Clinical trials

This randomized controlled trial compares criteria-based rehabilitation (CBR) with time-based rehabilitation (TBR) for football players aged 18-35 with ACL reconstruction, hamstring strain, or ankle sprain. Both groups receive a six-week supervised rehabilitation program; the progression rules differ between groups.

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.

Low back pain (LBP) is a condition characterized by fatigue, discomfort in the lumbosacral area, and a most common cause of disability . Low Back Pain (LBP) is defined as tiredness, discomfort or pain in the lower back region, radiating to lower extremities unilaterally or bilaterally. Low back pain is a bit common issue that most of the population experience sooner or later in their lives . Low back pain (LBP) is featured as pain and discomfort in the area between the costal margin and the inferior gluteal folds, with or without referred leg pain. Non-specific low back pain is the most common back pain, it is estimated that 70-80% of the entire population has experienced non-specific low back pain in their lifetime. Nonspecific low back pain (LBP) is usually defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds. It is the commonest musculoskeletal condition in the adult population and its prevalence amounts to 84%. Furthermore, it limits the activity of the affected population by 30.8% monthly and 38% every year. Consequently, CLBP poses a substantial economic burden on healthcare, social, and welfare systems. Only 15% of non-specific low back pain can be identified, while the remaining 85% are non-specific. Sixty to eighty percent of LBP patients report pain or disability a year later, and up to 40% report chronic pain. However, understanding the specific etiology of chronic nonspecific LBP remains elusive because it results from a variety of factors that can interact with each other. The diagnosis of Low Back Pain is divided into two, namely Specific and Non-specific Low Back Pain, In Specific Low Back Pain, there are certain pathophysiological mechanisms that cause symptoms such as infections of the spine, hernia nucleus pulposus, osteoporosis, rheumatoid arthritis, fractures, and tumors. In contrast to non-specific low back pain, where it is generally said that 80-90% of non-specific causes of low back pain are mechanical, and based on this percentage, 65-70% have no specific cause. Additionally, LBP restricts occupational activities and is among the main causes of absenteeism. So, it leads to high costs of health care and decreases productivity. Various factors contribute to the development of chronic LBP. Physical factors, such as reduced muscle strength and endurance are prognostic factors for chronic LBP. The occupational load carriage has the potential to alter the carrier's body posture and may lead to greater forward trunk lean. Besides, the presence and experience of nonspecific LBP could be affected by psychosocial factors, including anxiety and depression. These factors strongly influence the pain intensity during activity and degree of disability in patients with chronic nonspecific LBP. Apart from load carriage, other factors are also associated with LBP in these populations including a lack of physical fitness, higher fat mass, and long periods of sitting. Pain is the main symptom and account for disability and lack of work participation. Physiological testing shows reduced lumbar flexibility and flexion-relaxation, poorer static balance , poorer proprioception and spinal segment stability, and lower physical fitness and health-related quality of life (HRQoL) in patients with NLBP . Quadratus lumborum (QL) is a deep trunk muscle, and its tightness can trigger symptoms of significant low back tightness and discomfort. Recurrent episodes (lasting more than 3 months) are common presentations of nonspecific LBP usually accompanied by limitation of movement, long-term disability, and decreased quality of life.

