The patient is in a supine position with the leg extended. Look for a sensitive area four to five fingerbreadths above the knee on the medial side. This will be a long strip of fascia that is several inches in length. The fingers are then placed on either side of this strip on the medial side of the leg behind the sartorius muscle. The fingers are pulled apart in distal and proximal directions, as if to separate the strip as far as possible

The intervention program lasted six weeks and was performed three times per week. It included strengthening, manual therapy, and stretching exercises. Strengthening focused on both the hip and knee. Hip exercises consisted of side-lying hip abduction, clamshells, and prone hip extension, while knee exercises included straight leg raises, terminal knee extensions, and wall-supported mini-squats. Exercises progressed from 3 sets of 10 to 3 sets of 20 repetitions, with gradual resistance added, dynamic execution, brief pauses between repetitions, and short rest periods between sets.

Manual therapy involved patellofemoral joint mobilization performed in a supine position with the knee slightly flexed, using superior, inferior, medial, and lateral patellar glides.

Stretching exercises were performed in sitting or standing, targeting the posterior structures with the knee extended and ankle dorsiflexed. Static stretches were held for 15 seconds and repeated for three sets.

With the patient lying supine and the leg extended, a tender area is identified on the medial side of the thigh, approximately four to five fingerbreadths above the knee. This area corresponds to a longitudinal fascial strip located behind the sartorius muscle. The therapist places the fingers on either side of this strip and applies a gentle separating force in proximal and distal directions to mobilize the tissue and reduce sensitivity.

Visual analogue scale to measure pain intensity

Using the Biodex Stability System (Biodex balance system), static balance was measured

Kujala Anterior Knee Pain Scale (AKPS) for knee pain and function, The Kujala score is composed of 13 multiple choice questions: the presence of a limp, the need for support, the ability to walk, the ability to climb stairs, the ability to squat, the ability to run, the ability to jump, prolonged sitting with knees in the flexed position, the presence of knee pain, the presence of knee swelling, the presence of abnormal painful patellar movement, atrophy of the thigh muscles, and deficiency of knee flexion.

The Q-angle is the angle formed between a line from the anterior superior iliac spine (ASIS) to the center of the patella and a line from the center of the patella to the tibial tuberosity. It reflects the alignment of the quadriceps muscle and the patellofemoral joint and is commonly assessed in patients with PFPS.

Kinovea can be used to measure the Q-angle accurately by placing visual markers on the ASIS, patellar center, and tibial tuberosity, then capturing a frontal-plane image or video. Using Kinovea's angle measurement tool, the two lines are drawn and the angle is calculated. This provides a valid, reliable, and non-invasive method for assessing Q-angle in clinical and research settings, particularly for evaluating lower-limb alignment in PFPS.