This study is a randomised control trial and the purpose of this study is to investigate and compare the "Effects of Maitland mobilizations and Mulligan Mobilization With Movement (MWM) in patients with Patellofemoral Pain Syndrome
Referred patients from rehabilitation, orthopedic and rheumatology department
Both males and females of age 18-40 years
Having pain from at least 2 months.
Pain score ≥ 3 on NPRS.
None
Parallel
Group A (Active Comparator) Mulligan's Mobilization With Movement (MWM)
Procedure/SurgeryThis group will receive two techniques of mulligan i.e. Medial Patellar Glide relative to femoral trochlea and other is tibial internal rotation relative to femoral condyles.In Medial Patellar Glide; patient is positioned supine with 40 degree knee flexion. Stabilizing hand of therapist stabilizes the posterior aspect of tibia and fibula and with mobilizing hand, the therapist gently glides the patella medially. With that, the patient is asked to actively flex and then extend the knee. In the tibial internal rotation technique; similarly the patient is positioned supine with 40 degree knee flexion. Stabilizing hand of therapist stabilizes t After mobilization; following exercises are to be performed all in 3 sets of 7 repetitions: 1. Side-lying hip abduction 2. Clamshell exercises 3. Quadriceps setting exercise 4. Vastus Medialis Oblique strengthening 5. Mini squats 6. Hamstring stretch 7. Iliotibial band stretch
Group B(Experimental) Maitland's Patellar Mobilizations
Procedure/SurgeryFor all the mobilizations the patient is positioned either in supine or sitting with 30-0 degree knee flexion or full knee extension. The therapist holds patella between his/her thumb and index finger and glides it cranially (Superior Patellar glide), caudally (Inferior Patellar Glide) and medially (Medial Patellar Glide). The fourth one i.e. Patellofemoral Distraction is given by grasping the patella between two fingers and lifting it above/away from underlying femoral trochlea. All 4 of these techniques are repeated 10 times with total 3 sets. 3 sessions are performed in a week on alternate days. Total duration of interventions is 2 weeks. Both groups receive similar exercises therapy following mobilizations.
Patellofemoral Pain
It will be measured using numeric pain rating scale (NPRS). Subjects select a number ranging from 0-10 according to their intensity of pain where '0' indicates no pain while '10' indicates worst pain experienced.
Range of Motion
Universal goniometer is used to measure knee flexion and extension ranges. Patient is positioned in supine with the knee straight and foot flat on the table. Therapist stabilizes the femur with one hand. Axis of goniometer is aligned with the lateral epicondyle of the femur, stationary arm is kept parallel to the femur and moving arm is aligned with long axis of tibia. The patient is then asked to flex and extend the knee to maximum range without pain, subsequently aligning moving arm of goniometer with new position of tibia. Angle of flexion/extension are then recorded from the goniometer and documented.
Lower Extremity Function
It is measured using Lower Extremity Function Scale (LEFS). The LEFS is a questionnaire used to assess an individual's ability to perform daily activities and functional tasks related to the lower extremities (hips, knees, ankles, and feet). It comprises of total 20 questions and patients rate their ability to perform each activity on a scale from 0 (unable to perform) to 4 (able to perform without difficulty). The total score ranges from 0 to 80, with higher scores indicating better functional ability. The total sore before and after interventions of both groups is calculated and compared.
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