Strain Counterstrain Versus Graston Technique for Patellofemoral Pain Syndrome (SCS-GRAS-PFPS)

Immediate Effects of Strain CountetStrain Versus Graston Technique on Pain and Range of Motion in Patients With Patellofemoral Pain Syndrome: A Randomized Clinical Trail.

This clinical trial compares the effects of Strain Counterstrain technique versus Graston Technique on pain and range of motion in patients with patellofemoral pain syndrome.

Adults with patellofemoral pain syndrome were included in this study. A total of 60 participants were divided into two groups with 30 patients in each group.

One group received Strain Counterstrain technique and the other group received Graston Technique. Pain was assessed using the Kujala Scoring System and functional status was measured using a substructural questionnaire. Range of motion was also evaluated before and after treatment.

The main goal of this study is to determine which technique is more effective in reducing pain and improving knee function in patients with patellofemoral pain syndrome.

Study Overview

• Status: Completed
• Conditions: Patellofemoral Pain Syndrome
• Intervention / Treatment: Procedure: Strain Counterstrain; Procedure: Graston Technique

Detailed Description

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal condition characterized by anterior knee pain, especially during activities like squatting, climbing stairs, or prolonged sitting. Conservative management through manual therapy is widely used, but comparative effectiveness of different techniques remains unclear.

This randomized clinical trial was designed to compare the effects of Strain Counterstrain (SCS) technique versus Graston Technique on pain intensity, knee range of motion, and functional status in patients diagnosed with patellofemoral pain syndrome.

A total of 60 participants diagnosed with PFPS were recruited and randomly allocated into two equal groups, with 30 patients in each group. Group A received Strain Counterstrain technique, which involves passive positioning of the affected tissue to achieve a position of comfort and reduce tender point sensitivity. Group B received Graston Technique, an instrument-assisted soft tissue mobilization (IASTM) therapy that uses specialized stainless steel instruments to detect and treat soft tissue restrictions, scar tissue, and fascial adhesions around the knee.

The intervention period lasted for 12 weeks with 3 sessions per week. Outcome measures were assessed at baseline and post-intervention. Pain was evaluated using the Kujala Anterior Knee Pain Scale, also known as the Kujala Scoring System, which is a validated tool for PFPS. Functional status was assessed using a substructural questionnaire evaluating daily activities. Knee range of motion was measured using a standard goniometer.

The primary objective of this study is to determine whether Strain Counterstrain or Graston Technique provides superior outcomes in terms of pain reduction, improved range of motion, and enhanced functional capacity in patients with patellofemoral pain syndrome. The findings will help clinicians select the most effective manual therapy approach for managing PFPS.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Sir Ganga Ram Hospital, Department of Physical Therapy

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age 18-45 years.
• Anterior or peripatellar knee discomfort reproduced by a minimum of two aggravating exercises (e.g., squatting, stairs, running, prolonged sitting).
• No history of trauma.
• On the Numerical Pain Rating Scale (NPRS), pain severity is ≥3/10 at baseline.
• Symptom duration ≥2 months.
• Ability to understand instructions and provide informed consent (or parental consent for minors).

Exclusion Criteria:

• Individuals who have had lower limb surgery within the previous 12 months
• Existence of other knee pathologies (e.g., meniscal tear with locking, tibiofemoral osteoarthritis, inflammatory arthritis).
• Skin infection, open wound, or dermatological condition at the treatment site.
• Use of anticoagulants/bleeding disorders or recent corticosteroid injection within 3 months.
• Receipt of manual therapy (SCS, IASTM/Graston) to the affected knee within the past 4 weeks.

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
Experimental: Strain Counterstrain Group; Participants in this arm received Strain Counterstrain technique for patellofemoral pain syndrome. This technique involves identifying tender points and passively positioning the affected tissue to a position of comfort to reduce pain and muscle spasm. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group.	Procedure: Strain Counterstrain; Strain Counterstrain is a manual therapy technique that involves identifying tender points in muscles and fascia. The therapist passively positions the patient's body to a position of comfort that reduces or eliminates the tenderness. This position is held for 90 seconds to allow neuromuscular reset, followed by slow return to neutral. The technique aims to reduce muscle spasm, normalize proprioceptive activity, and decrease pain in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks.; Other Names: SCS; Positional Release Therapy
Experimental: Graston Technique Group; Participants in this arm received Graston Technique, an instrument-assisted soft tissue mobilization (IASTM) therapy. This technique uses specialized stainless steel instruments to detect and treat soft tissue restrictions, scar tissue, and fascial adhesions around the knee. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group.	Procedure: Graston Technique; Graston Technique is an evidence-based form of instrument-assisted soft tissue mobilization (IASTM). It uses six specialized stainless steel instruments to scan, detect, and treat soft tissue lesions, scar tissue, and fascial restrictions. The instruments are used by trained clinicians to apply controlled microtrauma to affected areas around the knee, promoting tissue healing and remodeling. The goal is to break down adhesions, reduce pain, and improve range of motion and function in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks.; Other Names: IASTM; Instrument-Assisted Soft Tissue Mobilization

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Pain and Function using Kujala Anterior Knee Pain Scale	The Kujala Anterior Knee Pain Scale, also known as Kujala Scoring System, was used to assess pain and functional limitations related to patellofemoral pain syndrome. This is a 13-item self-administered questionnaire evaluating symptoms such as pain during walking, stair climbing, squatting, running, and prolonged sitting. The total score ranges from 0 to 100 points, where 0 represents complete disability and 100 represents no disability. A higher score indicates less pain and better knee function. Change from baseline was calculated to determine treatment effectiveness.	Baseline and 12 weeks post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Knee Range of Motion	Knee flexion and extension range of motion was measured using a standard universal goniometer. Active range of motion was recorded in degrees. Increased range of motion indicates improvement in knee function.	Baseline and 12 weeks post-intervention
Change in Functional Status	Functional status was assessed using a substructural questionnaire evaluating the impact of patellofemoral pain syndrome on daily activities such as walking, stair climbing, squatting, and prolonged sitting. Higher scores indicate better functional capacity.	Baseline and 12 weeks post-intervention

Collaborators and Investigators

• Sponsor: Green International University
• Collaborators: Sir Ganga Ram Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2025
• Primary Completion (Actual): April 29, 2026
• Study Completion (Actual): May 5, 2026

Study Registration Dates

• First Submitted: May 10, 2026
• First Submitted That Met QC Criteria: May 10, 2026
• First Posted (Actual): May 15, 2026

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: May 10, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Knee Pain; Physical Therapy; Range of Motion; Randomized Clinical Trial; Manual Therapy; Anterior Knee Pain; Patellofemoral Pain Syndrome; Graston Technique; Kujala Scale; Strain Counterstrain
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Patellofemoral Pain Syndrome
• Other Study ID Numbers: GIU/REC/26-28

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Only IPD used in the results publication will be shared.
• IPD Sharing Time Frame: It will be available after the completion of the study.
• IPD Sharing Access Criteria: Data requests should be sent to the corresponding author. Access will be granted to qualified researchers for approved research proposals. Data will be de-identified before sharing.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

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