Compressive Myofascial Release of the Vastus Lateralis on Lateral Patellar Tracking in Patellofemoral Pain Syndrome

Official title

Effects of Compressive Myofascial Release of the Vastus Lateralis on Lateral Patellar Tracking in Patients With Patellofemoral Pain Syndrome

Overview

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

Detailed description

Patellofemoral pain syndrome (PFPS) is one of the most common health-related complaints in today's societies. PFPS refers to a syndrome that comprises of the following signs and symptoms: anterior knee pain, inflammation, imbalance and instability. About 50% of the non-specific knee pain is diagnosed as PFPS. PFPS frequently becomes chronic, and patients cannot do physical activity. Individuals with PFPS typically report pain that is either located in the peri-patellar or retro-patellar region during active movements involving knee movement.

Myofascial pain syndrome (MPS) has been attributed as the main cause and primary source of musculoskeletal pain in 30-85% of the patients attending physical therapy clinics. Myofascial pain syndrome often presents in the forms of pain, muscle spasm or TrP. TrP has been described as a hyperirritability spot located in a taut band of muscle; or a small pea or rope-like nodular or crepitant (crackling, grating) area within the muscle, which is painful to palpation or compression and refers pain, tenderness, or an autonomic response to a remote area. It is stated that "jump response" is elicited when pressure is applied to a Trp. TrP may result from mechanical overload, trauma, overuse, postural faults, or psychological stress. Based on their primary functions, muscles are categorized as "phasic" or "postural" muscles. In response to dysfunction or overuse, the phasic muscles tend to be inhibited or weakened; while the postural muscles tend to develop higher tone and ultimately shorten. A muscle imbalance between the dynamic and postural muscles may lead to MTP in the musculoskeletal system.

Interventions

• Other baseline physical therapy treatment
  Group 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.
• Other Compressive myofascial release of vastus lateralis.
  The 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 flexi

Primary outcome measures

• Numerical Pain Rating Scale (NPRS) [Time frame: 4 weeks]
• Q angle [Time frame: 4 weeks]
• Goniometry [Time frame: 4 weeks]
• Kujala score [Time frame: 4 weeks]

Eligibility criteria

Inclusion criteria

• 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
• Pain provoked during knee loading physical activity, such as jumping, running, squatting, or going up or down stairs in last 3 months
• Presence of excessive lateral patellar tracking on axial view radiographs

Exclusion criteria

• 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
• Use of intra-articular corticosteroid injections
• Presence of auto-immune disorder (spondylolisthesis, spondylitis, Rheumatoid arthritis etc.) other than knee OA or systemic conditions such as severe cardiovascular disease

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Social Security Hospital — Lahore

Publications

• Torrente QM, Killingback A, Robertson C, Adds PJ. The Effect of Self-Myofascial Release on the Pennation Angle of the Vastus Medialis Oblique and the Vastus Lateralis in Athletic Male Individuals: An Ultrasound Investigation. Int J Sports Phys Ther. 2022 Jun 1;17(4):636-642. doi: 10.26603/001c.35591. eCollection 2022. PMID 35693863
• Stanek J, Sullivan T, Davis S. Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion. J Athl Train. 2018 Feb;53(2):160-167. doi: 10.4085/1062-6050-386-16. Epub 2018 Jan 26. PMID 29373060
• Zago J, Amatuzzi F, Rondinel T, Matheus JP. Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Sport Rehabil. 2020 Dec 17;30(4):609-618. doi: 10.1123/jsr.2020-0108. PMID 33333491
• Halabchi F, Abolhasani M, Mirshahi M, Alizadeh Z. Patellofemoral pain in athletes: clinical perspectives. Open Access J Sports Med. 2017 Oct 9;8:189-203. doi: 10.2147/OAJSM.S127359. eCollection 2017. PMID 29070955
• Schoots EJ, Tak IJ, Veenstra BJ, Krebbers YM, Bax JG. Ultrasound characteristics of the lateral retinaculum in 10 patients with patellofemoral pain syndrome compared to healthy controls. J Bodyw Mov Ther. 2013 Oct;17(4):523-9. doi: 10.1016/j.jbmt.2013.03.005. Epub 2013 Apr 26. PMID 24139014

Identifiers

NCT: NCT06875804 · REC/RCR & AHS/24/0149

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