Adjunctive Effects of Heat vs Contrast Therapy With Otago Exercises on Patellofemoral Pain Syndrome

Inclusion Criteria: Participants having age group between 18 and 40 years with anterior, retropatellar, or peripatellar pain with at least severity of 3/10 on the numerical pain rating scale. Participants who have reported anterior knee pain for at least three months during at least two of the following activities: seating for prolonged periods of time; ascending and descending stairs; squatting; running and jumping, or have had experienced crepitus (popping, or crackling) while walking or running, pain on palpation, insidious pain lasting at least two months. Positive patellar compression and Grind tests. Clinical evidence of lateral patellar tracking, given its established role in patellofemoral joint dysfunction. Pain produced by at least two of the following four tests: (i) isometric muscle contraction with a mild bent knee, (ii) patellofemoral joint line palpation, (iii) compression of patella against the femur and (iv) active resisted knee extension were enrolled in the study. Exclusion Criteria: Pain lasting less than three months, previous knee operations, meniscal lesions, patellar instability (subluxation/dislocation), clinical evidence of tendinopathy or ligamentous injury, fractures or dislocations involving the pelvis, spinal surgical history, osteoporosis, pregnancy, neurological diseases or radiological findings of chondromalacia beyond grade 2 on MRI, ultrasound, or X-ray. Recent participation in lower-limb rehabilitation or structured training within six weeks, or prior diagnoses of rheumatoid arthritis, gout, or other rheumatic knee disorders. Use of NSAIDs in the preceding four weeks, prior history of cancer, infection, psychiatric conditions, cognitive impairment, autoimmune pathology, or neurological dysfunction likely to interfere with walking ability.