What is the evidence for visual biofeedback on lower-extremity alignment during hip and knee targeted exercises for PFPS?

• A. It should be used routinely
• B. It should not be used
• C. It should only be used for athletes
• D. It has strong evidence for improving hip alignment

Answer: (B)

Visual biofeedback for lower-extremity alignment during hip and knee targeted exercises in patellofemoral pain syndrome has not shown strong, consistent benefits in the research. The idea is to give immediate cues to reduce movements like knee valgus or excessive hip internal rotation, but well-conducted studies and reviews have produced mixed results. Some trials report small or short-term improvements, but these findings are not reliably replicated across larger, higher-quality studies, and there’s little evidence of meaningful long-term pain relief or functional gains solely from this approach. Methodological limitations and varied feedback methods make it hard to draw firm conclusions, so routine use isn’t recommended. Standard, evidence-supported care focuses on progressive hip and quadriceps strengthening, motor control retraining, and load management; visual biofeedback could be considered only on a case-by-case basis if a clinician suspects a clear, modifiable alignment issue and if practical and acceptable to the patient, rather than as a standard practice for all PFPS cases.