Patellofemoral pain syndrome (PFPS) is often associated with imbalance and weakness in several key muscle group. These include the quadriceps (especially the vastus medialis oblique), hip abductors and external rotators and hamstrings as well as tightness in iliotibial band and gastrocnemius. Exercises involving isometrics, stretching, strengthening of knee along with core muscles has improved range, strength, coordination and motor control. This study aim to determine the effects of active release along with myofascial release technique on pain, range of motion and function in patients with patellofemoral pain syndrome.
This study will be a randomized controlled trial and will be conducted in Riphah Rehabilitation Clinic Lahore (Physiotherapy Department) and Ghurki Trust Hospital Lahore. Non-probability consecutive sampling will be used to collect the data. Sample size of 30 subjects with age group between 15-40 years will be taken. Data will be collected from the patients having present complaint of anterior knee pain. Outcome measures will be taken by using Numeric pain rating scale (NPRS), Anterior knee pain scale (AKPS)for pain, Universal Goniometer (GU) for Range of motion and KOOS PS scale to assess physical function in patient with knee pain. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria and will be equally divided into two groups by random number generator table. Both the Groups will receive RICE protocol, ice, stretching, strengthening and knee isometrics exercises, while Group A will receive active release and Group B will receive myofascial release technique. Outcome measures will be measured at baseline and after 6 weeks. Data analysis will be done by SPSS version 25.
Experience retro patellar pain for at least three months, including pain at rest or during activities such as ascending or descending stairs, jumping, running, squatting, kneeling, or prolonged sitting (12).
Patients with + ive Squat test in the absence of any pathology
Patients also must have presented with an insidious onset of symptoms unrelated to trauma and a positive Clark test (19).
Reduced knee range of motion, especially extension
A history of significant lower extremity, pelvic, or spinal surgery/fracture, or traumatic lesions of ligaments or meniscus within the past six months.
Presence of other orthopedic conditions (e.g., ACL rupture, meniscal tears), neurological disorders (e.g., multiple sclerosis, paralysis), rheumatological diseases (e.g., rheumatoid arthritis, ankylosing spondylitis), or congenital conditions leading to osteoarthrosis.
Current pregnancy
A history of connective tissue disease, patellofemoral dislocation or subluxation, osteoarthrosis of the knees.
Parallel
Group A
Other interventionBefore applying active release technique, assess the knee joint, by palpating the area of tightness, tenderness and restricted movement .Then apply specific pressure to affected tissues, such as the quadriceps, hamstrings, iliotibial band (IT band) or patellar tendon, depending on the findings of the evaluation. The patient will then actively move the knee joint through prescribed range of motions, while the therapist maintain contact and provides appropriate pressure. This process is repeated several times, with the therapist adjusting pressure and movements as needed to improve tissue mobility and reduce pain.
Group B
Other interventionFor Myofascial release technique therapist will use their hands to apply sustained pressure to restricted areas fascia, gradually lengthening and releasing the tissue. Gentle stretching techniques can also be used to lengthen the tissue and muscles, improving flexibility and range of motion.
Lower Extremity Functional Scale
The lower extremity functional scale (LEFS) is a valid patient-rated outcome measure (PROM) for the measurement of lower extremity function. The scale consist of 4 groups with 20 questions. The questions in these group focus on activities with increasing physical demands like questions from walking between rooms to running on uneven ground. The scoring of this scale varies from 0 (extreme difficulty/unable to perform activity) to 4 (no difficulty). The total score can be obtained by summing the scores of the individual items. The maximum score of 80 indicates no functional limitations and the minimum score of 0 indicates extreme limitations
Patellofemoral Pain and Osteoarthritis Subscale of Knee injury and Osteoarthritis Outcome Score
Patellofemoral pain and patellofemoral osteoarthritis are highly prevalent knee disorders associated with pain and functional limitations. The subscale of the Knee Injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF) was developed to evaluate patients with patellofemoral pain and osteoarthritis.
Visual Analogue Scale
The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain"
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