Effects of Mulligan Technique With or Without Diclofenac Phonophoresis on Patellofemoral Pain Syndrome.

University of Lahore

Status and phase: Completed; Phase 2; Phase 1

Conditions: Patellofemoral Pain Syndrome

Treatments: Combination Product: Group 1; Combination Product: Group 2

Study type: Interventional

Funder types: Other

Identifiers

NCT06439251

REC-UOL-546-10-2023

Details and patient eligibility

About

The patellofemoral pain syndrome (PFPS) is a common cause for "anterior knee pain" and mainly affects young women. the effectiveness of Mulligan technique with or without diclofenac phonophoresis on pain, range of motion and functional disability of knee joint in patients with patellofemoral pain syndrome is known little. This study, ethically approved, focused on patients with anterior knee pain referred to the Physical Therapy Department from Lahore General Hospital. After eligibility assessments and consent, participants were randomly assigned to Group A (Experimental) or Group B (Control). Over four weeks, three sessions per week, routine physiotherapy and specific exercises will be administered, with Group A receiving additional Phonophoresis using ultrasound and diclofenac gel. Outcome variables (Numeric Pain Rating Scale, KOOS-PF, Universal Goniometer) will be assessed by a blinded assessor at baseline and study completion.

Full description

Background: The patellofemoral pain syndrome (PFPS) is a common cause for "anterior knee pain" and mainly affects young women without any structural changes such as increased Q-angle or significant pathological changes in articular cartilage.

Objective: To evaluate the effectiveness of Mulligan technique with or without diclofenac phonopheresis on pain, range of motion and functional disability of knee joint in patients with patellofemoral pain syndrome.

Methodology: This study, ethically approved, focused on patients with anterior knee pain referred to the Physical Therapy Department from Lahore General Hospital. After eligibility assessments and consent, participants were randomly assigned to Group A (Experimental) or Group B (Control). Over four weeks, three sessions per week, routine physiotherapy and specific exercises were administered, with Group A receiving additional Phonophoresis using ultrasound and diclofenac gel. Outcome variables (Numeric Pain Rating Scale, KOOS-PF, Universal Goniometer) were assessed by a blinded assessor at baseline and study completion.

Enrollment: 68 patients

Sex: All

Ages: 20 to 45 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• • Patients of age range 20-45 years and both genders (Rehman, 2021 #171)

  • Unilateral anterior knee pain persisting for over two months, referred by orthopedic (Rehman, 2021 #171)
  • Pain scoring rate on numeric pain rating scale (NPRS) >3 during at least two activities (Rehman, 2021 #171)
  • Patients with positive Clarke's test/ Patellar grind test (Rehman, 2021 #171)
  • Pain while going up and down stairs, when sitting with knees flexed and with squatting, kneeling or returning from squat. (Powers, 2017 #172)

Exclusion criteria

• • Patients with other knee pathologies; meniscus tears, bursitis, patellar tendon injury, ligamentous injury

  • Degenerative joint disorders; knee osteoarthritis, rheumatoid arthritis etc.
  • Patellofemoral dislocation and / or frequent subluxation.
  • Patients having undergone lower extremity surgery
  • Those taking any pain medications

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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68 participants in 2 patient groups

Diclofenac Phonophoresis

Experimental group

Description:

The participants randomly allocated in Group A were receive the Phonophoresis (Ultrasound with Diclofenac gel for 5 minutes and intensities 1 MHz and 1.5 W/cm² pulsed waves was used in the therapy sessions on affected knee with diclofenac gel on ultrasound head) as experimental technique

Treatment:

Combination Product: Group 1

Mulligan Technique

Active Comparator group

Description:

The treatment involved routine physiotherapy with TENS at 80 Hz and a pulse duration of 50-100 μs, followed by a 15-minute hot pack. It also included stretching exercises for the hamstring and calf muscles, isometric strengthening of the quadriceps and VMO, straight leg raises with traction, and tibial gliding techniques. The MWM technique consisted of SLR with traction, repeated 10 times with 3 sets and a 1-minute interval in between.

Treatment:

Combination Product: Group 2