The study
A systematic review with meta-analysis pulled together 82 randomised trials, 4,023 people with patellofemoral pain, and asked one specific question: when these patients get stronger, do their pain and function improve alongside the strength? It used a structural equation modelling approach to link change in muscle strength to change in self-reported pain and function, across the knee and hip muscle groups. The search ran to April 2026.
What they found
Strength improvements were associated with both less pain and better function, and the links were clearest at the hip and knee. For pain, the strongest associations were the hip abductors, hip internal rotators and knee extensors. For function, the same three led the way. Certainty of evidence was low to moderate for most of these associations, reaching high for a few of the function results.
This is an association, not proof of cause. Getting stronger and getting better travelled together here, but a design like this cannot show the strength itself is doing the work.
What it means for your practice
Keep strengthening at the centre of patellofemoral rehab, and weight it toward the hip, especially the abductors and rotators, alongside the knee extensors. The data give you a clean reason to measure strength and re-test it, because the patients whose strength climbed were the ones whose pain and function climbed with it.
Frame it honestly with patients and with yourself. Strength gains track with feeling and moving better, which is a good thing to chase, but this study cannot say the strength caused it on its own. That is fine. It still points you at the hip and knee and tells you to keep loading.
Bottom line
In patellofemoral pain, strength gains track with less pain and better function, most clearly at the hip and knee. Keep loading central, and target the hip.