To Compare the Effect of Closed Kinetic Chain and Isometric Exercises in Reducing Pain and Improving Functional Disability in Patients With Patellofemoral Pain Syndrome Associated With Knee Osteoarthritis

Comparison of the Closed Kinetic Chain and Isometric Exercise in Female Patient With Patellofemoral Pain Syndrome Associated With Knee Osteoarthritis: A Randomized Control Trial

Investigator study aims to compare the benefits of isometric exercise and closed kinetic chain exercises in strengthening programs to lessen pain along with enhance functionality in patients with PFP that are being associated with osteoarthritis and the assessment of PFP pertains to its recognition and the determination of significant therapeutic techniques. 70 Participants from the department of physiotherapy, Civil Hospital Karachi CHK and Dow University of Health Science (DIPMR) will be randomly assigned into two groups, an experimental group receiving closed kinetic chain exercise, and a control group receiving isometric exercises. The therapy will last four weeks, consisting of twelfth sessions. There will be 35 to 40 minutes in each session, Patients will be evaluated on primary outcome measure, pain intensity and functional limitation using various scales, including the numerical pain rating scale (NPRS) and Kujala/anterior knee pain scale (AKPS)

Study Overview

• Status: Active, not recruiting
• Conditions: Knee Osteoarthritis
• Intervention / Treatment: Behavioral: Terminal knee extension. .VMO squat. [TheraBand]; Behavioral: Isometric exercises [knee roller]

Detailed Description

The most prevalent issue of musculoskeletal knee joint that impact is patellofemoral pain syndrome (PFPS) particularly in young adults and the elderly, causing severe discomfort behind and around the patella, making it the primary etiology for anterior knee discomfort. Patellofemoral joint may be the first compartment affected in early knee osteoarthritis. Most exercise programs designed for treating p a t e l l o f e m o r a l p a i n ( PFP) focus on strengthening the quadriceps, primarily the vastus medialis oblique (VMO). A rehabilitation program including closed kinetic chain exercises and isometric exercises may be beneficial for patients with patellofemoral pain (PFP) to improve their functional limitations and minimize pain. Closed kinetic chain exercises improve functional movement patterns, while isometric exercises are better tolerated during pain or inflammation. The effectiveness of these approaches in individuals with patellofemoral pain (PFP) associated with knee OA is unclear, but understanding their differential impacts can guide targeted rehabilitation strategies for this complex patient population. Investigator aims to compare the benefits of isometric exercise and closed kinetic chain exercises in strengthening programs to lessen pain along with enhance functionality in patients with PFP that are being associated with osteoarthritis, Participants from the department of physiotherapy, Civil Hospital Karachi CHK and Dow University of Health Science (DIPMR) will be randomly assigned into two groups, an experimental group receiving closed kinetic chain exercise, and a control group receiving isometric exercises. The therapy will last four weeks, consisting of twelfth sessions. There will be 35 to 40 minutes in each session, Patients will be evaluated on pain intensity and functional limitation using various scales, including the numerical pain rating scale (NPRS) and Kujala/anterior knee pain scale (AKPS).

• Study Type: Interventional
• Enrollment (Actual): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Karachi, Pakistan
    • Saddar

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

• Age between (35 to 60) years.
• Gender: female.
• The numerical pain rating scale (NPRS) is greater than three out often i.e. 3/10 score.
• Patient experiences anterior knee pain due to such activities like squatting, prolonged sitting, running and stair climbing.
• Patient with unilateral or bilateral knee pain with positive radiographic imaging.
• Patients have grade 1 and 2 knee osteoarthritis (K&L classification).

Exclusion Criteria

• Any past record of knee surgery.
• Any past record of knee fracture.
• Patients with any neurological disorder.
• Cancer, malignancy or any bone tumor.
• Comorbid like diabetes mellitus.
• Any systemic inflammatory arthritis.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: GroupA . given treatment closed kinetic chain exercise; Terminal knee extension, The patient stand facing the plinth with feet shoulder-width apart and a theraband looped around their knee and other plinth legs. patient bend their knees to a 30-degree angle, extend their leg against the band's resistance, and hold this position for six seconds. VMO squat, The position of patient, hip and knee will bend, weight of the body on feet and feet about shoulder width apart and turn the feet outward about 45 degrees and position hold for 30 second.	Behavioral: Terminal knee extension. .VMO squat. [TheraBand]; Terminal knee extension, The patient stand facing the plinth with feet shoulder-width apart and a theraband looped around their knee and other plinth legs. They bend their knees to a 30-degree angle, extend their leg against the band's resistance, and hold this position for six seconds. VMO squat, The position of patient, hip and knee will bend, weight of the body on feet and feet about shoulder width apart and turnthe feet outward about 45 degrees and position hold for 30 second.
Experimental: GroupB . given treatment isometric exercise SLR, Static quads.; Static Quads The patient is long sitting or supine on their back, with a foam roll or towel behind their knee. Contract your quadriceps muscles while pressing down on the towel, maintaining this position for five seconds. Straight leg raising (SLR) The patient will be laying in supine, and before the exercise's lifting phase, a maximal isometric quadriceps contraction will be executed, followed by raising the leg to a height of 10cm above the plinth for 10 seconds.	Behavioral: Isometric exercises [knee roller]; Static Quads The patient is long sitting or supine on their back, with a foam roll or towel behind their knee. Contract your quadriceps muscles while pressing down on the towel, maintaining this position for five seconds. Straight leg raising (SLR) The patient will be laying in supine, and before the exercise's lifting phase, a maximal isometric quadriceps contraction will be executed, followed by raising the leg to a height of 10 cm above the plinth for 10 seconds.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
numerical pain rating scale (NPRS)	1. Numerical pain rating scale (NPRS) Pain intensity will measure using NPR scale (no need for permission), a reliable instrument retest reliability of 0.95 , 0 represents no pain and 10 represents severe suffering. 10= indicate worse pain 5= indicate moderate pain 0 = indicate no pain.	12th sessions for four weeks ,outcome measures will take place both, at the baseline when intervention start and four weeks, following the intervention
. Kujala/ Anterior knee pain scale (AKPS)	we will use the Kujala scale to measure functional limitations, a reliable instrument retest reliability of 0.9 in patient with PFPS, total 13 self-reported questionnaire. AKPS graded 0 to 100, 100 being the highest possible score with no pain and disability. Lower scores reflect greater pain and disability.	12th sessions for four weeks, ,outcome measures will take place both, at the baseline when intervention start and four weeks, following the intervention

Collaborators and Investigators

• Sponsor: Dow University of Health Sciences

Publications and helpful links

Helpful Links

• Efficacy of electromyographic-biofeedback supplementation training with patellar taping on quadriceps strengthening in patellofemoral pain syndrome among young adult male athletes
• McConnell patellar taping on postural control of women with patellofemoral pain syndrome

Study record dates

Study Major Dates

• Study Start (Actual): November 9, 2023
• Primary Completion (Actual): February 28, 2026
• Study Completion (Estimated): November 8, 2027

Study Registration Dates

• First Submitted: August 26, 2025
• First Submitted That Met QC Criteria: December 9, 2025
• First Posted (Actual): December 23, 2025

Study Record Updates

• Last Update Posted (Actual): May 19, 2026
• Last Update Submitted That Met QC Criteria: May 16, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise
• Other Study ID Numbers: IRB4014/DUHS/Approval/2025/268

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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