Effect of Adding Inguinal Ligament Mobilization to Talonavicular Joint Mobilization on Patellofemoral Pain Syndrome

Overview

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 .

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.