The goal of this clinical trial is to determine whether gastrocnemius myofascial release is effective in reducing pain and improving physical function in females with knee osteoarthritis. The main question this study aims to answer are: * Does adding gastrocnemius MFR to conventional physical therapy treatment influence pain, physical function, foot posture, and knee disability compared to conventional physical therapy treatment and sham MFR in knee osteoarthritis? * Participants receive gastrocnemius myofascial release treatment or sham gastrocnemius myofascial release treatment for 3 times weekly for 4 weeks for both groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
Gastrocnemius MFR Procedures : * Technique 1: With the elbow flexed to 90◦ and take up a contact in the Tendo Achilles. Establish a line of tension in a superior direction. * Technique 2: with the index and middle fingers of each hand to take up a contact on the tendons of the GM at the epicondyles of the femur. Establish a line of tension in an inferior direction. * Technique 3: With the index, middle and ring fingers of each hand to get into the medial and lateral aspects of the calcaneus . The release begins proximally. * (5 minutes× 1 repetition) for the three technique * Gastrocnemius TrP pressure release is repeated for 90 seconds (usually 3 repetitions). * Anterior glide \& Posterior glide (grade IV) * Riding a stationary bike for 5 minutes * Quadriceps set exercise * Terminal knee extension * Step-up exercises for 30 seconds * Lateral Step-up for 30 seconds. * Self-stretching of Hamstring, Rectus femoris ,and Calf muscles. * TENS for 20 minutes
Patient position: Prone, with feet off the end of the table to allow for adequate dorsiflexion. Therapist's position:, facing toward the feet while standing at the patient's side, at around mid-thigh level for techniques. Technique: one hand is positioned at the attachments of the GM at the epicondyles of the femur, and the other at the Achilles tendon without applying significant pressure or tissue deformation. Mimic the hand movements of real myofascial release (e.g., slow stroking, superficial gliding) but avoid: Deep pressure, Skin stretch, and Muscle compression. * Anterior glide \& Posterior glide (grade IV) * Riding a stationary bike for 5 minutes * Quadriceps set exercise * Terminal knee extension * Step-up exercises for 30 seconds * Lateral Step-up for 30 seconds. * Self-stretching of Hamstring, Rectus femoris ,and Calf muscles. * TENS for 20 minutes
Faculty of Physical Therapy, Cairo University
Giza, Giza Governorate, Egypt
RECRUITINGPain during rest and single leg squat (Visual analogue scale)
Participants are instructed to draw a vertical mark on the line indicating their pain level during rest and single leg squat -single leg squat: The Participants stand on the limb being evaluated, with the other leg lifted off the ground so that the hip is flexed to approximately 45 degrees and the knee to approximately 90 degrees. The Participants' shoulders is forward flexed to 90 degrees with the elbows in full extension and the hands clasp together in front. The Participants are forward flexed to squat down until feeling pain and discomfort and return to the start position.
Time frame: pain is measured at baseline at the first session and reassessed at the end of the second week, and at the end of four weeks.
Physical function (40 m fast-paced walk test )
\- 40MFPW : The participants walk as quickly and safely as possible on a 10-m walkway, turn around a cone placed 2 m beyond each end of the walkway, and return for a total distance of 40 m.
Time frame: Physical function is measured at baseline at the first session and reassessed at the end of the second week, and at the end of four weeks.
Physical function (the 30-s chair-stand test)
\- 30sCST : The participants stand up completely from a sitting position from an unarmed and straight-backed chair ; and then completely back down until they are completely on the seat. The maximum number of chair-stand repetitions completed in 30 seconds is recorded.
Time frame: Physical function is measured at baseline at the first session and reassessed at the end of the second week, and at the end of four weeks.
Physical function (a stair-climb test )
\- 9-s SCT: The participants ascend and descend nine stairs as quickly as possible but in a safe manner. The time for the participants to complete the ascending and descending tasks is recorded.
Time frame: Physical function is measured at baseline at the first session and reassessed at the end of the second week, and at the end of four weeks.
Foot posture (foot posture index 6)
FPI-6 is considered a quick, easy, inexpensive, and multi-segmental clinical quantification tool, which can assess the posture of the foot. FPI-6 score consisted of six items: (1) Talar head palpation, (2) curves above and below the lateral malleolus, (3) Talonavicular joint bulging (4) Calcaneal frontal plane position, (5) Medial longitudinal arch height and congruence (6) Forefoot abduction or adduction. the participant are in a standing, relaxed stance position, arms by the side, and looking straight ahead. Then, take several steps in place before settling into a comfortable stance position. The assessor needs to be able to move around the patient during the assessment and to have uninterrupted access to the posterior aspect of the leg and foot. Approximately two minutes for the assessment to be conducted. the total score ranging from -12 to +12. * Pronated postures are given a positive value * Supinated features are given a negative value * neutral foot score around zero
Time frame: Foot posture is measured at baseline at the first session and reassessed at the end of the second week, and at the end of four weeks.
Knee Disability (Arabic version of Algofunctional index of lequense)
The Lequesne Algofunctional Index is a 10-question interview format questionnaire that was designed as a single unit. These 10 parameters are divided into three sections to assess 'pain or discomfort' (L1), 'maximum distance walked' (L2), and 'activities of daily living' (L3). The Lequesne index directly aggregates symptoms and function, which results in a single global index score ranging from 0 (no pain, no disability) to 24 (maximum pain, stiffness, and disability).
Time frame: Knee Disability is measured at baseline at the first session and reassessed at the end of the second week, and at the end of four weeks.
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