Telerehabilitation vs. Conventional PT for Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common, overuse-related musculoskeletal condition causing widespread anterior knee pain that is exacerbated by joint-loading activities like running, squatting, and climbing stairs. Affecting over 22% of the general population, PFPS is a complex disorder with high recurrence rates that frequently frustrate both patients and clinicians. Its etiology is multifactorial, stemming from structural and neuromuscular impairments, particularly quadriceps weakness and reduced gluteal activation, which lead to dynamic knee valgus and excessive joint stress. While conventional in-person physical therapy focusing on targeted strengthening remains the standard treatment, digital healthcare alternatives are rapidly expanding. Telerehabilitation delivers physical therapy remotely using telecommunication technologies through real-time synchronous or recorded asynchronous methods. To combine the benefits of both approaches, hybrid telerehabilitation integrates remote digital tracking with periodic face-to-face clinical sessions. Ultimately, these remote and hybrid models aim to improve patient adherence and reduce financial or logistical barriers like travel time, while maintaining the diagnostic accuracy and personalized feedback of traditional, hands-on care.

Inclusion criteria

• Participants must have a prior clinical diagnosis of PFPS made by an orthopedic physician, which was then confirmed and verified by the principal investigator through physical therapy assessment. The diagnosis is characterized by anterior or retropatellar knee pain aggravated by at least one activity that loads the patellofemoral joint during weight bearing, such as stair climbing, squatting, running, or prolonged sitting.
• Participants aged between 18 and 35 years.
• Participants with BMI ≤ 25 kg/m² to ensure inclusion of individuals within a normal weight range.
• Insidious onset of anterior knee pain with a duration greater than 12 weeks.
• Experienced a minimum pain level of 3/10 on a visual analogue scale (VAS) during activity within the previous week.

Exclusion criteria

Participants meeting any of the following conditions will be excluded from the study:

• Individuals with previous knee surgery, fracture, ligament reconstruction, patellar dislocation, osteoarthritis, meniscal injuries, inflammatory joint disease, or other conditions that may mimic or contribute to anterior knee pain.
• Participants with neurological, cardiovascular, or systemic musculoskeletal disorders that may affect gait, strength, or exercise tolerance
• Pregnant women will be excluded due to potential alterations in joint biomechanics and safety considerations during exercise interventions.