Clinical trial NCT07013617: Effect of Specific Versus General Hamstring Stretch on Clinical Outcomes in Patellofemoral Pain Syndrome (PFPS)
Official title: Effect Of Hamstring Stretch On Clinical Outcomes In Patellofemoral Pain Syndrome
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Hamstring Shortness
Patellofemoral Pain Syndrome
Hamstring Flexibility
Patellofemoral Pain (PFPS)
Keywords: patellofemoral pain syndrome
PFPS
hamstring flexibility
active knee extension test
medial hamstring
lateral hamstring
specific hamstring stretch
Muscle Energy Technique
TENS
Visual Analogue Scale
Hand Held Dynamometer (HHD)
Kujala Score
Lead sponsor: Cairo University
Sponsor class: OTHER
First posted: 2025-06-10
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Maximum age (years): 37
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This randomized, Single-blind, parallel-group trial will compare the effects of three hamstring stretching interventions-general hamstring Muscle Energy Technique (MET), medial hamstring MET, and lateral hamstring MET-each combined with standardized TENS and progressive hip/knee strengthening, on hamstring flexibility (knee-extension ROM), anterior knee pain (Arabic Kujala score), pain intensity visual analogue scale (VAS), and lower-limb strength (hand-held dynamometer) in adults with patellofemoral pain syndrome (PFPS).

Detailed description: Patients with chronic PFPS will be randomized (1:1:1) into:

General MET group: standard non-specific hamstring MET stretch

Medial MET group: targeted medial-hamstring MET stretch

Lateral MET group: targeted lateral-hamstring MET stretch

All groups receive:

TENS: 20 min asymmetric biphasic square-pulse, 120 μs pulse width, 180 Hz, electrodes around patella (5-7 cm apart)

Strengthening: 3×/week for 4 weeks; hip/knee exercises, start 3×10 reps → 3×20, progress with weights or resistance bands.

Outcomes are measured pre-intervention and at 4 weeks. Analysis by mixed-design MANOVA (α \< 0.05).

Eligibility criteria: Inclusion Criteria:

* Anterior or retropatellar knee pain lasting at least three months
* Pain reproduced by at least two functional tasks: squatting, kneeling, prolonged sitting, stair climbing, hopping or running
* Pain intensity of ≥3 on a Visual Analog Scale
* positive active knee extension test (inability to achieve greater than 160° of knee extension with the hip at 90° of flexion)
* Body mass index (BMI) \< 30 Kg/m² and \> 18Kg/m²

Exclusion Criteria:

* Previous knee surgery
* History of knee pathologies, such as meniscal injury' ligament injury, or knee osteoarthritis
* Psychological, cardiovascular' or neurological disorders
* Dizziness or fainting while doing exercises, pregnancy, or any contraindications to exercise
* Physical therapy treatment in the last 3 months

Primary outcomes:
measure: hamstring flexibility (knee extension range of motion )
timeFrame: 4 weeks
measure: Arabic Kujala Anterior knee pain score
timeFrame: 4 weeks
Secondary outcomes:
measure: pain intensity by visual analogue scale (VAS)
timeFrame: 4 weeks
measure: lower limb strength using handheld dynamometer
timeFrame: 4 weeks
Other outcomes:
Locations:
city: Giza
country: Egypt
facility: faculty of physical therapy Cairo university
Study officials:
References:
citation: Zahra Rojhani-Shirazi, Mohamad Reza Salimifard, Fatemeh Barzintaj. Comparison of the effects of static stretching and muscle energy technique on Hamstring flexibility, pain, and function in athletes with patellofemoral pain. J Adv Pharm Edu Res 2021;11(S1):33-38.
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citation: Hamdan M, Haddad B, Isleem U, Hamad A, Hussein L, Shawareb Y, Hadidi F, Alryalat SA, Samarah O, Khanfar A, Alzoubi B. Validation of the Arabic version of the Kujala patellofemoral pain scoring system. J Orthop Sci. 2019 Mar;24(2):290-293. doi: 10.1016/j.jos.2018.09.008. Epub 2018 Oct 10.
citation: John Gibbons. (2022). Muscle energy techniques: a practical guide for physical therapists / JOHN GIBBONS (second edition). Lotus publishing / North Atlantic book
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citation: Hott A, Brox JI, Pripp AH, Juel NG, Liavaag S. Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity. Scand J Med Sci Sports. 2020 Apr;30(4):741-753. doi: 10.1111/sms.13613. Epub 2020 Jan 5.
citation: Constantinou A, Mamais I, Papathanasiou G, Lamnisos D, Stasinopoulos D. Comparing hip and knee focused exercises versus hip and knee focused exercises with the use of blood flow restriction training in adults with patellofemoral pain. Eur J Phys Rehabil Med. 2022 Apr;58(2):225-235. doi: 10.23736/S1973-9087.22.06691-6. Epub 2022 Jan 5.