This randomized, Single-blind, parallel-group trial will compare the effects of three hamstring stretching interventions-general hamstring Muscle Energy Technique (MET), medial hamstring MET, and lateral hamstring MET-each combined with standardized TENS and progressive hip/knee strengthening, on hamstring flexibility (knee-extension ROM), anterior knee pain (Arabic Kujala score), pain intensity visual analogue scale (VAS), and lower-limb strength (hand-held dynamometer) in adults with patellofemoral pain syndrome (PFPS).
Anterior or retropatellar knee pain lasting at least three months
Pain reproduced by at least two functional tasks: squatting, kneeling, prolonged sitting, stair climbing, hopping or running
Pain intensity of ≥3 on a Visual Analog Scale
positive active knee extension test (inability to achieve greater than 160° of knee extension with the hip at 90° of flexion)
Previous knee surgery
History of knee pathologies, such as meniscal injury' ligament injury, or knee osteoarthritis
Psychological, cardiovascular' or neurological disorders
Dizziness or fainting while doing exercises, pregnancy, or any contraindications to exercise
Parallel
Transcutaneous Electrical Nerve Stimulation Device
DeviceEach participant will receive 20 minutes of TENS, Electrodes will be positioned around the patella with a 5 - 7 cm distance in between, The TENS settings include a continuous asymmetric biphasic square-pulse wave, a pulse width of 120 microseconds, and a pulse rate of 180 Hz.
Strength exercises for lower limb
Other interventionEach participant will receive progressive strengthening program targeting the hip and knee, begin with 3 sets of 10 repetitions and progress to 3 sets of 20 repetitions.
Hamstring Stretch Muscle Energy Technique(MET) (General )
Other interventionThe participant will be supine and the leg will be taken into hip flexion until a tightness is felt then patient will be asked to push down with his lower leg and hold the contraction for 10 seconds then relax for 2 to 3 seconds then the therapist will take the patient's leg into further flexion for 30 seconds this will be repeated for 3 times each session .
Medial Hamstring Muscle energy technique(MET) stretch
Other interventionThe Participant will be supine' then the therapist will take his leg in flexion, abduction and external rotation at the same time until he feels tightness then he will ask the patient to push his leg down and in or toward him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more abduction 'external rotation and flexion for 30 seconds, this will be repeated for 3 times each session
Lateral hamstring Muscle Energy Technique(MET)Stretch
Other interventionThe Participant will be supine' then the therapist will take his leg in flexion, adduction and internal rotation at the same time until he feels a tightness then he will ask the patient to push his leg down and out or away from him him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more adduction 'internal rotation and flexion for 30 seconds, this will be repeated for 3 times each session
hamstring flexibility (knee extension range of motion )
measuring knee extension range of motion(hamstring flexibility) by active knee extension test using kinovea software
Arabic Kujala Anterior knee pain score
Arabic Kujala Anterior knee pain score is used to measure pain and functional activities in anterior knee pain patients consisting of 13 questions, the Patient will be asked to mark the most suitable answer for him. Each answer has points up to 5 or 10, and the total score is 100. The higher the score, the better for the patient.
pain intensity by visual analogue scale (VAS)
from 0 to 10 centimeter line patient will detect on it the usual pain felt and the worst pain during the day
lower limb strength using handheld dynamometer
using handheld dynamometer to assessment the strength of hip abductor, extensors, external rotators and knee extensors
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