The Impact of Lower Limb Muscle Strengthening on Pain Reduction in Women With Patellofemoral Pain Syndrome: A Systematic Review

Background & Aims: Patellofemoral pain syndrome (PFPS) is a common condition in women, characterized by diffuse anterior or retropatellar knee pain.This systematic review aimed to evaluate the effectiveness of lower limb muscle strengthening in reducing pain among women with PFPS, with secondary outcomes assessing improvements in functional ability and balance.Materials & Methods: A systematic review was conducted following the PRISMA guidelines.Studies published in Persian and English between January 2000 and January 2025 were retrieved from databases including SID, Web of Science, PubMed, Scopus, and Google Scholar.Eleven articles meeting the inclusion criteria (e.g., focus on lower limb strengthening interventions, female participants, and quantitative outcome reporting) were selected for final analysis. Results:The reviewed studies demonstrated that lower limb muscle strengthening significantly reduces pain and improves functional outcomes in women with PFPS.Hydrotherapy, particularly in deep water, was identified as an effective adjunct therapy, contributing to pain alleviation and balance enhancement.Evidence suggests that hydrotherapy may yield superior short-term results compared to land-based exercises.Furthermore, combining strengthening exercises with motor pattern re-education, stretching, and neuromuscular training provided additional benefits in pain reduction, functional improvement, and gait modification. Conclusion:Lower limb muscle strengthening is a core therapeutic strategy for pain management and functional recovery in women with PFPS.Adjunctive interventions such as hydrotherapy and multimodal approaches may enhance treatment efficacy.Future research should prioritize long-term follow-ups and direct comparisons between therapeutic modalities to optimize clinical guidelines.