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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).
Patients with chronic PFPS will be randomized (1:1:1) into:
General MET group: standard non-specific hamstring MET stretch
Medial MET group: targeted medial-hamstring MET stretch
Lateral MET group: targeted lateral-hamstring MET stretch
All groups receive:
TENS: 20 min asymmetric biphasic square-pulse, 120 μs pulse width, 180 Hz, electrodes around patella (5-7 cm apart)
Strengthening: 3×/week for 4 weeks; hip/knee exercises, start 3×10 reps → 3×20, progress with weights or resistance bands.
Outcomes are measured pre-intervention and at 4 weeks. Analysis by mixed-design MANOVA (α < 0.05).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm A (general hamstring stretch group) | Active Comparator |
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| Arm B (medial hamstring stretch) | Active Comparator |
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| Arm C (lateral hamstring stretch) | Active Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transcutaneous Electrical Nerve Stimulation Device | Device | Each 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. |
| Measure | Description | Time Frame |
|---|---|---|
| hamstring flexibility (knee extension range of motion ) | measuring knee extension range of motion(hamstring flexibility) by active knee extension test using kinovea software | 4 weeks |
| 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. | 4 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| 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 | 4 weeks |
| lower limb strength using handheld dynamometer |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Amna Ibrahim Shemila, BSc | Contact | 201157072513 | 10722021419373@pg.cu.edu.eg | |
| Ahmed Omar Abdelnaeem, lecturer | Contact | 201140736820 | ahmed.omar@pt.cu.edu.eg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| faculty of physical therapy Cairo university | Giza | Giza Governorate | 12613 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Zahra Rojhani-Shirazi, Mohamad Reza Salimifard, Fatemeh Barzintaj. Comparison of the effects of static stretching and muscle energy technique on Hamstring flexibility, pain, and function in athletes with patellofemoral pain. J Adv Pharm Edu Res 2021;11(S1):33-38. | ||
| 37669706 | Background | Lopes HS, Waiteman MC, Priore LB, Glaviano NR, Bazett-Jones DM, Briani RV, Azevedo FM. There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. J Sport Health Sci. 2024 Jul;13(4):521-536. doi: 10.1016/j.jshs.2023.08.004. Epub 2023 Sep 3. | |
| 33533400 |
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statistician
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| Strength exercises for lower limb | Other | Each 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. |
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| Hamstring Stretch Muscle Energy Technique(MET) (General ) | Other | The 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 . |
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| Medial Hamstring Muscle energy technique(MET) stretch | Other | The 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 |
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| Lateral hamstring Muscle Energy Technique(MET)Stretch | Other | The 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 |
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using handheld dynamometer to assessment the strength of hip abductor, extensors, external rotators and knee extensors
| 4 weeks |
| Background |
| Wallis JA, Roddy L, Bottrell J, Parslow S, Taylor NF. A Systematic Review of Clinical Practice Guidelines for Physical Therapist Management of Patellofemoral Pain. Phys Ther. 2021 Mar 3;101(3):pzab021. doi: 10.1093/ptj/pzab021. |
| 30316659 | Background | Hamdan M, Haddad B, Isleem U, Hamad A, Hussein L, Shawareb Y, Hadidi F, Alryalat SA, Samarah O, Khanfar A, Alzoubi B. Validation of the Arabic version of the Kujala patellofemoral pain scoring system. J Orthop Sci. 2019 Mar;24(2):290-293. doi: 10.1016/j.jos.2018.09.008. Epub 2018 Oct 10. |
| Background | John Gibbons. (2022). Muscle energy techniques: a practical guide for physical therapists / JOHN GIBBONS (second edition). Lotus publishing / North Atlantic book |
| 31166989 | Background | Puig-Divi A, Escalona-Marfil C, Padulles-Riu JM, Busquets A, Padulles-Chando X, Marcos-Ruiz D. Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. PLoS One. 2019 Jun 5;14(6):e0216448. doi: 10.1371/journal.pone.0216448. eCollection 2019. |
| 31846113 | Background | Hott A, Brox JI, Pripp AH, Juel NG, Liavaag S. Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity. Scand J Med Sci Sports. 2020 Apr;30(4):741-753. doi: 10.1111/sms.13613. Epub 2020 Jan 5. |
| 34985237 | Background | Constantinou A, Mamais I, Papathanasiou G, Lamnisos D, Stasinopoulos D. Comparing hip and knee focused exercises versus hip and knee focused exercises with the use of blood flow restriction training in adults with patellofemoral pain. Eur J Phys Rehabil Med. 2022 Apr;58(2):225-235. doi: 10.23736/S1973-9087.22.06691-6. Epub 2022 Jan 5. |
| ID | Term |
|---|---|
| D046788 | Patellofemoral Pain Syndrome |
| ID | Term |
|---|---|
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| ID | Term |
|---|---|
| D004561 | Transcutaneous Electric Nerve Stimulation |
| ID | Term |
|---|---|
| D004599 | Electric Stimulation Therapy |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
| D000698 | Analgesia |
| D000760 | Anesthesia and Analgesia |
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