A NARRATIVE REVIEW OF PATELLOFEMORAL PAIN AND ITS BIOMECHANICAL CONTRIBUTORS, NON PHARMACOLOGICAL MANAGEMENT, AND PREVENTION STRATEGIES RELEVANT TO RUNNERS

Abstract

Background: Patellofemoral pain (PFP), historically termed patellofemoral pain syndrome (PFPS), is a common and often persistent musculoskeletal condition among physically active individuals and runners. Its development is multifactorial, involving interactions between lower-limb biomechanics, muscle function, training exposure, and environmental demands. Runners exposed to uphill and downhill terrain may experience altered patellofemoral joint loading; however, evidence specifically addressing prevention in hilly-terrain running populations remains limited. Objective: This narrative review synthesised evidence on biomechanical contributors to PFP, non-pharmacological management approaches, and prevention strategies relevant to runners. Methods: Literature was identified through database searches and reference list screening. Searches addressed PFP/PFPS and related terms, biomechanical and aetiological factors, running, and non-pharmacological prevention and management. Of 81 identified records, 39 duplicates were removed, and 42 records underwent title and abstract screening. Eighteen full-text reports were sought, of which 13 were assessed for eligibility; 12 studies were included in the final narrative synthesis. Evidence was interpreted with attention to study design, diagnostic definitions, population characteristics, intervention components, outcome measures, follow-up duration, and applicability to runners. Results: Biomechanical factors associated with PFP include impaired hip and knee muscle function, altered frontal- and transverse-plane lower-limb mechanics, reduced knee flexion during running or functional tasks, and foot-related factors such as increased pronation or rearfoot eversion. These factors should be interpreted cautiously because much of the evidence is cross-sectional and therefore does not establish causality. Exercise therapy and patient education represent the principal components of non-pharmacological management. Hip- and knee-targeted strengthening, combined interventions, patellar taping, foot orthoses, gait retraining, and lower-quadrant manual therapy may provide benefit for selected individuals; however, adjunctive treatments should be tailored to the patient’s clinical presentation. Prevention evidence remains limited. Supervised lower-limb exercise programmes, patellofemoral bracing in selected high-risk populations, and running-technique retraining show potential preventive benefit, whereas evidence for foot orthoses, stretching, footwear modification, and education alone is inconsistent or of low certainty. Conclusion: PFP in runners should be understood as a multifactorial condition rather than the consequence of a single biomechanical abnormality. Individualised exercise-based management and education are the most consistently supported approaches, with adjunctive interventions selected according to patient presentation and running-related demands. High quality prospective studies are required to establish modifiable causal risk factors and to evaluate feasible, context-specific prevention programmes, particularly for runners exposed to sustained uphill and downhill terrain.