. Neurodynamics could be used as an adjunct in PFPS subgroups with positive screening neural tests, not as routine care. Confirmatory trials with blinded assessors and longer follow-ups are needed.

Rehab Clinician (OT/PT) rater

As a physiotherapist, this is noteworthy because it demonstrates that adding femoral nerve neurodynamic techniques to standard rehabilitation may provide clinical benefits for patellofemoral pain syndrome. The findings offer evidence supporting the inclusion of neurodynamic interventions for appropriately selected patients and may contribute to clinical decision-making. However, due to the short follow-up period and the lack of assessor blinding, the results should be interpreted with caution and confirmed in larger studies with more rigorous methodology.

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