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The effects of exercise for the prevention of overuse anterior knee pain: a randomized controlled trial
Coppack RJ, Etherington J, Wills AK
The American Journal of Sports Medicine 2011 May;39(5):940-948
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Anterior knee pain (AKP) is the most common activity-related injury of the knee. The authors investigated the effect of an exercise intervention on the incidence of AKP in UK army recruits undergoing a 14-week physically arduous training program. HYPOTHESIS: Modifying military training to include targeted preventative exercises may reduce the incidence of AKP in a young recruit population. STUDY DESIGN: Randomized controlled trial; level of evidence, 1. METHODS: A single-blind cluster randomized controlled trial was performed in 39 male and 11 female training groups (median age 19.7 years; interquartile range 17 to 25) undergoing phase 1 of army recruit training. Each group was randomly assigned to either an intervention (n = 759) or control (n = 743) protocol. The intervention consisted of 4 strengthening and 4 stretching exercises completed during supervised physical training lessons (7 per week). The control group followed the existing training syllabus warm-up exercises. The primary outcome was a diagnosis of AKP during the 14-week training program. RESULTS: Forty-six participants (3.1%; 95% confidence interval (CI) 2.3 to 4.1) were diagnosed with AKP. There were 36 (4.8%; 95%CI 3.5 to 6.7) new cases of AKP in the control group and 10 (1.3%; 0.7 to 2.4) in the intervention group. There was a 75% reduction in AKP risk in the intervention group (unadjusted hazard ratio = 0.25; 95% CI 0.13 to 0.52; p < 0.001). Three participants (0.4%) from the intervention group were discharged from the military for medical reasons compared to 25 (3.4%) in the control group. CONCLUSION: A simple set of lower limb stretching and strengthening exercises resulted in a substantial and safe reduction in the incidence of AKP in a young military population undertaking a physical conditioning program. Such exercises could also be beneficial for preventing this common injury among nonmilitary participants in recreational physical activity.

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