Hamstring Flexibility, Hamstring Shortness, Patellofemoral Pain (PFPS), Patellofemoral Pain Syndrome
Conditions
Keywords
patellofemoral pain syndrome, PFPS, hamstring flexibility, active knee extension test, medial hamstring, lateral hamstring, specific hamstring stretch, Muscle Energy Technique, TENS, Visual Analogue Scale, Hand Held Dynamometer (HHD), Kujala Score
Brief summary
This randomized, Single-blind, parallel-group trial will compare the effects of three hamstring stretching interventions-general hamstring Muscle Energy Technique (MET), medial hamstring MET, and lateral hamstring MET-each combined with standardized TENS and progressive hip/knee strengthening, on hamstring flexibility (knee-extension ROM), anterior knee pain (Arabic Kujala score), pain intensity visual analogue scale (VAS), and lower-limb strength (hand-held dynamometer) in adults with patellofemoral pain syndrome (PFPS).
Detailed description
Patients with chronic PFPS will be randomized (1:1:1) into: General MET group: standard non-specific hamstring MET stretch Medial MET group: targeted medial-hamstring MET stretch Lateral MET group: targeted lateral-hamstring MET stretch All groups receive: TENS: 20 min asymmetric biphasic square-pulse, 120 μs pulse width, 180 Hz, electrodes around patella (5-7 cm apart) Strengthening: 3×/week for 4 weeks; hip/knee exercises, start 3×10 reps → 3×20, progress with weights or resistance bands. Outcomes are measured pre-intervention and at 4 weeks. Analysis by mixed-design MANOVA (α \< 0.05).
Interventions
Each participant will receive 20 minutes of TENS, Electrodes will be positioned around the patella with a 5 - 7 cm distance in between, The TENS settings include a continuous asymmetric biphasic square-pulse wave, a pulse width of 120 microseconds, and a pulse rate of 180 Hz.
OTHERStrength exercises for lower limb
Each participant will receive progressive strengthening program targeting the hip and knee, begin with 3 sets of 10 repetitions and progress to 3 sets of 20 repetitions.
OTHERHamstring Stretch Muscle Energy Technique(MET) (General )
The participant will be supine and the leg will be taken into hip flexion until a tightness is felt then patient will be asked to push down with his lower leg and hold the contraction for 10 seconds then relax for 2 to 3 seconds then the therapist will take the patient's leg into further flexion for 30 seconds this will be repeated for 3 times each session .
OTHERMedial Hamstring Muscle energy technique(MET) stretch
The Participant will be supine' then the therapist will take his leg in flexion, abduction and external rotation at the same time until he feels tightness then he will ask the patient to push his leg down and in or toward him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more abduction 'external rotation and flexion for 30 seconds, this will be repeated for 3 times each session
OTHERLateral hamstring Muscle Energy Technique(MET)Stretch
The Participant will be supine' then the therapist will take his leg in flexion, adduction and internal rotation at the same time until he feels a tightness then he will ask the patient to push his leg down and out or away from him him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more adduction 'internal rotation and flexion for 30 seconds, this will be repeated for 3 times each session
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
statistician
Eligibility
Sex/Gender
ALL
Age
18 Years to 37 Years
Healthy volunteers
No
Inclusion criteria
* Anterior or retropatellar knee pain lasting at least three months * Pain reproduced by at least two functional tasks: squatting, kneeling, prolonged sitting, stair climbing, hopping or running * Pain intensity of ≥3 on a Visual Analog Scale * positive active knee extension test (inability to achieve greater than 160° of knee extension with the hip at 90° of flexion) * Body mass index (BMI) \< 30 Kg/m² and \> 18Kg/m²
Exclusion criteria
* Previous knee surgery * History of knee pathologies, such as meniscal injury' ligament injury, or knee osteoarthritis * Psychological, cardiovascular' or neurological disorders * Dizziness or fainting while doing exercises, pregnancy, or any contraindications to exercise * Physical therapy treatment in the last 3 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| hamstring flexibility (knee extension range of motion ) | 4 weeks | measuring knee extension range of motion(hamstring flexibility) by active knee extension test using kinovea software |
| Arabic Kujala Anterior knee pain score | 4 weeks | Arabic Kujala Anterior knee pain score is used to measure pain and functional activities in anterior knee pain patients consisting of 13 questions, the Patient will be asked to mark the most suitable answer for him. Each answer has points up to 5 or 10, and the total score is 100. The higher the score, the better for the patient. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| pain intensity by visual analogue scale (VAS) | 4 weeks | from 0 to 10 centimeter line patient will detect on it the usual pain felt and the worst pain during the day |
| lower limb strength using handheld dynamometer | 4 weeks | using handheld dynamometer to assessment the strength of hip abductor, extensors, external rotators and knee extensors |
Countries
Egypt
Contacts
Primary ContactAmna Ibrahim Shemila, BSc
Backup ContactAhmed Omar Abdelnaeem, lecturer
Outcome results
None listed