Patellofemoral Pain Syndrome
Conditions
Brief summary
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 .
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.
Interventions
OTHERinguinal 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
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
A randomized controlled trial (RCT).
Intervention model description
Group A: An intervention group (n = 20) receiving inguinal ligament mobilization (ILM) with conventional physical therapy exercises. Group B: An intervention group (n = 20) receiving talonavicular joint mobilization (TJM) with conventional physical therapy exercises. Group C: An intervention group (n = 20) receiving combined inguinal ligament mobilization, talonavicular joint mobilization and conventional physical therapy exercises. Group D: A control group (n = 20) receiving conventional physical therapy exercises only which is "Straight leg raise "SLR" exercise, Quadriceps setting exercise, Side Lying Hip Abduction, Side lying hip adduction, self stretching exs for Calf, Hamstring, Quadriceps muscles"
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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. | 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) |
| pain threshold | 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. | 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). |
| knee function | 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. | 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). |
| Q angle | 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. | 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) |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORmohamed is mohamed, PHD
doctoral degree in cairo uneversity
Outcome results
None listed