Combined Physical Therapy and Hold-Relax Technique for Adolescent Osgood-Schlatter Knee Pain

Exploratory Effects of a Combined Hold-Relax Technique and Progressive Rehabilitation Program on Knee Pain in Adolescent Athletes With Osgood-Schlatter Disease: A Pilot Study

This pilot study evaluates the preliminary effectiveness of a combined rehabilitation program incorporating hold-relax (H-R) stretching techniques and progressive therapeutic exercises on knee pain and range of motion (ROM) in adolescent athletes diagnosed with Osgood-Schlatter disease. Utilizing a retrospective, single-group pre-post design on a cohort of six athletic participants, this study aims to generate preliminary clinical evidence and assess feasibility to inform future larger-scale randomized controlled trials. Participants underwent a structured, multi-week rehabilitation protocol, with primary clinical outcomes assessed before and after the intervention period using validated measures of pain intensity and knee joint mobility.

Study Overview

• Status: Completed
• Conditions: Osgood-Schlatter Disease
• Intervention / Treatment: Behavioral: Hold-Relax Proprioceptive Neuromuscular Facilitation (PNF); Behavioral: Progressive Rehabilitation Program

• Study Type: Interventional
• Enrollment (Actual): 6
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Algeria
  • Batna
    • Batna City, Batna, Algeria, 05078
      • Batna 2 University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Clinical diagnosis of Osgood-Schlatter disease
• Presence of anterior knee pain localized at the tibial tuberosity
• Regular participation in sports involving running and jumping
• No participation in structured rehabilitation programs within the previous 3 months

Exclusion Criteria:

• History of knee surgery or major trauma
• Presence of other knee pathologies (e.g., ligament or meniscal injuries)
• Neurological or systemic disorders affecting movement

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Active Comparator: Combined Rehabilitation and Hold-Relax Cohort; A single experimental group of adolescent athletes diagnosed with Osgood-Schlatter Disease (OSD). All participants in this cohort receive a structured, multi-week progressive rehabilitation program combined with Hold-Relax (H-R) proprioceptive neuromuscular facilitation (PNF) stretching techniques. The intervention protocol consists of: Hold-Relax stretching targeting the quadriceps and hamstring muscle groups to reduce tensile stress on the tibial tuberosity.; Progressive therapeutic exercises focusing on lower extremity strengthening, load tolerance, and functional biomechanics.

Behavioral: Hold-Relax Proprioceptive Neuromuscular Facilitation (PNF); A target-specific, manual stretching technique administered by a physical therapist to address muscular tightness in the lower extremity. The protocol focuses on the bilateral quadriceps and hamstring muscle groups to reduce the cumulative tensile traction forces exerted on the tibial tuberosity. For each target muscle group, the procedure is performed as follows: Passive Stretch: The physical therapist moves the joint to the limit of comfortable range of motion (ROM) where mild muscle tightness is felt. Isometric Contraction: The participant performs an active, sub-maximal isometric contraction (approximately 50% of maximum voluntary contraction) against the therapist's manual resistance for 6 to 10 seconds, ensuring no actual joint movement occurs. Relaxation and Deeper Passive Stretch: The participant is instructed to relax completely, and the therapist immediately moves the limb passively into a newly gained, deeper range of motion, holding the stati; Behavioral: Progressive Rehabilitation Program; A structured, step-by-step active exercise program designed to build lower-limb load tolerance, correct biomechanical compensations, and stabilize the knee joint complex. The rehabilitation progresses systematically through targeted phases based on individual pain levels and movement quality:Phase 1 (Pain Mitigation and Muscle Activation): Focuses on isometric quadriceps setting, straight leg raises (SLR), gluteal bridging, and ankle/hip mobility exercises to avoid direct loading of the patellar tendon while minimizing disuse atrophy.Phase 2 (Strength and Load Tolerance): Introduces closed-kinetic chain exercises with controlled ranges of motion, including shallow wall sits, leg presses, bilateral squats, and progressive calf raises.Phase 3 (Eccentric and Functional Progression): Focuses on eccentric quadriceps strengthening (e.g., controlled step-downs) and sport-specific functional retraining to prepare the adolescent athlete's patellar tendon and tibial tubercle to absorb high groun

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Knee Pain Intensity on the Visual Analog Scale (VAS)	Knee pain during athletic activity is assessed using a 10-centimeter Visual Analog Scale (VAS). The scale is a horizontal line where 0 centimeters indicates "no pain" and 10 centimeters indicates "the worst possible pain." The outcome is calculated as the change in the pain score (post-intervention score minus baseline score). A negative change indicates an improvement (reduction) in knee pain.	Baseline (Day 1, pre-intervention) and post-intervention (Week 10, immediately following completion of the last rehabilitation session).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Active Knee Flexion Range of Motion	Active knee joint flexion range of motion measured in degrees of joint angle using a standard universal goniometer. The participant lies in a supine position and actively bends the knee as far as possible. The outcome is calculated as the change in degrees from baseline to post-intervention. An increase in degrees indicates an improved range of motion.	Baseline (Day 1, pre-intervention) and post-intervention (Week 10, immediately following completion of the last rehabilitation session).

Collaborators and Investigators

• Sponsor: Benha University
• Investigators: Principal Investigator: Mahmoud El sayed, Bachelor of Physical Therapy, Benha University; Principal Investigator: Ahmed Said, Bachelor of Physical Therapy, Benha University

Study record dates

Study Major Dates

• Study Start (Actual): January 2, 2026
• Primary Completion (Actual): March 30, 2026
• Study Completion (Actual): April 15, 2026

Study Registration Dates

• First Submitted: May 11, 2026
• First Submitted That Met QC Criteria: May 11, 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 11, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Osteochondrosis
• Other Study ID Numbers: SKE 05/2026

Drug and device information, study documents

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