EFFECTS OF MANUAL THERAPY ON REDUCING PAIN

AND IMPROVING FUNCTIONS IN YOUNG ADULTS

WITH PATELLOFEMORAL PAIN SYNDROME (PFPS)

By

MOHAMMAD SUHAIL

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In Partial Fulfillment
Of the requirement for the degree of

MASTER OF PHYSIOTHERAPY [M.P.T]

in
Musculoskeletal and Sports Physiotherapy

Under the guidance of

Dr. U.T. IFTHIKAR ALI
Professor

Dr. M.V. SHETTY COLLEGE OF PHYSIOTHERAPY

MANGALORE

2010
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “EFFECTS OF MANUAL THERAPY

ON REDUCING PAIN AND IMPROVING FUNCTIONS IN YOUNG ADULTS

WITH PATELLOFEMORAL PAIN SYNDROME (PFPS)” is a bonafide and genuine

work carried out by me under the guidance of Dr. U.T. Ifthikar Ali, Professor, Dr. M.

V. Shetty College of Physiotherapy, Mangalore.

Date: SIGNATURE OF THE CANDIDATE

Place: MOHAMMAD SUHAIL

II
 CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “EFFECTS OF MANUAL THERAPY

ON REDUCING PAIN AND IMPROVING FUNCTIONS IN YOUNG ADULTS

WITH PATELLOFEMORAL PAIN SYNDROME (PFPS)” is a bonafide research

work done by Mohammad Suhail in partial fulfillment of the requirement for the degree

of MASTER OF PHYSIOTHERAPY IN MUSCULOSKELETAL AND SPORTS

PHYSIOTHERAPY

Date: SIGNATURE OF THE GUIDE

Place: DR. U.T. IFTHIKAR ALI,

Professor,
Dr. M.V. Shetty College of Physiotherapy

III
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA

ENDORSEMENT BY THE HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “EFFECTS OF MANUAL THERAPY

ON REDUCING PAIN AND IMPROVING FUNCTIONS IN YOUNG ADULTS

WITH PATELLOFEMORAL PAIN SYNDROME (PFPS)” is a bonafide research

work done by Mohammad Suhail under the guidance of Dr. U.T. Ifthikar Ali,

Professor, Dr. M.V. Shetty College of Physiotherapy.

Date: SEAL AND SIGNATURE OF

THE PRINCIPAL

Place: DR. SUSAN VARGHESE, M.P.T.

IV
 COPY RIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health sciences, Karnataka

shall have the right to preserve, use and disseminate this dissertation in print or electronic

format for academic/research purpose.

Date: Signature of the candidate

Place: MOHAMMAD SUHAIL

V
© Rajiv Gandhi University of Health Sciences, Karnataka.

Dedicated

To My

Dear

VI
 Mom, Paa &
Sis
ACKNOWLEDGEMENT

First of all, I would like to thank Almighty God for the strength and energy to

undertake this study till its completion.

I express my sincere thanks and gratitude to my guide Dr. U.T. Ifthikar Ali,

Professor, Dr. M.V. Shetty College of Physiotherapy for the constant support and

encouragement throughout my study and also during the entire Master’s program.

I would like to place on record my recognition and thanks to Dr. M.R. Shetty

Secretary, Dr. M.V. Shetty Trust College who has given me this opportunity to pursue

this program in this Institution.

It is my pleasure and privilege to record my deepest sense of gratitude to

Dr. Amit Sharma and Dr. Earnest Jacob, Associate Professor, Dr. M.V. Shetty College

of Physiotherapy for giving meticulous guidance throughout the study which helped me

in framing and completing this dissertation work.

I would like to thank Dr. Susan Varghese, Principal, Dr. M.V. Shetty College of

Physiotherapy for his expert guidance for this study.

VII
 I want to express my gratitude to the patients for their participation, involvement

and cooperation for the successful completion of this project which would not have been

possible without them.

Last but not the least I would like to express my deep gratitude to my friends

Saheer, Vikash and Vaishali who were very helpful & supportive throughout the course

of this study.

