"Mulligan Technique vs Phonophoresis With Chitosan for Patellofemoral Pain" ("MTPP")

Mulligan Technique Vs Phonophoresis With Chitosan Gel on Neuromuscular Control in Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common knee condition causing pain and dysfunction. This study aims to compare the effectiveness of two physical therapy treatments for PFPS: Mulligan mobilization with movement technique versus phonophoresis with chitosan gel.

Forty-five participants with patellofemoral pain syndrome will be randomly assigned to one of three groups: (1) Mulligan technique group, (2) Phonophoresis with chitosan gel group, or (3) Control group receiving standard physical therapy exercises. Each group will receive treatment 3 times per week for 4 weeks.

The researchers want to determine which treatment is more effective in improving neuromuscular control, reducing pain, and improving function in patients with patellofemoral pain syndrome. Participants will be assessed before and after the treatment period.

This study may help physical therapists and healthcare providers choose the most effective treatment approach for patients with patellofemoral pain.

Study Overview

• Status: Not yet recruiting
• Conditions: Patellofemoral Pain Syndrome
• Intervention / Treatment: Procedure: Mulligan technique; Procedure: Phonophoresis with Chitosan Gel; Behavioral: Standard Physical Therapy Exercise Program

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mennat-Allah Ali Elshafey, Master degree; Phone Number: +201227232387; Email: Mennatallah.elshafey@acu.edu.eg

Study Locations

• Egypt
  • Giza Governorate
    • Cairo, Giza Governorate, Egypt, 12573
      • Ahram Canadian unveracity
      • Contact: Nashwa Allam Alla Elden Alam, Doctoral; Phone Number: +20 10 65357571; Email: nashwa.allam@acu.edu.eg

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Insidious onset of anterior knee pain
• Retro patellar or peripatellar pain
• Pain duration more than four weeks (chronic/subacute)
• Pain severity ≥ 3/10 on Visual Analog Scale (VAS)
• Pain during at least two of the following activities: stair ascent or descent, squatting, prolonged sitting (theater sign), or kneeling
• Positive patellar compression test (pain reproduced by compressing the patella into the trochlear groove)
• Patellar tenderness along the medial or lateral borders
• Age between 18 and 35 years
• Baseline Kujala score (Arabic version): approximately 67-71 (indicating moderate to severe dysfunction)

Exclusion Criteria:

• Traumatic injury (e.g., dislocation, fracture, ligament or meniscus pathology)
• Inflammatory arthritis (e.g., rheumatoid arthritis, gout)
• Prior knee surgery
• Current use of NSAIDs or corticosteroids

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mulligan Technique Group; Participants receive hip and knee strengthening exercises combined with Mulligan mobilization with movement (MWM) technique for the patellofemoral joint. MWM is performed in three sets of 10 repetitions, with a 30-second rest interval between sets. Treatment sessions are conducted 3 times per week for 6 weeks.	Procedure: Mulligan technique; Each mobilization with movement (MWM) is performed in three sets of 10 repetitions, with a 30-second rest interval between sets, 3 times per week for 6 weeks, before hip and knee strengthening exercises.
Experimental: Phonophoresis with Chitosan Group; Phonophoresis (ultrasound with chitosan gel) is applied at 1 MHz, 1.0 W/cm², continuous mode, for 5 minutes, 3 times per week for 6 weeks before hip and knee exercises.	Procedure: Phonophoresis with Chitosan Gel; Phonophoresis (ultrasound with chitosan gel) is applied at 1 MHz, 1.0 W/cm², continuous mode, for 5 minutes, 3 times per week for 6 weeks before hip and knee exercises.
Active Comparator: Control Group ( Standard Physical Therapy Group); Participants receive standard physical therapy for patellofemoral pain consisting of hip and knee strengthening exercises, stretching, and functional training. Sessions are conducted 3 times per week for 6 weeks. Exercises include hip and knee strengthening exercises and stretches for the quadriceps, hamstring, iliotibial band, and calf muscles with weekly progression.	Behavioral: Standard Physical Therapy Exercise Program; Participants attend 3 sessions per week for 6 weeks. Each session includes stretching and hip and knee focused exercises. Progression involves weekly increases in repetitions and resistance based on pain levels (less than 3/10).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximal rate of force development (RFD)	Calculated from the slope of force- or torque-time curves obtained during rapid, explosive voluntary contractions also termed ballistic or rapid actions has become a key metric for assessing explosive strength in diverse populations, including athletes, older adults, and clinical patients	Baseline and 6 weeks
Pain at patella	Pain measured using the Kujala Anterior Knee Pain Scale (AKPS). The scale ranges from 0 to 100 points, with 0 indicating maximum disability and 100 indicating no disability. Higher scores indicate better outcome (less pain and better function)	Baseline and 6 weeks

Collaborators and Investigators

• Sponsor: Ahram Canadian University

Study record dates

Study Major Dates

• Study Start (Estimated): February 15, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): August 1, 2026

Study Registration Dates

• First Submitted: February 22, 2026
• First Submitted That Met QC Criteria: February 27, 2026
• First Posted (Actual): March 3, 2026

Study Record Updates

• Last Update Posted (Actual): March 3, 2026
• Last Update Submitted That Met QC Criteria: February 27, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Patellofemoral Pain Syndrome; Therapeutics; Drug Administration Routes; Drug Therapy; Phonophoresis
• Other Study ID Numbers: CUPT-MULLIGAN-2026

Drug and device information, study documents

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