Inclusion Criteria:  Patients diagnosed as II degree bilateral knee OA having active MTrP in vastus medialis and medial head of gastrocnemius muscles and over the calf muscle . The patients from both gender aged were ranged from 35 to 55 years.  Exclusion Criteria:  Reactive synovitis, corticosteroids or hyaluronic acid application during the last six months Not indicated and no history of knee joint arthroplastic surgery. Malignant tumors and chronic infection. Not diagnosed with cushing's syndrome.