Effects of Core Stability Exercises in Patients With Patellofemoral Pain Syndrome

Study Overview
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Brief Summary
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The purpose of the study is to compare the effects of routine physical therapy with and without core stability exercises on pain and range of motion, in patients with patellofemoral pain syndrome. The spine, abdominal region, pelvis, hips, and proximal lower extremities, are defined as the core of the body. The effects of core muscle strengthening have been proven as an effective method of management in various cases. The knee is the frequently injured joint in core instability with the decreased hip strength. Deficiency in the control of the neuromuscular system of the body's trunk or core may affect the stability of the lower extremity, which can lead to injury in the tibiofemoral or patellofemoral joints.

Detailed Description
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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. Patellofemoral pain syndrome (PFPS) is the most common overuse syndrome in athletes. Patellofemoral pain is more common among female athletes especially adolescents and young adults. Symptoms include: persistent pain behind the patella or peripatellar. Pain increases on ascending and descending stairs and squatting and prolonged sitting. Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal disorder typically occurring in physically active people aged 40 years and younger, causing pain, functional deficits and lower limb weakness. Traditional treatment has been aimed at strengthening the knee, however recent research suggests the muscles around the hip also play an important role in the development and continuity of Patellofemoral Pain Syndrome. Patellofemoral pain (PFP) is pain in the peripatellar/retropatellar region that aggravates with physical activities such as squatting, stair climbing, running and jumping or sitting for prolonged periods of time. It is the most common source of anterior knee ailment in active adolescents and young adults and is much more prevalent in women than men. Patellofemoral pain (PFP) is a very common problem in athletes who participate in jumping sports. Several risk factors may play a part in the pathogenesis of PFP. Overuse, trauma and intrinsic risk factors are particularly important among athletes. Physical examination has a key role in PFP diagnosis. common risk factors should be investigated, such as hip muscle dysfunction, poor core muscle endurance, muscular tightness, excessive foot pronation and patellar malalignment. Studies conducted on core muscle strengthening exercises program for the management of pain in hip, quadriceps region and ankle joint but limited studies were conducted in patient with patellofemoral pain syndrome. There is a need to compare the effectiveness of routine physiotherapy with and without core stability exercises in patient with patellofemoral pain syndrome. This study is intended to determine the effectiveness of core muscle strengthening exercises for the management of patellofemoral pain syndrome. The spine, abdominal region, pelvis, hips, and proximal lower extremities, are defined as the core of the body. The effects of core muscle strengthening have been proven as an effective method of management in various cases. The knee is the frequently injured joint in core instability with the decreased hip strength. Deficiency in the control of the neuromuscular system of the body's trunk or core may affect the stability of the lower extremity, which can lead to injury in the tibiofemoral or patellofemoral joints.

Official Title
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Effects of Routine Physical Therapy With and Without Core Stability Exercises in Patients With Patellofemoral Pain Syndrome -a Randomized Controlled Trial

Conditions
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Patellofemoral Pain Syndrome

Intervention / Treatment
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* Other: Core stability exercises
* Other: Conventional Physical Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Age between 18-40 Years Both Gender Patient with Anterior knee pain for at least 4 weeks Exclusion Criteria: • History of trauma ,fracture of spine and lower extremity History of any congenital deformity History of lumbar radiculopathy History of hip osteoarthritis History of rheumatoid arthritis History of Any surgical procedure involving lumber or lower extremity

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Active group<br>Conventional Physical therapy | Other: Conventional Physical Therapy<br>* Moist heating pads will be applied on knee joint for 10 minutes before each treatment session. Apply TENS on knee joint for 10 minutes treatment session. Knee Isometric exercise perform.<br>|
| Experimental: Experimental group<br>Conventional Physical therapy with Core stability | Other: Core stability exercises<br>* Moist heating pads will be applied on knee joint for 10 minutes before each treatment session. Apply TENS on knee joint for 10 minutes treatment session. Knee Isometric exercises will be performed along with core stability exercises..<br>* Other names: Conventional Physical Therapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain (Visual Analogue Scale) | The visual analogue scale is a simple and commonly used way for the assessment of variations in intensity of pain. In clinical practice the ratio of pain relief, evaluated by VAS, is frequently considered as a measure of the efficacy of treatment. VAS range is 0-10. It's a categorical scale with 0-4 mild pain, 4-7 moderate or distressing pain while 7-10 unbearable pain30. In this study inclusion criteria will be categorically 0-7 score, mild & moderate pain intensity on VAS. Use is scale for intensity of pain. Total eight treatment sessions will be given to each patient, and pre-treatment assessment will be done on very first day. Second assessment will be done on fourth treatment session, and final assessment will be on eighth treatment session. | 6 weeks | 
| Range of Motion (Goniometer) | A goniometer is a device used in physical therapy to measure a joint's range of motion (ROM). There are two arms-one that is stationary and one that is movable-that are hinged together. In order to assess the range of knee joint, goniometer will be used. Stationary arm will be placed on lateral epicondyle of the femur, movement arm along the fibula to lateral malleolus. Total eight treatment sessions will be given to each patient, and pre-treatment assessment will be done on very first day. Second assessment will be done on fourth treatment session, and final assessment will be on eighth treatment session. | 6 weeks | 
| Lower extremity functional scale (LEFS) | The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person's ability to perform everyday tasks. The LEFS can be used by clinicians as a measure of patients' initial function, ongoing progress and outcome, as well as to set functional goals. The resultant AKPS is a 13-item self-report questionnaire that evaluates subjective responses to specific activities and symptoms that are thought to correlate with anterior knee pain syndrome. The AKPS is scored from a minimum score of 0 to a maximum score of 100 points. This scale used for function of lower limb. Total eight treatment sessions will be given to each patient, and pre-treatment assessment will be done on very first day. Second assessment will be done on fourth treatment session, and final assessment will be on eighth treatment session. | 6 weeks | 
| Anterior knee pain scale (AKPS) | The resultant AKPS is a 13-item self-report questionnaire that evaluates subjective responses to specific activities and symptoms that are thought to correlate with anterior knee pain syndrome. The AKPS is scored from a minimum score of 0 to a maximum score of 100 points. This scale used for daily living performance status Total eight treatment sessions will be given to each patient, and pre-treatment assessment will be done on very first day. Second assessment will be done on fourth treatment session, and final assessment will be on eighth treatment session. | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Patellofemoral Pain Syndrome, Core stability