Date: Signature of the Candidate

Place: MOHAMMAD SUHAIL

LIST OF ABBREVIATIONS USED

1. PFPS – Patellofemoral Pain Syndrome

2. ROM - Range of Motion

3. PFPSS – Patellofemoral Pain Severity Scale

4. PFPSQ – Patellofemoral Pain Severity Questionnaire

5. VMO - Vastus Medialis Obliques

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 ABSTRACT

BACKGROUND AND OBJECTIVE:

Researchers in the past have analyzed that combination of patellofemoral taping, muscle
stretching, strengthening and co-ordination exercises could be the preferred treatment
mode for the subjects with Patellofemoral Pain Syndrome. The present study was done to
know the effects of manual therapy technique which include transverse friction massage
to the lateral retinaculum, tilt patellofemoral stretches and medial glide to the lateral
retinaculum in increasing range of motion and decreasing pain and improving functions
in subjects with acute Patellofemoral Pain Syndrome.

METHOD:

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50 subjects with acute Patellofemoral Pain Syndrome in the age group of 18 - 35 years
were included in the study. A pre test was conducted which recorded the pain, range of
motion and step test score before giving the treatment. Six sessions (Each session per day
and each session lasted for 15 – 20 minutes) of manual therapy consisting of transverse
frictions to the lateral retinaculum both in the fully extended and fully flexed position; tilt
patellofemoral stretches, and a sustained medial glide during repeated flexion and
extension of the knee was given. At the end of the sixth session, post test results were
recorded.

RESULTS:

The results showed positive changes in patellofemoral pain severity scale, range of
motion and step test after treating the subjects with manual therapy technique. The paired
‘t’ test was used to find the significance of the difference which showed a highly
significant difference with ‘p’ value equal to 0.000. They showed a mean difference in
the range of motion and step test of the subjects which is an objective measure. It denoted
that the mean difference in the flexion range of motion is 11.720, in extension range of
motion is 12.0340, and in step test there is an increase of about 4 steps.

CONCLUSION:

The manual therapy technique used in this study showed decrease in pain and increase
range of motion and improvement in function in the subjects with acute Patellofemoral
Pain Syndrome. Hence they can be preferred as a treatment mode for the subjects who are
having anterior knee pain and limitation in function due to Patellofemoral Pain
Syndrome.

Future studies with a control group and long term follow up so as to know the long term
effects of the intervention are warranted.

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KEYWORDS: Patellofemoral Pain Syndrome, pain, ROM, step test, manual therapy
techniques.

TABLE OF CONTENTS

Page No.

1. INTRODUCTION 1

2. OBJECTIVES 11

3. REVIEW OF LITERATURE 12

4. METHODOLOGY 32

5. RESULTS 42

6. DISCUSSION 52

7. CONCLUSION 60

8. SUMMARY 61

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 9. BIBLIOGRAPHY 63

10. ANNEXURES 74

LIST OF TABLES

Table No. Contents Page No.

5.1 Gender wise distribution of subjects 42

5.2 Age wise distribution of subjects 43

5.3 Mean of the age of the subjects 44

5.4 Pre and Post test PFPSQ data 45

5.5 Pre and Post test flexion ROM data 46

5.6 Pre and Post test extension ROM data 47

5.7 Pre and Post test step test data 48

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5.8 Analysis of gender variation in PFPSQ, 49
ROM and Step Test after intervention
after intervention
Correlations
5.9 51

LIST OF FIGURES

Fig. No. Contents Page No.

Transverse friction to the lateral retinaculum in
4.1 39
knee flexed position
Transverse friction to the lateral retinaculum in
4.2 39
knee extended position
Sustained medial glide to the lateral retinaculum
4.3 40
of the knee
4.4 40
Tilt Patellofemoral stretches
4.5 41
Step Test
4.6 41
Goniometer
5.1 Gender wise distribution of subjects 42

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5.2 Age wise distribution of subjects 43

5.3 Pre and Post test PFPSQ data 45

5.4 Pre and Post test flexion ROM data 46

Pre and Post test extension ROM data
5.5 47
Pre and Post test step test data
5.6 48

5.7 Analysis of gender variation in PFPSQ, ROM and 50

Step Test after intervention after intervention

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