Efficacy of Adding Patellar Mobilization to Hip and Knee Exercises in Patients With Patellofemoral Pain Syndrome

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.

Study Overview

• Status: Completed
• Conditions: Patellofemoral Pain Syndrome
• Intervention / Treatment: Procedure: Patellar mobilization, retinacula release, deep friction message, stretch and strength

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 59
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt
    • Cairo university

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 35 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age ranging between 18 and 35 years
2. Tenderness of medial and lateral borders of patella
3. Retropatellar pain
4. Duration of symptoms of patellofemoral pain syndrome is greater than 4 weeks
5. Positive patellar compression test
6. Pain intensity is more than 3 at visual analogue scale
7. Had a history of insidious onset
8. Had anterior knee pain during 2 or more of provocative activities that include stair ascent or descent, kneeling, prolonged sitting, or squatting

Exclusion Criteria:

1. Previous patellar realignment surgery or patellar fracture
2. Had a history of traumatic patellar dislocation
3. Had a history of previous knee surgery
4. Had any form of inflammatory arthritis that include osteoarthritis or rheumatoid arthritis
5. Had a history of knee menisci, ligaments, bursae, or synovial plica syndrome dysfunction
6. Taking corticosteroids or nonsteroidal anti-inflammatory medication
7. Inability to attend treatment program to the end of sessions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group (1); patients will receive stretch and strength exercises	Procedure: Patellar mobilization, retinacula release, deep friction message, stretch and strength; 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.
Experimental: Group (2); patients will receive stretch, strength, patellar mobilization, retinacula release and deep friction message	Procedure: Patellar mobilization, retinacula release, deep friction message, stretch and strength; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Secondary Outcome Measures

Outcome Measure	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	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

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Nadia A Mohamed, Msc, Assistant lecturer at orthopedic department of faculty of physical therapy

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2023
• Primary Completion (Actual): December 11, 2023
• Study Completion (Actual): March 18, 2024

Study Registration Dates

• First Submitted: October 26, 2022
• First Submitted That Met QC Criteria: December 22, 2022
• First Posted (Actual): December 27, 2022

Study Record Updates

• Last Update Posted (Actual): August 21, 2024
• Last Update Submitted That Met QC Criteria: August 19, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: release; strength; mobilization; patellofemoral pain syndrome; stretch; deep friction message; retinacula
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Disease; Joint Diseases; Musculoskeletal Diseases; Syndrome; Somatoform Disorders; Patellofemoral Pain Syndrome
• Other Study ID Numbers: P.T.REC/012/004020

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No