Comparison of Open and Closed Chain Exercises in Athletes With Patellofemoral Pain Syndrome

Study Overview
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Brief Summary
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Patellofemoral pain syndrome (PFPS) is a common source of knee pain in the physically active population, predominantly in women. The incidence rate of PFPS among athletes is 25 percent, which is higher than that of general population. PFPS is caused by repetitive stress and aggravated in athletes by cycling and running. These symptoms are caused by structural or biomechanical changes of the joint, which becomes exacerbated by activities such as going up and down stairs, sit for a prolonged period, squatting or kneeling, resulting in increased compressive forces in the joint patellofemoral. It is characterized by defused pain in front of knee. Other signs also present are the patellar crepitus, swelling, and joint blockage despite being deemed a multifactorial condition with no single cure, PFPS is commonly attributed to muscular dysfunction, for which conservative rehabilitation is the treatment of choice. Historically, PFPS has been linked to impairments of the quadriceps muscle.

Detailed Description
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This study will be a randomized clinical trial will be conducted in Pakistan sports board Lahore, Model town Sports Club Lahore and Sheikh Zaid Hospital, Lahore. Sample size will be taken to evaluate the effects of open chain exercise and closed chain exercise among athletes with an age group of 18 - 40 years. Non probability convenient sampling technique would be used. Players having an experience of at least 8 months would be a part of study experiencing recurrent knee pain. Participants will be randomly assigned to 2 groups. Group A will include participants who will receive open kinetic chain exercises 3sets of 10 repetitions for each exercise along with the general training. Group B will include the participants who will receive closed kinetic chain exercises 3sets of 10 repetitions for each exercise along with general training.3sessions per week will be given for 6weeks.The subjects will be assessed for pain, function and balance at baseline and after 6weeks of treatment. After collecting data from defined settingit will be entered and analyzed using statistical package for social sciences (SPSS) for Windows software, version 25.

Official Title
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Comparison of Open and Closed Chain Exercises on Pain Function and Balance in Athletes With Patellofemoral Pain Syndrome

Conditions
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Patellofemoral Pain Syndrome

Intervention / Treatment
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* Other: Open kinetic chain exercises
* Other: Closed kinetic chain exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult athletes with age 18 to 30 years Anterior Knee pain An insidious onset of symptoms not related to trauma. Pain with compression of patella. Pain on palpation of patellar facets. Experienced players (who are in practice from last 8 months or a year). Exclusion Criteria: Symptoms present less than 1 month. Intra-articular knee pathologies like O.A, R.A etc History of knee surgery within last year. History of traumatic injuries like patellar dislocations or subluxation Any other lower extremity injuries.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 30 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: Open chain kinetic exercises<br>In open chain exercises extremities are free to move and there is no weight bearing. Subjects performed group of exercises, 3sets of 10 repetitions for each exercise after warm-up and stretching exercises The open kinetic chain exercise program consisted of 1) maximal static quadriceps muscle contractions | Other: Open kinetic chain exercises<br>* In open chain exercises extremities are free to move and there is no weight bearing.<br>|
| Experimental: Closed Chain Kinetic Exercises<br>In closed kinetic chain exercises extremities are fixed and weight bearing is done. Subjects performed group of exercises, 3sets with 10 repetitions for each exercise after warm up and stretching exercises. The closed kinetic chain exercise program consisted of 1) seated leg presses, 2) one-third knee bends on one leg and on both legs, 3) stationary bicycling, 4) rowing-machine exercises, 5) step-up and step-down exercises. Each exercise in the closed kinetic chain protocol was performed dynamically with a 3-second rest between repetitions. | Other: Closed kinetic chain exercises<br>* In closed kinetic chain exercises extremities are fixed and weight bearing is done.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NPRS | Numerical Pain Rating Scale (NPRS) is a subjective measure in which individuals rate their pain on an eleven-point numerical scale. | 6 weeks | 
| LEFS | Lower Extremity Functional Scale (LEFS) is to measure patients' initial function, ongoing progress, and outcome for a wide range of lower-extremity conditions. | 6 week | 
| Y balance test | Y Balance test is a dynamic test required for proprioception along with strength and flexibility. | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PFPS, OCKE, CCKE