BMC sports science, medicine & rehabilitation · 2026
Effects of neuromuscular training on pain, physical function, balance, muscle strength, and lower limb kinematics in individuals with patellofemoral pain: a systematic review and meta-analysis of randomized controlled trials.
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Maleki Ali Asghar, Pappas Evangelos, Piva Sara R, Mousavi Seyed Hamed
Аннотация
BACKGROUND: Patellofemoral pain (PFP) is a common musculoskeletal condition that impairs daily function and quality of life. Neuromuscular training (NMT) has been proposed to address pain, functional limitations, and biomechanical deficits in PFP, but its overall effectiveness across multiple outcomes remains unclear.
METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the effects of NMT in individuals with PFP. PubMed, Web of Science, Scopus, and Embase were searched from inception to May 2025. Eligible studies compared NMT with control conditions or active interventions such as strength training (ST) and reported at least one of the following outcomes: pain, physical function, balance, muscle strength, or lower-limb kinematics. Data were pooled using random-effects models to calculate mean differences (MD) with 95% confidence intervals (CI). The certainty of evidence was assessed using the GRADE approach.
RESULTS: Seventeen RCTs (n = 871; 66% female; mean age 23 years) met the inclusion criteria. Compared with control groups, NMT reduced pain (MD = - 0.60; 95% CI: - 0.96 to - 0.23; moderate certainty) and improved physical function (MD = 10.83; 95% CI: 9.71 to 11.94; moderate certainty). Compared with strength training, NMT produced greater pain reduction (MD = - 0.55; 95% CI: - 0.77 to - 0.34; moderate certainty) but did not improve physical function beyond ST alone (MD = - 2.32; 95% CI: - 10.31 to 5.66; low certainty). Although NMT appears effective for reducing pain and improving physical function, its effects on lower-limb biomechanics remain inconclusive, with current evidence showing inconsistent findings across studies.
CONCLUSIONS: NMT is an effective intervention for reducing pain and improving physical function in individuals with PFP. Although not superior to ST for functional outcomes, NMT may provide added value when incorporated into multimodal rehabilitation programs targeting neuromuscular control, proprioception, and dynamic stability. Further high-quality trials with standardized protocols are needed to clarify its effects on balance, strength, and kinematics.
METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the effects of NMT in individuals with PFP. PubMed, Web of Science, Scopus, and Embase were searched from inception to May 2025. Eligible studies compared NMT with control conditions or active interventions such as strength training (ST) and reported at least one of the following outcomes: pain, physical function, balance, muscle strength, or lower-limb kinematics. Data were pooled using random-effects models to calculate mean differences (MD) with 95% confidence intervals (CI). The certainty of evidence was assessed using the GRADE approach.
RESULTS: Seventeen RCTs (n = 871; 66% female; mean age 23 years) met the inclusion criteria. Compared with control groups, NMT reduced pain (MD = - 0.60; 95% CI: - 0.96 to - 0.23; moderate certainty) and improved physical function (MD = 10.83; 95% CI: 9.71 to 11.94; moderate certainty). Compared with strength training, NMT produced greater pain reduction (MD = - 0.55; 95% CI: - 0.77 to - 0.34; moderate certainty) but did not improve physical function beyond ST alone (MD = - 2.32; 95% CI: - 10.31 to 5.66; low certainty). Although NMT appears effective for reducing pain and improving physical function, its effects on lower-limb biomechanics remain inconclusive, with current evidence showing inconsistent findings across studies.
CONCLUSIONS: NMT is an effective intervention for reducing pain and improving physical function in individuals with PFP. Although not superior to ST for functional outcomes, NMT may provide added value when incorporated into multimodal rehabilitation programs targeting neuromuscular control, proprioception, and dynamic stability. Further high-quality trials with standardized protocols are needed to clarify its effects on balance, strength, and kinematics.