Patellofemoral Pain Syndrome
Conditions
Keywords
PATELLOFEMORAL PAIN SYNDROME, Balance, pain, knee function, saphenous nerve
Brief summary
Patellofemoral Pain Syndrome (PFPS) is a frequent cause of anterior knee pain in young, physically active individuals, especially females, and is commonly managed with quadriceps and hip-focused exercises. However, the role of neural factors has been largely overlooked. The saphenous nerve, which supplies sensation to the anteromedial knee, may become irritated or entrapped and contribute to pain and neuromuscular dysfunction in PFPS. This study suggests that manual therapy targeting the saphenous nerve could improve pain, function, and balance, providing a more holistic approach to PFPS rehabilitation.
Detailed description
Patellofemoral Pain Syndrome (PFPS) is a common cause of anterior knee pain, particularly affecting adolescents and young adults, with a higher prevalence among females. It accounts for a significant proportion of knee complaints seen in sports medicine and is especially common in physically active individuals. Traditional rehabilitation for PFPS has mainly focused on quadriceps strengthening and knee mechanics, with more recent attention given to hip-focused exercises. However, the neural contribution to PFPS, particularly involving the saphenous nerve and its infrapatellar branch, has been relatively under-explored. The saphenous nerve is a purely sensory branch of the femoral nerve that supplies the anteromedial knee and lower leg and plays an important role in proprioception. Anatomical variations and its course near the sartorius muscle may predispose it to irritation or entrapment, potentially contributing to chronic anteromedial knee pain. This study proposes that irritation or mechanosensitivity of the saphenous nerve may be a contributing factor in PFPS, leading to pain and impaired neuromuscular control. By incorporating manual therapy targeting the saphenous nerve, the research aims to fill a gap in current PFPS management. Addressing neural factors may enhance pain reduction, functional performance, and balance, offering a more comprehensive and holistic physiotherapy approach for individuals with PFPS. (summarize in short)
Interventions
OTHERSaphenous nerve release
With the patient lying supine and the leg extended, a tender area is identified on the medial side of the thigh, approximately four to five fingerbreadths above the knee. This area corresponds to a longitudinal fascial strip located behind the sartorius muscle. The therapist places the fingers on either side of this strip and applies a gentle separating force in proximal and distal directions to mobilize the tissue and reduce sensitivity.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Intervention model description
Saphenous nerve release
Eligibility
Sex/Gender
ALL
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
1 - Age from 18 to 35 and BMI 18 to 25 kg/m2. 2. Both gender (male and female) 3. Patients who had anterior knee pain for at least six weeks 4. Patients with positive saphenous neurodynamic test (SAPHNT)
Exclusion criteria
1. Knee replacement 2. An intraarticular injection within the past 3 months 3. Previous operative treatment or arthroscopy, other secondary knee-related problems (bursitis, tendinopathy, osteochondritis, neuromas, intraarticular pathology (such as osteoarthritis), tumor, and rheumatologic diseases 4. Diabetic neuropathic pain or fibromyalgia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| knee pain | up to 6 weeks | Visual analogue scale to measure pain intensity |
| Balance | up to 6 weeks | Using the Biodex Stability System (Biodex balance system), static balance was measured |
| Function | up to 6 weeks | Kujala Anterior Knee Pain Scale (AKPS) for knee pain and function, The Kujala score is composed of 13 multiple choice questions: the presence of a limp, the need for support, the ability to walk, the ability to climb stairs, the ability to squat, the ability to run, the ability to jump, prolonged sitting with knees in the flexed position, the presence of knee pain, the presence of knee swelling, the presence of abnormal painful patellar movement, atrophy of the thigh muscles, and deficiency of knee flexion. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Q angle | up to 6 weeks | The Q-angle is the angle formed between a line from the anterior superior iliac spine (ASIS) to the center of the patella and a line from the center of the patella to the tibial tuberosity. It reflects the alignment of the quadriceps muscle and the patellofemoral joint and is commonly assessed in patients with PFPS. Kinovea can be used to measure the Q-angle accurately by placing visual markers on the ASIS, patellar center, and tibial tuberosity, then capturing a frontal-plane image or video. Using Kinovea's angle measurement tool, the two lines are drawn and the angle is calculated. This provides a valid, reliable, and non-invasive method for assessing Q-angle in clinical and research settings, particularly for evaluating lower-limb alignment in PFPS. |
Countries
Egypt
Contacts
Primary ContactMarkos Boshra, bachelor's
Backup ContactMarkos Boshra, bachelor's
Outcome results
None listed