Effect of Adding Inguinal Ligament Mobilization to Talonavicular Joint Mobilization on Patellofemoral Pain Syndrome

This study will be conducted to:

• To assess the effect of adding the inguinal ligament mobilization to talonavicular joint mobilization on pain intensity subjects with PFPS
• To assess the effect of adding the inguinal ligament mobilization to talonavicular joint mobilization on pain threshold in subjects with PFPS.
• To assess the effect of adding the inguinal ligament mobilization to talonavicular joint mobilization on knee function in subjects with PFPS .
• To assess the effect of adding the inguinal ligament mobilization to talonavicular joint mobilization on Q angle in subjects with PFPS .

Study Overview

• Status: Enrolling by invitation
• Conditions: Patellofemoral Pain Syndrome
• Intervention / Treatment: Other: inguinal ligament mobilization or talonavicular joint mobilization or both inguinal and talonavicular joint mobilizations or conventional physical therapy exercises

Detailed Description

Patellofemoral pain syndrome is pain around and under the patella (kneecap). The condition is also known as runner's or jumper's knee and affects both kids and adults. It can also occur in one or both knees . Patellofemoral pain syndrome (PFPS) is one of the most common orthopedic knee afflictions among both adults and adolescents. This syndrome, constitutes 5% of all injuries and 25% of knee injuries. It is characterized by pain in the back of the knee cap that comes in contact with the femur , and it is usually aggravated by walking stairs, deep squatting, kneeling, prolonged sitting, and standing up from sitting.

The treatment of PFPS varies from medication and up to different rehabilitation approaches, including balance and proprioceptive exercises to regain normal activities of daily level and optimizing function. Also, the rehabilitation of PFPS includes conservative treatments of physical therapy for symptoms such as muscle strengthening exercises (quadriceps femoris and hip abductors), flexibility exercises (rectus femoris, hamstring, gastrocnemius, hip flexors), foot orthoses to reduce pronated foot, patellofemoral joint taping, braces, and non-steroidal anti-inflammatory drugs (NSAIDs).

Some studies have reported a pronated foot as an intrinsic risk factor for PFPS, suggesting that it may be a solution to the underlying problem. Abnormal motion of the talonavicular joint due to navicular drop or drift in the pronated foot is an indicator of the overall function of the foot. Similarly, studies have shown a correlation between the pronated foot and PFPS. A pronated foot is defined as the flattening or loss of the medial longitudinal arch (MLA). Changes in the lower extremity alignment can cause calcaneal eversion, tibia internal rotation, valgus knee, and femur internal rotation in the normal structure, altering the angle of muscle contraction of the quadriceps femoris, causing the patella to track in the lateral direction, resulting in lower extremity dysfunction.

Foot interventions in patients with patellofemoral pain have shown significant effectiveness of the talonavicular joint mobilization (TJM) to maintain foot posture and to control hypermobility of the talonavicular joint of the pronated foot which will cause changes in PFPS pain, lower extremity function, valgus knee, foot posture. Foot core strengthening: relevance in injury prevention and rehabilitation for runners.

One potential intervention that has gained attention is inguinal ligament mobilization (ILM), a manual therapy technique designed to address pelvic and hip alignment that could indirectly affect knee mechanics. Inguinal ligament mobilization is thought to improve the mobility and function of the surrounding structures, potentially alleviating PFPS symptoms.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Sharkeya
    • Fāqūs, Sharkeya, Egypt, 055
      • Faqus

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• • Diagnosis of PFPS, based on clinical and radiographic criteria (no other knee pathologies) referred by orthopedic physicians.

  • Subjects diagnosed with unilateral PFP with at least three months.
  • Age of subjects ranges from 18 to 40 years .
  • BMI less than 30 kg/ m2.
  • Subjects complaining from increasing pain severity after at least two of the following provocative activities as (Stair ascent and descent, Squatting, Kneeling, running, or prolonged sitting).
  • Subjects included in the study should record a positive grind test.
  • Subjects with tension of inguinal ligament either "mechanical strain, injury, repetitive movement or pelvic instability as anterior pelvic tilting" which leads to PFPS based on positive inguinal ligament tension test.
  • Foot pronation position "mobile type" which leads to PFPS based on positive "The wear test or the wet foot test".
  • Q angle in men 18-22 degree and in women 22 25 degree.

Exclusion Criteria:

• • Chronic pain conditions unrelated to PFPS.

