The aim of the present study was to evaluate the effect of exercise combined with patella mobilization/manipulation in the treatment of patellofemoral pain syndrome (PFPS). This randomized, assessor-blind, controlled clinical trial was conducted at the chiropractic clinic of the University of Surrey, Guildford, Surrey, UK. The participants were 12 volunteers with PFPS who were aged between 19 and 54 years (mean 30.17 years), and who had been recruited through a poster advertisement. The subjects were divided into two groups of six. Subjects in group 1 received patella mobilization/manipulation twice a week for a 4-week period, while those in group 2 received patella mobilization/manipulation combined with exercise, also twice a week for a 4-week period. Both subjective and objective measurements were taken. Subjective measures were obtained by the Short-form McGill Pain Questionnaire (SMPQ). the Numerical Pain Rating Scale 1 to 1 101 (NPRS-101) and the Patient-Specific Functional Scale (PSFS). Objective data to assess patient progress were obtained using an algometer. All data was analysed at the 95% level of confidence and was statistically significant if p < 0.05. The Wilcoxon signed-ranks test and the Mann-Whitney u-test were used for intra- and inter-group data, respectively. The investigator (or observer) remained blinded throughout the trial to the treatment received by either group. Subjects had a 50% chance of being allocated to either treatment. Both groups showed a statistically significant intra-group increase in both their algometer pressure-pain threshold and tolerance throughout the treatment period (p < 0.05). The intra-group null hypothesis was rejected for the NPRS-101 (pain at its worst) from baseline to after treatment for both groups, from baseline to the second and fifth treatments, and after treatment in the mobilization combined with exercise group (p < 0.05). The intra-group results for the PSFS (functional disability) indicate that, although both groups experienced improvement overall (from baseline to after treatment; p < 0.05), there was an earlier, statistically significant difference in favour of the mobilization combined with exercise group (from baseline to the second and fifth treatments, and after treatment; p < 0.05). Inter-group analysis of NPRS-101 scores at the second treatment, and for the SMPQ at the second and fifth treatments, and after treatment showed a statistically significant difference in favour of the mobilization combined with exercise group (p < 0.05). The small size and methodological limitations of this pilot trial do not allow for the complete statistical evaluation of either effect or effectiveness. Nevertheless, the design and results of the present study cautiously suggest that there is a possibility that combined mobilization/manipulation and exercise may produce a marginally better outcome than patella mobilization/manipulation alone in the short-term treatment of PFPS. It is recommended that a larger, more representative sample size with a long-term follow-up should be used in future investigations.

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