Efficacy of Neuromuscular Training and Manual Therapy With Augmented Low-Dye Taping Technique for Correction of Pronated Foot in the Management of Anterior Knee Pain

The goal of this clinical trial\] is to To find out the effect of Neuromuscular Training and Manual therapy with Augmented Low - Dye Taping technique for correction of Pronated foot in the management of Anterior knee pain patients. The main question\[s\] it aims to answer are:

* Is there any Kinematic association of biomechanical risk factors between anterior knee pain \& pronated foot?
* Is there any potential impact of therapeutic foot interventions for correction of Pronated foot in the management of anterior knee pain?

Patellofemoral pain syndrome (PFPS) is one of the most prevalent musculoskeletal injuries seen by physiotherapists and sport medicine practitioners. The PFPS occurs in 17% of male and 33% of female knee pathology. The pain is usually aggravated by activities involving patellofemoral compressive forces such as remaining in the sitting position with the knees flexed for long periods of time (movie goers sign). Patellofemoral pain syndrome (PFPS) is an important clinical problem and the most prevalent disorder of the knee.

The etiology of PFPS is not fully understood and may consist of multiple factors including lower leg and foot malalignment. Patella femoral pain syndrome (PFPS) may arise from abnormal muscular and biomechanical factors that alter tracking of the patella within the femoral trochlear notch contributing to increased patellofemoral contact pressures that result in pain and dysfunction.

Excessive foot pronation during gait is frequently linked to patellofemoral pain syndrome (PFPS) development, due a proposed coupling of increased foot pronation with increased tibial and femoral internal rotation. This excessive pronation can result in increased soft tissue stress and changes in overall lower limb alignment, often predisposing the individual in question to injury of the lower extremity. Excessive rear foot pronation therefore may lead to abnormal tibia internal rotation which could possibly translate to greater stress on the knee structure, altering patella tracking. Excessive pronation of the subtalar joint particularly is thought to lead to patellofemoral disorders. The excessive subtalar joint pronation may delay external rotation of the leg, and therefore will inhibit supination of the foot. Physiotherapy consisted of a combined therapy approach that has proved efficacious in patellofemoral pain syndrome. Physical therapy is the mainstay in non-operative treatment.

Joint proprioceptors have historically been considered "limit detectors", stimulated at the extremes of joint range-of-motion (ROM). Joint proprioceptors provide input throughout a joint's entire ROM under both low and high load conditions stimulating strong discharges from the muscle spindle and are thus vital for joint stability.

The augmented low-Dye (ALD) is a taping technique frequently used by clinicians in the management of lower limb musculoskeletal pain and injury. A recent review of the literature concluded that ALD tape produces a biomechanical effect, specifically by increasing medial longitudinal arch height, reducing calcaneal eversion and tibial internal rotation, reducing medial forefoot pressures and increasing lateral midfoot pressures during standing, walking and jogging. The LD taping technique aims to reduce excessive pronation by creating an external supinating force medial to the subtalar joint axis, namely at the medial plantar surface of the foot.

Patients with plantar heel pain treated with the manual therapy demonstrated complete pain relief and full return to activities. Manual therapy helps in bringing back the malalignment of the foot and correcting foot problems which intern reduces the heel pain.

The Aim of the study is to find out the effect of Neuromuscular Training and Manual therapy with Augmented Low - Dye Taping technique for correction of Pronated foot in the management of Anterior knee pain. The previously available studies are mainly limited to foot orthoses \& focused on the knee joint interventions. There is a lack of research related to therapeutic interventions for the foot, an intrinsic risk factor, can address the fundamental component of anterior knee pain.

The Novelty of Study is to the find out potential impact of therapeutic foot interventions for correction of Pronated foot in the management of anterior knee pain.

The Objectives of the study is followed below

* To find out the association of biomechanical risk factors between Anterior knee pain \& pronated foot.
* To find out the effect of Manual therapy with Augmented Low- Dye taping technique on the selective outcome parameters.
* To find out the effect of Neuromuscular Training with Augmented Low- Dye taping technique on the selective outcome parameters.
* To compare the effect of Manual therapy and Neuromuscular Training with Augmented Low- Dye taping technique on the selective outcome parameters.

Null Hypothesis:

• There is no significant improvement in the pain and functional Limitations, following Manual therapy \& Neuro muscular training with Augmented Low - Dye Taping technique for correction of Pronated foot in the management of Anterior knee pain.

Alternative Hypothesis:

• There is a significant improvement in the pain and functional Limitations, following Manual therapy \& Neuro muscular training with Augmented Low - Dye Taping technique for correction of Pronated foot in the management of Anterior knee pain.

Eligibility Criteria:
Inclusion Criteria:

* Age - 18 to 35 years
* Sex - both males \& females
* Clinically diagnosed patient of PFPS with Pronated foot
* Anterior or posterior pain in the knee area lasting for more than 12 weeks
* Excessive calcaneal eversion measured at 6° in the relaxed posture
* Score of between three and seven points on the numerical pain rating in activities of daily living Kujala Scale Point 40 \& Above

Exclusion Criteria:

* A history of diagnosis of meniscus or joint injury \& knee joint surgery
* Taking nonsteroidal anti-inflammatory drugs or corticosteroids within 24 hrs before the test
* History of brain injury or vestibular disorder within the last 6 months
* Positive sign of Patellar Apprehension test
* Congenital or traumatic deformity
* Allergic reactions to taping
* Concomitant diagnosis of pre patellar bursitis or tendonitis
* knee Ligamentous injury or laxity
* Plica syndrome \& Osgood Schlatter's disease
* Malignancy \& Skin Infection
* Pregnant woman or lactating women.