  • Pregnancy or recent trauma to the pelvic or knee region. (Mills et al., 2005).
  • History of steroid injection of the knee.
  • Ankle arthritis, gouty arthritis.
  • History of any surgical intervention of the back, hip, knee or foot.
  • Lower limb deformity such as pes-planus, knee valgus or varus deformities.
  • Previous lower limb disease such as hip and tibiofemoral osteoarthritis.
  • Diabetes or Peripheral neuropathy.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: group A recieving inguinal ligament mobilization; Group A: An intervention group (n = 20) receiving inguinal ligament mobilization (ILM) with conventional physical therapy exercises.	Other: inguinal ligament mobilization or talonavicular joint mobilization or both inguinal and talonavicular joint mobilizations or conventional physical therapy exercises; 2 sessions per week for total 4 weeks of treatment
Experimental: group B recieving talonavicular joint mobilization; Group B: An intervention group (n = 20) receiving talonavicular joint mobilization (TJM) with conventional physical therapy exercises.	Other: inguinal ligament mobilization or talonavicular joint mobilization or both inguinal and talonavicular joint mobilizations or conventional physical therapy exercises; 2 sessions per week for total 4 weeks of treatment
Experimental: group C recieving talonavicular joint mobilization and inguinal ligament mobilization; Group C: An intervention group (n = 20) receiving combined inguinal ligament mobilization, talonavicular joint mobilization and conventional physical therapy exercises.	Other: inguinal ligament mobilization or talonavicular joint mobilization or both inguinal and talonavicular joint mobilizations or conventional physical therapy exercises; 2 sessions per week for total 4 weeks of treatment
Placebo Comparator: group D recieving conventional physical therapy exercises; Group D: A control group (n = 20) receiving conventional physical therapy exercises only	Other: inguinal ligament mobilization or talonavicular joint mobilization or both inguinal and talonavicular joint mobilizations or conventional physical therapy exercises; 2 sessions per week for total 4 weeks of treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity	1.Effect of adding inguinal ligament mobilization to talonavicular joint mobilization on pain intensity in subjects with PFPS. and it is measured by Visual Analogue Scale (100 mm (10-cm) straight line with descriptive anchors at each extreme to measure pain intensity)	Inguinal Ligament Mobilization will last 20 minutes, with 2 sessions per week over 4 weeks.Mobilization of talonavicular Two sets of 5 minutes totally for 4 weeks for two sessions per week.conventional physical therapy 2 sessions per week for 4 weeks.
pain threshold	2.Effect of adding inguinal ligament mobilization to talonavicular joint mobilization on pain threshold in subjects with PFPS. and it is measured by pressure algometer (a handheld diagnostic device used to objectively quantify pain sensitivity by measuring the exact force at which a patient begins to feel pain).	Inguinal Ligament Mobilization will last 20 minutes, with 2 sessions per week over 4 weeks.Mobilization of talonavicular Two sets of 5 minutes totally for 4 weeks for two sessions per week.conventional physical therapy 2 sessions per week for 4 weeks.
knee function	3.Effect of adding inguinal ligament mobilization to talonavicular joint mobilization on knee function in subjects with PFPS. and it is measured by Kujala Patelofemoral Pain Questionnaire (in score from 13-question survey used to measure knee pain, function, and symptoms related to the kneecap. It scores from 0 to 100 points, where 100 means no pain or disability).	Inguinal Ligament Mobilization will last 20 minutes, with 2 sessions per week over 4 weeks.Mobilization of talonavicular Two sets of 5 minutes totally for 4 weeks for two sessions per week.conventional physical therapy 2 sessions per week for 4 weeks.
Q angle	4.Effect of adding inguinal ligament mobilization to talonavicular joint mobilization on Q angle in subjects with PFPS. and it is measured by Goniometer (in angles)	Inguinal Ligament Mobilization will last 20 minutes, with 2 sessions per week over 4 weeks.Mobilization of talonavicular Two sets of 5 minutes totally for 4 weeks for two sessions per week.conventional physical therapy 2 sessions per week for 4 weeks.

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: mohamed is mohamed, PHD, doctoral degree in cairo uneversity

Publications and helpful links

General Publications

• Petersen W, Ellermann A, Gosele-Koppenburg A, Best R, Rembitzki IV, Bruggemann GP, Liebau C. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2264-74. doi: 10.1007/s00167-013-2759-6. Epub 2013 Nov 13.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: February 27, 2026
• First Submitted That Met QC Criteria: July 24, 2026
• First Posted (Actual): July 29, 2026

Study Record Updates

• Last Update Posted (Actual): July 29, 2026
• Last Update Submitted That Met QC Criteria: July 24, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Patellofemoral Pain Syndrome
• Other Study ID Numbers: TNJ on PFPS

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