Frozen shoulder has been described as a painful condition associated with stiffness and difficulty in sleeping on the affected side. People with this condition have difficulty in dressing, overhead movements and sleep disturbance. It occurs in 2 - 5% of general adult population, 10 - 15% of the people with diabetes. It mainly affects the individuals of 35 - 65 years of age with female predominance. Frozen shoulder is characterized by fibroproliferative tissue fibrosis whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts, which is accompanied by inflammation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. There are two frozen shoulder syndromes, namely primary syndrome and secondary syndrome. In primary or idiopathic syndrome, frozen shoulder that occurs spontaneously or directly without knowing the causative factors. Primary syndrome occurs due to a chronic inflammatory response with fibroblast proliferation which can actually be a response from an abnormal immune system. Secondary syndromes occur due to several triggers such as trauma that can cause shoulder injuries or surgery associated with the onset of other conditions such as diabetes mellitus, autoimmune diseases and cardiovascular disorders. The clinical presentation of frozen shoulder typically progresses through three stages: the freezing stage, where the shoulder becomes painful and progressively stiff over two to nine months; the frozen stage, characterized by significant stiffness and reduced pain over four to twelve months; and the thawing stage, where gradual improvement in shoulder mobility occurs over five to twenty-four months. The condition can be severely debilitating, impacting daily activities and overall quality of life. Adhesive capsulitis treatment primarily consists of pain relief and physical therapy techniques. Anti-inflammatory medication is helpful in pain relief, so that mobility interventions can be initiated. Therapeutic modalities include Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Therapy (IFT), Ultrasound, Short Wave Diathermy (SWD) etc, and the physical therapy exercises such as stretching, Codman exercise can be used. Exercises which may be active, passive or active assisted, play a crucial role in the early rehabilitation of these patients.

Upper Cross Syndrome (UCS) is a prevalent musculoskeletal disorder characterized by a specific pattern of muscular imbalance and postural dysfunction. This condition arises from prolonged poor posture. The resulting imbalance often manifests as visible postural changes, including rounded shoulders, forward head posture, and increased thoracic kyphosis. UCS is characterized by tightness and weakness of the neck, shoulders, and upper back muscles that cross between the dorsal and the ventral sides of the body. Postural abnormalities associated with UCS include a forward head posture (FHP), cervical lordosis, thoracic hyper kyphosis, protracted and elevated shoulders (round shoulders), and scapular winging with increased internal rotation and abduction. In UCS, neck and chest muscles, such as the sternocleidomastoid (SCM), levator scapulae, Pectoralis major and minor, Scalenes, and Upper Trapezius (UT), are tightened or shortened, whereas muscles of the neck and posterior upper back, such as the Deep Neck Flexors (DNFs), Serratus Anterior (SA), Rhomboids, Middle Trapezius (MT), and Lower Trapezius (LT), are weakened, stretched, and restrained. Opposite-group muscle imbalances in UCS bring postural disturbances, misalignments in the upper limbs, and atlanto-occipital, cervicothoracic, and glenohumeral joint dysfunction. The muscular imbalances may also lead to various musculoskeletal symptoms, such as headaches, neck pain, chest pain, upper back pain, tingling in the upper arms, or a limited range of motion in the neck or shoulders. The alteration in scapula muscles in UCS affects the movement of the scapula, which acts as a bridge and provides mobility and stability to the shoulders and neck. A proper posture is necessary for optimal functional performance in daily activities. The awkward positions put constant pressure on the joints, and degenerative changes in joints progress rapidly when exposed to sustained pressure, causing muscle imbalances and pain. If a muscle imbalance continues and progresses, this may lead to altered movement patterns and joint damage, creating further dysfunction. The main risk factor for developing UCS is maintaining an abnormal posture for a prolonged duration. Some daily activities that involve bad postures are often occupation-related. Repetitive tasks or continuous work for long hours can aggravate postural deviations. For example, patients with improper postures are more prone to musculoskeletal injuries after handling or lifting heavy objects than others with a proper posture. Musculoskeletal pain, most commonly neck pain, may present as the main symptom of UCS. Musculoskeletal pain may increase in relation to standing continuously or improperly sitting for long hours.

This randomized clinical trial aims to compare the effects of multi-component training and motor learning techniques on attention, cognitive performance, and motor coordination in adults with Attention Deficit Hyperactivity Disorder (ADHD). ADHD in adults is associated with impairments in executive function, attention regulation, and motor coordination, which significantly impact daily functioning and quality of life. While pharmacological and behavioral therapies are commonly used, non-pharmacological interventions such as structured exercise and motor learning approaches have shown potential benefits. A total of 44 participants aged 18-30 years with clinically diagnosed ADHD will be recruited and randomly allocated into two groups. Group A will receive multi-component training including aerobic, resistance, balance, and flexibility exercises, while Group B will receive motor learning techniques focusing on task-oriented and cognitive-motor dual-task training. Both interventions will be administered three times per week for eight weeks. Outcome measures will include standardized tools assessing attention, executive function, and cognitive performance, including ADHD rating scales and cognitive assessments. Data will be analyzed pre- and post-intervention to determine within-group and between-group differences. This study aims to identify effective, non-pharmacological rehabilitation strategies for improving cognitive and motor outcomes in adults with ADHD.

