Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain

Before any prescription of exercise, the physiotherapist will spend a period of time educating the participant about pain mechanisms. Descriptions of tissue-based pathology models of pain, e.g. patellar mal-tracking, or limb mal-alignment, will be actively discouraged and challenged by the physiotherapist. The participant will gain an evidence-based understanding of dysfunctional central nociceptive processing as an explanation of chronic and persistent pain [42] and the role and impact of fear [43]. This period of intense learning is designed to facilitate the reconceptualisation of pain, with an emphasis on descriptions of pain neuroscience rather than psychology [44], and from the perspective and context of the participant and their pain [45]. The education regarding pain mechanisms will take up a large portion of clinical time, such as to address any beliefs or fear within the participant that pain is a sign of tissue damage, and will be delivered in a Socratic teaching style [46]. It is expected that the education period will be completed in the first session, which typically lasts 30–40 min within the NHS, but participants that require further re-assurance may continue into their second session