Clinical and functional outcomes of aquatic plyometrics in adolescent patellofemoral pain syndrome: a dual-arm randomized controlled trial

OBJECTIVE: Optimal management of adolescent patellofemoral pain syndrome requires evidence-based interventions that maximize physical recovery without overloading the patellofemoral joint. This study investigated the efficacy of aquatic plyometric (Aquatic-Plyo) exercises on pain, muscle strength, and functional disability and health-related quality of life in this demographic. DESIGN: A dual-arm randomized controlled trial. SUBJECTS/PATIENTS: 56 adolescents with patellofemoral pain syndrome (age: 10-18 years). METHODS: Adolescents were allocated to an experimental Aquatic-Plyo group or a control group performing conventional exercises. Both arms completed 45-min sessions twice weekly for 12 weeks. Pre- and post-treatment assessments included pain intensity, isokinetic knee (quadriceps and hamstrings) torque at 120°/s and 180°/s, functional disability, and health-related quality of life. RESULTS: Mixed-model ANOVA confirmed the therapeutic dominance of the Aquatic-Plyo protocol. It yielded superior pain relief (p = 0.004, η2p = 0.14) and larger increases in quadriceps [120°/s (p = 0.006, η2p = 0.13); 180°/s (p = 0.008, η2p = 0.12)] and hamstring [120°/s (p = 0.007, η2p = 0.13); 180°/s (p = 0.023, η2p = 0.09)] peak torque. Moreover, the Aquatic-Plyo intervention drove greater reduction in functional disability (p = 0.03, η2p = 0.08) and notable enhancement in perceived health-related quality of life (p = 0.023, η2p = 0.09). CONCLUSION: Aquatic-Plyo exercises effectively reduces pain and disability while improving muscle strength and health-related quality of life in adolescents with patellofemoral pain syndrome, making it a valuable addition to conservative rehabilitation strategies.