The goal of this comparative cross-sectional study is to learn about the effects of gestational diabetes on lumbopelvic stability in primigravida subjects. The main question it aims to answer is: Does gestational diabetes effect lumbopelvic stability during pregnancy?

A single-blinded randomized clinical trial was conducted with 30 male overhead athletes (17-35 years) recruited from cricket clubs and sports complexes in Faisalabad. Participants were randomized into Group A (rotator cuff drills: plyometric medicine ball throws, wall dribbles) or Group B (PREs: resistance band exercises with progressive loading). Both groups underwent 12-week interventions (3 sessions/week) following the FIIT principle (Frequency, Intensity, Time, Type), preceded by a standardized 20-minute warm-up. Outcomes were assessed using the Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), and Upper Limb Rotation Test (ULRT) at baseline, 6 weeks, and 12 weeks. Data were analyzed using SPSS v24, with statistical significance set at \*p\* ≤ 0.05. Descriptive statistics (mean, SD) summarized continuous variables, while frequencies/percentages described categorical data. Normality was confirmed via Kolmogorov-Smirnov test. Between-group differences were analyzed using independent \*t\*-tests, and within-group changes via paired \*t\*-tests. The study's rigorous blinding and standardized protocols minimized bias, ensuring robust comparisons between interventions.

This randomized controlled trial study will include 32 athletes aged 18-35 who had ACL surgery. After surgery, participants will be selected and assigned randomly to the Functional Movement Training or Functional Stability Training groups. The Functional Movement Training protocol will include exercise: deep squat, hurdle step, in-line lunge, active straight leg raise, trunk stability push-up, and rotatory stability etc. The Functional Stability Training protocol will emphasize exercises Single-leg squats, Balance boards or BOSU ball training, Planks and side planks., Step-ups, lunges, and agility drills. Both exercises will be performed 3 times per week for 8 weeks. The main goals will be to assess pain, balance and function and knee stability. The Numeric Pain Rating Scale (NPRS), Japanese Knee Questionnaire (JACL 25) and PRSI tools will be used for collecting data. The analysis will be conducted with SPSS software and it will include use of descriptive statistics, Normality test, independent t-tests, and paired t-tests. The significance level will be p \< 0.05 for this study.

This study is a randomized, double-blind, placebo-controlled clinical trial designed to evaluate the effectiveness of botulinum toxin type A (BoNT-A) in patients with temporomandibular myofascial pain who have not improved after at least 3 months of conservative treatment. Eligible patients aged 18-60 years will be randomly assigned to one of two groups: * Intervention group: Intramuscular injection of 100 U BoNT-A into the bilateral masseter and temporalis muscles. * Control group: Intramuscular injection of 0.9% normal saline (placebo) using the same technique. The primary outcomes will be: * Pain intensity, measured using a 0-10 pain scale (VAS/NRS). * Maximum mouth opening (maximal interincisal distance), measured in millimetres. Assessments will be performed before treatment (baseline) and at 1 week, 1 month, and 3 months after injection. The study will also monitor adverse events associated with the injections. The aim is to determine whether BoNT-A provides greater pain relief and improved mouth opening compared with placebo in patients with temporomandibular myofascial pain. The findings may help support the use of BoNT-A as a treatment option for patients who do not respond to conventional therapy and provide valuable evidence for clinical practice in Pakista

Anterior cruciate ligament (ACL) injuries are among the most common and functionally disabling knee injuries, particularly in physically active individuals. Despite advancements in surgical techniques, optimal post-operative rehabilitation remains critical for successful functional recovery, minimizing re-injury risk, and restoring pre-injury performance levels

The study aims to compare the effectiveness of these two core training approaches in improving urinary incontinence, pelvic floor function, and quality of life in postpartum women.

