Internal versus external focus during quadriceps training for patellofemoral pain

Effects of Attentional Focus Strategies During Isokinetic Quadriceps Training on Strength and Functional Performance in Individuals With Patellofemoral Pain Syndrome.

This study will see if using an internal or external focus during six weeks of quadriceps training reduces pain and improves strength and function in adults with patellofemoral pain.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 36 (estimated)
• Ages: 18 Years to 45 Years
• Sex: All
• Sponsor: Istanbul University - Cerrahpasa (Academic / other)
• Locations: 1 site (Istanbul)
• Trial ID: NCT07384858 on ClinicalTrials.gov

What this trial studies

Adults aged 18–45 with patellofemoral pain will be assigned to use either an internal or an external attentional focus while performing a standardized six-week isokinetic quadriceps training program. Muscle activation, quadriceps mechanical properties, pain, and functional performance will be measured before and after the intervention using isokinetic testing, MyotonPRO device readings, and functional tests. The protocol directly compares the two motor learning strategies to determine whether instruction style alters objective strength measures and patient-reported outcomes. Findings aim to clarify whether simple changes in exercise cues can improve rehabilitation results in PFPS.

Who should consider this trial

Good fit: Ideal candidates are adults 18–45 years old with a clinical diagnosis of patellofemoral pain for at least four weeks, pain >3/10 that worsens with activities like squatting or stairs, and who can attend a six-week supervised training program.

Not a fit: Patients with prior knee surgery, ligament instability, meniscal injuries, fractures, inflammatory joint disease, radiographic osteoarthritis, pregnancy, or other conditions that prevent exercise participation are unlikely to benefit from or be eligible for this protocol.

Why it matters

Potential benefit: If successful, the preferred attentional focus could be adopted in rehab to reduce pain faster and improve quadriceps strength and daily function for people with PFPS.

How similar studies have performed: External attentional focus has shown performance and learning benefits in other motor-control and rehabilitation studies, but direct evidence for its superiority in PFPS during isokinetic training is limited.

Eligibility criteria

Inclusion Criteria:

* Aged between 18 and 45 years.
* Diagnosed with patellofemoral pain syndrome (PFPS).
* Anterior or retropatellar knee pain persisting for at least four weeks with a VAS score \> 3.
* Pain exacerbated by at least two functional activities (e.g., squatting, stair climbing, prolonged sitting).
* Willing to regularly participate in the 6-week program throughout the study period.

Exclusion Criteria:

* History of patellar subluxation or dislocation.
* Anterior or posterior cruciate ligament insufficiency.
* Lower extremity fractures.
* Neurological or systemic musculoskeletal disorders.
* Rheumatoid arthritis or other inflammatory joint diseases.
* History of knee surgery, meniscal injury, or any other underlying musculoskeletal condition that would prevent the participant from performing the exercises.
* Pregnancy or postpartum period.
* Participation in a similar exercise program within the last 3 months.
* Radiographic evidence of osteoarthritis classified as Kellgren-Lawrence grade 2 or higher.

Where this trial is running

Istanbul

• Istanbul University-Cerrahpasa — Istanbul, Turkey (Türkiye) (Recruiting)

Study contacts

• Study coordinator: SEDA ATEŞ, bachelor degree

Conditions Patellofemoral Pain, PFP