Patellofemoral Pain Syndrome is a prevalent condition characterized by anterior knee pain, often exacerbated by activities such as squatting, running, and stair climbing. This condition is frequently associated with improper patellar tracking, particularly lateral displacement, which can be influenced by various factors including muscular imbalances and tightness. The vastus lateralis muscle, part of the quadriceps group, is often implicated in contributing to lateral patellar tracking due to its attachment and alignment. Compressive myofascial release (CMFR) is a therapeutic technique aimed at reducing muscle tightness and restoring optimal muscle function. This study will explore the effects compressive myofascial release on the vastus lateralis in improving patellar tracking in patients diagnosed with Patellofemoral Pain Syndrome.The methodology of this study involves a randomized controlled trial with a sample of patients diagnosed with Patellofemoral Pain Syndrome. Non-probability convenience sampling technique will be used and participants will be recruited in groups after randomization. Participants(n=26) will be divided into two groups: the intervention group (n=13) receiving compressive myofascial release on the vastus lateralis, and a control group receiving(n=13) a routine treatment. The intervention will be administered over a period of four weeks, with sessions occurring three times weekly. Patellar tracking will be assessed using q-angle analysis both pre- and post-intervention. Additionally, subjective measures of pain and functional ability will be evaluated using the Numeric pain rating scale (NPRS) and the Kujala Patellofemoral Score. Data analysis will focus on comparing the changes in lateral patellar displacement and patient-reported outcomes between the two groups to determine the efficacy of compressive myofascial release in correcting lateral patellar tracking and alleviating symptoms of Patellofemoral Pain Syndrome. SPSS version 25 will be used for data analysis
Age group between 20 to 40 years
Male and female gender
Diagnosed cases of Patellofemoral syndrome
Participants with positive J sign and Clarke's test
History of knee surgery in the past year.
Any contraindications to myofascial release therapy, such as active infections, open wounds.
Presence of hip pathology or other knee conditions such as ligament tears, meniscal injuries, Osgood-Schlatter or Sinding-Larsen-Johanssen syndrome or jumpers knee
Participants with a history of trauma or repetitive episodes of patellar subluxation or dislocation
Parallel
baseline physical therapy treatment
Other interventionGroup A focuses on pain relief, muscle relaxation, and strengthening. Hot packs and TENS are applied to the lateral thigh and knee for 20 minutes to reduce pain and muscle tension. Hip strengthening exercises include side-lying hip abduction, clam-shells, prone hip extension, bridging, and lunges. Quadriceps exercises involve straight leg raises, prone terminal knee extension, and mini-squats. Each exercise is done in 2-3 sets of 10-15 repetitions, holding stretches for 5 seconds.
Compressive myofascial release of vastus lateralis.
Other interventionThe experimental group receives an additional session of Compressive Myofascial Release (CMFR) for the Vastus Lateralis to address lateral patellar tracking in PFPS patients. The patient lies on their side, and the therapist identifies tight areas, applying firm pressure for 20-30 seconds. Deeper pressure is held for 30-60 seconds, followed by 1-2 minutes of cross-fiber friction. The session includes muscle shaking for 30 seconds and stretching the Vastus Lateralis by extending the hip and flexing the knee for 30-60 seconds, repeated 2-3 times. Patient response is documented for progress tracking.
Numerical Pain Rating Scale (NPRS)
It is a standardized self-report device consisting of a horizontal line used to estimate the subjective level of pain intensity. It is a 10 points numerical scale, corresponding to the degree of pain.
Q angle
Quadriceps angle (Q-angle) has been used as a diagnostic measurement to assess factors which appear to increase the risk of the development of acute and/or chronic patellofemoral injury and pain in bipedal individuals. The Q-angle is the angle between the line of pull of the quadriceps (anterior superior iliac spine to mid-patella) and a line connecting the center of patella with tibial tuberosity. Normal Q-angle for males is 10-13 degrees and 15-17 degrees for females.
Goniometry
A goniometer is the most common instrument used to measure range of motion. If a patient has altered range of motion in a particular joint, the therapist can use a goniometer to assess what the range of motion is at the initial assessment, and then make sure the intervention is working by using the goniometer in subsequent sessions to assess the effectiveness of the intervention. Goniometric measurements should be performed with functional AROM and PROM. The typical documentation for the knee motion is: 10-0-135 degrees beginning with hyperextension, moving through neutral 0 and into flexion.
Kujala score
The "Kujala Score" is the eponymous name for the Anterior Knee Pain Scale (AKPS). It is a patient-reported outcome survey and diagnostic tool that aims to assess the severity of symptoms and physical limitations in patients with patellofemoral pain syndrome (PFPS). It was initially derived due to the diagnostic inconsistency among other tools that were used with PFPS patients. The Kujala Patellofemoral Scale is a valid and reliable questionnaire to evaluate functioning in patients with PFPS. The scores range from a maximum of 100 to a minimum of 0, with lower scores indicating greater pain and disability.
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