What is the evidence for EMG-based biofeedback in PFPS?

• A. Strongly recommended to use EMG biofeedback
• B. Moderate evidence that clinicians should not use EMG-based biofeedback on vastus medialis activity
• C. EMG biofeedback is harmful
• D. No evidence on EMG biofeedback

Answer: (B)

In PFPS, researchers looked at using EMG biofeedback to selectively retrain the vastus medialis activation in hopes of improving patellar tracking and reducing pain. The best evidence shows only moderate support for not routinely using this approach to target vastus medialis activity. Trials and reviews generally fail to show clear, consistent improvements in pain or function beyond standard exercise programs, and findings can be inconsistent due to small sample sizes, variations in biofeedback protocols, and measurement challenges with surface EMG. So, while EMG biofeedback can sometimes be explored as an adjunct in specific cases, it is not supported as a broadly recommended or backbone treatment for PFPS.