The psychological features of patellofemoral pain: A systematic review

Liam Maclachlan, Natalie Collins, Mark Matthews, Paul Hodges, Bill Vicenzino

Research output: Contribution to journalArticlepeer-review

125 Citations (Scopus)


Patellofemoral pain (PFP) is prevalent in adolescence and adulthood and often persists. In contrast to other persistent musculoskeletal conditions, for which non-physical, psychological features are implicated, PFP remains largely conceptualised in mechanical terms.

To (1) identify whether the psychological characteristics of individuals with PFP differs from asymptomatic controls and (2) evaluate the correlations between psychological characteristics and PFP severity.

Systematic review
METHODS: A systematic review of the literature was conducted according to PRISMA guidelines. The Epidemiological Appraisal Instrument was used to evaluate quality. Studies measuring psychological constructs with patient-reported measures were included. Standardised mean differences were calculated and supported by narrative synthesis.

Twenty-five studies were eligible. Quality results ranged from 28.3% to 61.7%. Psychological constructs were reported under four groupings: mental health, cognitive factors, behavioural factors and other factors. There is limited evidence of mental health and cognitive differences in some individuals with PFP. Features demonstrating linear correlations with pain and physical function included anxiety/depression, catastrophising, praying and hoping and pain-related fear.

Anxiety, depression, catastrophising and fear of movement may be elevated in individuals with PFP and correlate with pain and reduced physical function. These results derive from a limited number of studies. Future research should aim to evaluate if and how psychological factors contribute to PFP.

Patients are likely to benefit from clinician vigilance to the presence of psychological factors.
Original languageEnglish
Pages (from-to)732-742
Number of pages11
JournalBritish Journal of Sports Medicine
Issue number9
Early online date20 Mar 2017
Publication statusPublished (in print/issue) - 20 Apr 2017


  • Non-mechanical
  • Patellofemoral pain
  • Psychological features
  • non-physical features


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