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Patellofemoral pain syndrome is a common source of anterior knee pain. The causes of PFPS may be multifactorial such as biomechanical disorders, muscle weakness which affect the dynamic stability of lower limb and alter patellar tracking in trochlear groove. Moreover, the syndrome associated with muscular tightness of iliotibial band, gastrocnemius, soleus, hamstring and quadriceps. Strengthening and stretching exercises are effective in improving patient's symptoms. However, they do not sufficient in correction of kinematic changes associated with PFPS. Patellar mobilization is effective in improving patient'symptoms in cases with PFPS. However, studies that conducted patellar mobilization were either low quality studies or no study combined patellar mobilization with hip and knee exercises.
Therefore, APTA guidelines recommended for conducting high quality study to investigate the effect of adding patellar mobilization to exercise therapy to support the definite recommendation delivered to therapists.
this is interventional study in which patients will receive stretching and strengthening exercises in control group. in addition, experimental group will receive the same exercises of control group in addition to patellar mobilization, retinacula release and deep friction message.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group (1) | Active Comparator | patients will receive stretch and strength exercises |
|
| Group (2) | Experimental | patients will receive stretch, strength, patellar mobilization, retinacula release and deep friction message |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Patellar mobilization, retinacula release, deep friction message, stretch and strength | Procedure | All exercises will be performed for 30 to 45 minutes per session, 3 times per week for 4 weeks (12 sessions). Group (1): stretch exercises are performed for calf, hamstring, iliotibial band and quadriceps. strength exercises consist from open kinetic chain (hip abductors, hip external rotators and quadriceps) and closed kinetic chain exercises (mini wall squat exercise, forward step up exercise, lateral step up exercise and terminal knee extension exercise). Group (2): stretch exercises are performed for calf, hamstring, iliotibial band and quadriceps. strength exercises consist from open kinetic chain (hip abductors, hip external rotators and quadriceps) and closed kinetic chain exercises (mini wall squat exercise, forward step up exercise, lateral step up exercise and terminal knee extension exercise). manual therapy consists from iliotibial band release, deep friction message for lateral retinacula and medial patella mobilization. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in pain that felt during ascending, descending, squatting and prolonged sitting | Pain during ascending, descending, squatting and prolonged sitting will be assessed using visual analogue scale, it is a horizontal line from 0 to 10, where 0 no pain and 10 maximum pain. | It will be assessed one week before and after treatment |
| Changes in functional disability | Functional disability will be assessed using Kujala questionnaire.The scale ranges from 0 to 100 score where 100 represents no functional limitation. | It will be assessed one week before and after treatment |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in hip abductors strength | It will be assessed using handheld dynamometer | It will be assessed one week before and after treatment |
| Changes in hip external rotators strength | It will be assessed using handheld dynamometer |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nadia A Mohamed, Msc | Assistant lecturer at orthopedic department of faculty of physical therapy | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cairo University | Giza | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40987761 | Derived | Abdo N, Youssef EF, Ibrahim MM. Efficacy of adding manual therapy to hip and knee exercises in patients with patellofemoral pain syndrome: a double-blinded randomized controlled clinical trial. Sci Rep. 2025 Sep 23;15(1):32655. doi: 10.1038/s41598-025-17453-9. |
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| ID | Term |
|---|---|
| D046788 | Patellofemoral Pain Syndrome |
| ID | Term |
|---|---|
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| It will be assessed one week before and after treatment |
| changes in quadriceps strength | It will be assessed using handheld dynamometer | It will be assessed one week before and after treatment |
| changes in functional performance | It will be assessed using step down test | It will be assessed one week before and after treatment |
| changes in hamstring flexibility | It will be assessed using 90-90 test | It will be assessed one week before and after treatment |
| changes in gastrocnemius flexibility | It will be assessed using ankle dorsiflexion range of motion | It will be assessed one week before and after treatment |
| changes in knee valgus | It will be assessed using Q angle | It will be assessed one week before and after treatment |
| changes in foot pronation | It will be assessed using navicular drop test | It will be assessed one week before and after treatment |