The study aims to determine whether lumbopelvic manipulation yields superior improvements in pain, pelvic alignment, and functional ability when combined with METs compared to the treatment provided through METs solely.

Piriformis Syndrome (PS) is a condition which is characterized by pain, numbness, and limited range of motion (ROM) due to compression or irritation of the sciatic nerve by the piriformis muscle. It often leads to discomfort in the buttock region, radiating pain along the posterior thigh, and functional limitations in daily activities. Manual therapy techniques, particularly Muscle Energy Techniques (METs), have been widely used for the management of musculoskeletal dysfunctions, including piriformis syndrome.

The objective of study is to compare the pain intensity, disability and functional capacity by Deep Transverse Friction Massage and Instrument Assisted Soft Tissue Mobilization Techniques in patients with plantar fasciitis.

This study aims to determine the combined effect of resisted deep breathing and Myofascial release on pain, respiratory efficiency, chest mobility and lymph edema in Postmastectomy.

The aim of this study is to determine the combine effects of core stabilization exercises and Myofascial Induction therapy on lumber pain, core endurance and quality of life on postpartum low-back pain.

This study aims to compare the effects of the Tyler Twist exercise versus traditional eccentric exercises on pain, grip strength, and functional outcomes in patients diagnosed with lateral epicondylalgia. The primary objective is to determine which intervention offers greater improvement in clinical symptoms and overall function over a defined treatment period.

The aim of this study is to determine the comparative effects of sacral release technique and lumbar mobilization in pain, symptoms severity and quality of life in primary dysmenorrhea.

To evaluate the combined effects of motor control retraining and scapular stabilization exercises on pain reduction, muscle strength improvement, and functional enhancement in breastfeeding females diagnosed with scapular dyskinesia, and to determine the effectiveness of this combined approach in addressing their musculoskeletal impairments.

The primary objective of this study is to translate the Nordic Musculoskeletal (E-NMQ) Questionnaire Modified Version into Urdu following international guidelines. Presently, there exists no validated tool to comprehensively measure symptoms such as pain, stiffness and weakness in Urdu-speaking patients in Pakistan. Specifically, the widely used E-NMQ, having these three vital categories, has yet to be translated and validated for Urdu-speaking individuals with musculoskeletal disease (MSD).

This study aims to determine the comparative effects of Pilates and Progressive Prone Plank exercises on pain, strength and inter rectus distance in Diastasis Recti

The aim of this study is to compare the combined effects of Paula method \& tibial nerve stimulation on incontinence, pelvic floor muscles strength, sexual function and quality of life in stress urinary incontinence

The study will be a randomized control trial and will be conducted in DHQ and Sadiq Hospital in Sargodha District. This study will be completed in time duration of 10 months after the approval of synopsis. Nonprobability convenience sampling technique will be used and 50 participants will be recruited in study after randomization. The subjects will be divided into two groups. Group A(Experimental) will receive core stability and pelvic clock exercises with baseline treatment while Group B(Control) will receive only core stability exercises after baseline treatment. The tools that will be used are Numeric Pain Rating Scale (NPRS), Oswestry Disability index (ODI) and WHOQOL-BREF. Treatment have duration of 8 weeks with 3 sessions per week and an hour per session is requires. After data collection, data will be analyzed by using SPSS version 26.

This study will be randomized clinical trial and will be conducted in Services Hospital and poly clinics. The total duration of treatment will be 12 weeks. Non-probability convenience sampling technique will be used and 56 participants will be recruited in study after randomization. The participants are randomly assigned to one of two groups: Group A performs corrective exercises focused on deep core engagement, while Group B performs plank exercises aimed at overall abdominal activation. Each group follows their respective regimen three times per week for 12 weeks. Baseline EMS and pelvic floor exercises are conducted for all participants to ensure core stability before the interventions begin. Outcome measures, including manual muscle testing (MMT) for strength, and the Numerical Pain Rating Scale (NPRS) for pain, are recorded both before and after the 12-week intervention. After data collection data will be analyzed by using SPSS version 25.