Comparing the Effects of Positional Release Technique Versus Myofascial Release Technique of Gluteus Medius

Study Overview
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Brief Summary
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Patellofemoral pain syndrome is a condition of misleading diagnosis. It mostly affects individuals with ages between 18-40 years. It is believed that much work has been done on the joint itself in treating the Quadriceps muscles and triggers related to it but now literature is focusing on the segmental involvement, where weakness of the hip abductors and lateral rotators play a major role. Therefore, interventions used for treating this syndrome should include on focusing the hip muscles for trigger point therapy as well as strengthening them in increasing the stability of the hip and pelvis to reduce excessive valgus forces on the knee.

Detailed Description
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Literature regarding Gluteus Medius trigger point is quite scarce especially in alleviating the pain related to Patellofemoral Pain Syndrome. The management of Patellofemoral Pain Syndrome includes a segmental treatment, giving special focus to the lateral rotators and abductors of the hip especially Gluteus Medius muscle, rather than treating the Patellofemoral Joint itself. It will help in improving the pain of the subjects suffering from this syndrome effectively, and within a shorter duration of time. It will also provide the practicing physiotherapist with an insight for treating such patients with better outcomes. Myofascial Trigger Points of the Gluteus Medius are important contributing factors in the management of Patellofemoral Pain Syndrome which is identified in a single study as per author's knowledge. But the treatment used to release the trigger point of Gluteus Medius in managing this syndrome has not yet been explored. So, this study will compare two well-known treatments in comprehending which one of the two techniques have better effects on the population to be studied. Written consent will be taken from all the study participants. Simple randomization technique will be used through Randomization Main software and randomization sheet will be generated. 60 participants with patellofemoral pain syndrome having Gluteus Medius trigger point will be randomly allocated in two equal group.

Official Title
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Comparing the Effects of Positional Release Technique Versus Myofascial Release Technique of Gluteus Medius in the Management of Patellofemoral Pain Syndrome - A Randomized Control Trial

Conditions
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Patellofemoral Pain Syndrome

Intervention / Treatment
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* Other: Physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Anterior knee pain >1month and <3 month Pain in activities like ascending & descending stairs, running or sports activity & prolonged sitting Presence of Gluteus Medius trigger point in the affected limb Age group 18-40 years Both genders Exclusion Criteria: Dislocation of Patella Damaged cartilage and ligament of Knee Joint Soft tissue injury related to Knee Any knee or hip surgery Lumbar spine dysfunction Sacroiliac joint dysfunction Pelvic malalignment Flat foot Chondromalacia patellae Young onset Osteoarthritis

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental<br>Following physiotherapy will be given to the participants in this group for 6 weeks, 2 times a week: 1. Positional Release Technique 2. Ultrasound 3. Cold Packs 4. Hip Strengthening Exercises 5. Knee Strengthening exercises | Other: Physiotherapy<br>* Treatment will be given in 3 sessions per week for 6 weeks with home exercise program and participants will be provided with exercises sheets to remember the exercises. The selected outcome measure will be taken on baseline (initial visit) and 6th week (post intervention)<br>|
| Active Comparator: Comparator<br>Following physiotherapy will be given to the participants in this group for 6 weeks, 2 times a week: 1. Myofascial Release Technique 2. Ultrasound 3. Cold Packs 4. Hip Strengthening Exercises 5. Knee Strengthening exercises | Other: Physiotherapy<br>* Treatment will be given in 3 sessions per week for 6 weeks with home exercise program and participants will be provided with exercises sheets to remember the exercises. The selected outcome measure will be taken on baseline (initial visit) and 6th week (post intervention)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anterior Knee pain Scale | It is 13-item questionnaire with different categories relating various levels of individual's current knee function. Score ranges from 1 representing severe disability to 100 representing no disability. | Baseline and end of intervention (6th week) | 
| Visual Analog Scale | A subjective psychometric response scale used to measure discrete behavioral or physiological phenomena based on linear numerical gradient in measuring the intensity of pain. | Baseline and end of intervention (6th week) | 
| Pain Pressure Threshold | It is the amount of direct pressure required in eliciting a response in pain on a selected area obtained by an Algometer in kilograms (kg.) | Baseline and end of intervention (6th week) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle strength | In kilograms (kg.) obtained by Hand Held Dynamometer | Baseline and end of intervention (6th week) | 
| World Health Organization Quality of Life Questionnaire- Brief | An integrated instrument used to evaluate health related quality of life. It is a 26-item version of the WHOQOL-100 assessment. | Baseline and end of intervention (6th week) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anterior knee pain, Gluteus medius, trigger point therapy