This study compares two treatments - motor control retraining and close kinetic chain exercises - to improves the pain, VMO strength, knee function. Fifty participants out of which 4 dropped out; will be randomly assigned to receive either motor control retraining or close kinetic chain exercises training for 45 minutes per session, three times per week, for six weeks. Pain intensity will be measured using the visual analogue scale. Knee function will be measured using Kujala anterior knee pain scale. Vastus medialis oblique strength will be measured using digital dynamometer. Dynamic knee valgus will be measured using Kinovea-2D video analysis. Q-angle will be measured using manual goniometer. Patellar maltracking will be measured using combined assessment of dynamic knee valgus and q-angle. This study aims to determine which treatment produces greater improvements, which may help physiotherapists choose more effective treatments for patient with patellofemoral pain syndrome in Pakistan.
Background: Patellofemoral pain syndrome, another name for anterior knee discomfort, is brought on by a combination of abnormal patellar tracking, changed biomechanics, and muscle imbalances that put more strain on the patellofemoral joint during activities including jogging, squatting, and stair climbing. In general practice, patellofemoral pain contributes to 11-17% of all knee pain syndromes. Motor control retraining is a rehabilitation treatment that focus on activation and timing of VMO, controlled functional movements, dynamic integration while close kinetic chain exercises is also a rehabilitation treatment that focus on low and moderate load close kinetic chain exercises with advanced functional exercises that focuses on VMO activation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
50
What: A supervised exercise program consisting of motor control retraining exercises designed to improve neuromuscular control, movement coordination, muscle activation, and postural stability. The exercises are performed under supervision three times per week for 6 weeks. When: 45 minutes per session, 3 sessions per week, for 6 consecutive weeks (total 18 sessions). How much: Each exercise performed for 10-15 seconds, with 3×5 reps, with rest periods as needed. By whom: Licensed physiotherapist trained in motor control retraining exercises. Where: Outpatient rehabilitation department of MTH (Madinah Teaching Hospital), Faisalabad; Pro Health Rehab \& Medical Centre, Faisalabad; United Hospital, Faisalabad.
What: A supervised exercise program consisting of closed kinetic chain exercises designed to improve muscle strength, joint stability, neuromuscular control, and functional movement. The exercises are performed under supervision three times per week for 6 weeks. When: 45 minutes per session, 3 sessions per week, for 6 consecutive weeks (total 18 sessions). How much: Each exercise performed for 10-15 seconds, with 3×5 reps, with rest periods as needed. By whom: Licensed physiotherapist trained in close kinetic chain exercises. Where: Outpatient rehabilitation department of MTH (Madinah Teaching Hospital), Faisalabad; Pro Health Rehab \& Medical Centre, Faisalabad; United Hospital, Faisalabad.
Department of Rehabilitation Sciences, The University of Faisalabad
Faisalabad, Punjab Province, Pakistan
Pain Intensity
The visual analogue scale (VAS), a robust and trustworthy self-reported measure of pain, was used to gauge pain severity. The VAS is a 10-cm straight line, with "no pain" at one end and "worst pain" at the other. The participants were asked to mark the location that most accurately reflected the level of pain they were experiencing at the time. Greater pain severity was reflected by higher scores. With reported validity coefficients ranging from r = 0.71 to 0.78 and great reliability (ICC = 0.97), the visual analogue scale is a reliable and valid tool for measuring pain intensity.
Time frame: Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)
Knee Function
The kujala anterior knee pain scale (AKPS), a disease-specific questionnaire intended to assess symptoms and functional limitations associated with patellofemoral diseases, was used to measure knee function. Thirteen elements make up the scale, which evaluates pain, limping, swelling, stair climbing, squatting, jogging, jumping, extended sitting, and other functional tasks. Better knee function and less complaints are indicated by higher scores, which range from 0 to 100. A highly valid and reliable tool for assessing symptoms and functional limitations related to patellofemoral diseases is the Kujala Anterior Knee Pain Scale (AKPS). It exhibits great test-retest reliability, greater internal consistency (Cronbach's α = 0.83-0.91), and strong validity (r = 0.90-0.92).
Time frame: Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)
Vastus Medialis Oblique Strength
A hand-held dynamometer (Lafayette Instrument Model 01160) was used to evaluate the strength of the vastus medialis oblique (VMO) muscle. In standardized testing positions, participants executed maximal voluntary isometric contractions, and the force produced was measured. Stronger quadriceps and VMO muscles were indicated by higher values. A Hand-Held Dynamometer (HHD; Lafayette 01160) was used to measure the strength of the Vastus Medialis Oblique (VMO) muscle at 60° knee flexion. The HHD's application for assessing lower-extremity muscle strength is supported by its moderate to strong validity (r = 0.62-0.91) and acceptable to excellent reliability (ICC ≥ 0.70).
Time frame: Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)
Dynamic Knee Valgus
Kinovea 2D motion analysis software was used to measure dynamic knee valgus. Functional exercises like squatting, step-down chores, and single-leg movements were captured on video. Frontal-plane knee motion was measured and lower-limb alignment was examined using Kinovea software. Greater dynamic knee valgus was indicated by increased medial displacement of the knee during movement. For evaluating lower-extremity kinematics and dynamic movement patterns, such as Dynamic Knee Valgus, Kinovea 2D Motion Analysis Software has shown great concurrent validity and excellent reliability (ICC = 0.916)
Time frame: Baseline (week 0, before first intervention session) and post-intervention (week 6, within 48 hours after the final intervention session)
Q-Angle
The q-angle was measured using a universal manual goniometer. An imagined line was drawn from the ASIS to the patella center, and another line was drawn from the patella center to the tibial tuberosity in order to calculate the angle. Increased lateral patellar tracking and modified patellofemoral biomechanics are linked to higher Q-angle values. A viable and trustworthy tool for determining the Q-angle is the manual goniometer. Good validity, greater intra-rater reliability (ICC = 0.88), and moderate to high inter-rater reliability (ICC = 0.77-0.85) have all been shown.
Time frame: Baseline (week 0, before first intervention session) and post-intervention (week 6, within 48 hours after the final intervention session)
Patellar Maltracking
Dynamic knee valgus analysis and q-angle measurements were coupled to evaluate functional patellar maltracking. Instead of static anatomical malalignment, a normal Q-angle in the presence of severe dynamic knee valgus may suggest functional patellar maltracking because of changed lower-extremity movement patterns. This evaluation helped detect aberrant movement patterns causing anterior knee pain and shed light on the mechanics of the patellofemoral joint during functional activities A useful measure of lower-limb alignment during practical activities, functional patellar maltracking assessment using the combination of Normal Q-angle and High Frontal Plane Projection Angle (FPPA) has demonstrated acceptable to strong validity (r ≈ 0.64-0.78) and excellent reliability (ICC ≈ 0.88-0.89).
Time frame: Baseline (week 0, before first intervention session) and post-intervention (week 6, within 48 hours after the final intervention session)
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