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Yalfani A, Ahadi F, Ahmadi M. Distal Approaches in Patellofemoral Pain: A Systematic Review, Part I. PTJ 2023; 13 (1) :1-10
URL: http://ptj.uswr.ac.ir/article-1-561-en.html

Purpose: Increased patellofemoral joint reaction force is the main cause of patellofemoral pain syndrome. Foot pronation causes faulty joint coupling of the lower limb and increases the patellofemoral joint reaction force; accordingly, this study aims to systematically review the effect of the distal interventions on the clinical symptoms and kinematics of patients with patellofemoral pain. 
Methods: The search strategy was applied to Google Scholar, PubMed, Science Direct, Medline, Web of Science, and Scopus databases. The search was limited to the English language. The studies were from 2000 to 2022. In 4 stages, the selected articles were screened for systematic review. The quality of the study was evaluated by the Downs and Black scale. Meanwhile, the articles were classified into 3 categories as follows: High, medium, and low quality.
Results: A total of 12 articles were screened for this systematic review. The quality of the study was medium. Meanwhile, 5 articles had medium quality and 7 articles had high quality. The results of the systematic review showed that distal interventions are effective in improving clinical symptoms and correcting the faulty kinematics of the lower limb.
Conclusion: Distal interventions by correcting the faulty joint coupling reduce the patellofemoral joint reaction force and pain. As a result, distal interventions in combination with proximal exercise have a better effect on clinical symptoms.