Comparison of IASTM and Muscle Energy Technique in Patellofemoral Pain Syndrome.

The aim of this randomized controlled trial is to compare the effect of Instrument Assisted Soft Tissue Mobilization (IASTM) and muscle energy technique on iliotibial band tightness on pain, range of motion and functional mobility in patients with patellofemoral pain syndrome.

Patellofemoral pain syndrome (PFPS) is termed as anterior knee pain and is characterized by peripatellar or retro patellar pain as a result of changes in the physical and biochemical components of the patellofemoral joint due to increased load during activities such as running, squatting, going up and down stairs, cycling and jumping. Patellofemoral syndrome is one of the most common knee conditions seen by clinicians. In active individuals, it may account for 25% to 40% of all knee problems The iliotibial band is a lateral thickening of the fascia which attaches to the tensor fascia lata proximally. Most of the lateral retinaculum (superficial oblique and deep transverse portion) arises from the ITB, therefore the ITB indirectly provides lateral stabilisation and acts as a passive restraint to medial patella glide. A tight ITB could theoretically lead to lateral patella tracking, lateral patella tilt and lateral patella compression. Several authors have suggested that tightness in the iliotibial band may contribute to patellofemoral syndrome and knee pain by pulling the patella laterally, thereby causing abnormal tracking of the patella in the trochlear groove.

The Instrument-Assisted Soft Tissue Mobilization (IASTM) technique is the most frequent soft tissue mobilization techniques. It involves the use of a tool that causes mechanical micro-traumatic injury to the treated area. As a result, an inflammatory reaction is elicited, speeding up the healing process and restoring the flexibility and integrity of the tissue and cartilage healing. The therapeutic effects of this approach appear to include decreasing tissue adhesion, enhancing the number of fibroblasts, and stimulating collagen synthesis.

Muscle energy technique is a soft tissue technique designed to improve musculoskeletal function through stretching tight muscles and fascia, to reduce pain and improve circulation. MET is characterized by a patient-induced skeletal muscle contraction against physiotherapist resistance in a controlled direction and position. The pathological barrier of a muscle is located through joint positioning which is followed by active muscle contraction by the patient moving away from the resistance followed by relaxation of the muscle. A new pathological barrier is located through passive movement and the process is repeated.

The rationale for the use of these techniques is to compare the effects of IASTM and MET of iliotibial band tightness in improving pain, range of motion and functional mobility in patients with patellofemoral pain syndrome.

Eligibility Criteria:
Inclusion Criteria:

* • Age between 18 and 35 years

  * Both Genders.
  * Anterior or retro patellar knee pain for at least the past 3 months.
  * Knee pain during at least 3 of the following activities: ascending/descending stairs, squatting, hopping/ running, and prolonged sitting.
  * Retro patellar pain in patellar grind test (positive clarke's sign).
  * A score of at least 3 on the visual analog scale (VAS).
  * Positive Ober's test.

Exclusion Criteria:

* • Any meniscal or ligament tears of knee.

  * Knee osteoarthritis.
  * Any previous surgery of lower limb.
  * Patellar fracture or fracture of lower extremity.
  * Having received knee injections of corticosteroids or hyaluronic acid.
  * Osteoporosis of knee joint.