Motor Control Retraining vs Close Kinetic Chain Exercises for Pain, Function and Vastus Medialis Oblique Strength in Patients With Patellofemoral Pain Syndrome
Comparative Effects of Motor Control Retraining and Close Kinetic Chain Exercises on Pain, Function and Vastus Medialis Oblique Strength in Patients With Patellofemoral Pain Syndrome
- Registry ID
- NCT07766083
- Source registry
- NCT
- Status
- COMPLETED
- Phase
- NA
- Study type
- INTERVENTIONAL
- Sponsor
- University of Faisalabad
- Enrollment
- 50
- Start date
- 2026-04-24
- Completion date
- 2026-08-09
- Last update
- 2026-08-14
Conditions
- Patellofemoral Pain Syndrome
- Close Kinetic Chain Exercises
- Motor Control Retraining
Summary
This study compares two treatments - motor control retraining and close kinetic chain exercises - to improves the pain, VMO strength, knee function. Fifty participants out of which 4 dropped out; will be randomly assigned to receive either motor control retraining or close kinetic chain exercises training for 45 minutes per session, three times per week, for six weeks. Pain intensity will be measured using the visual analogue scale. Knee function will be measured using Kujala anterior knee pain scale. Vastus medialis oblique strength will be measured using digital dynamometer. Dynamic knee valgus will be measured using Kinovea-2D video analysis. Q-angle will be measured using manual goniometer. Patellar maltracking will be measured using combined assessment of dynamic knee valgus and q-angle. This study aims to determine which treatment produces greater improvements, which may help physiotherapists choose more effective treatments for patient with patellofemoral pain syndrome in Pakistan.
Detailed description
Background: Patellofemoral pain syndrome, another name for anterior knee discomfort, is brought on by a combination of abnormal patellar tracking, changed biomechanics, and muscle imbalances that put more strain on the patellofemoral joint during activities including jogging, squatting, and stair climbing. In general practice, patellofemoral pain contributes to 11-17% of all knee pain syndromes. Motor control retraining is a rehabilitation treatment that focus on activation and timing of VMO, controlled functional movements, dynamic integration while close kinetic chain exercises is also a rehabilitation treatment that focus on low and moderate load close kinetic chain exercises with advanced functional exercises that focuses on VMO activation.
Interventions
- OTHER: Close Kinetic Chain Exercises
- OTHER: Motor Control Retraining
Inclusion criteria
Inclusion Criteria:
* Age between 18 and 40 years old.
* Both genders male \& female.
* Clinically diagnosed PFPS patients.
* Anterior knee pain \>3 on VAS for \> 2 weeks.
* Retropatellar pain during at least 3 of the following activities, i.e., jumping, kneeling, ascending \& descending stairs, squatting, running, prolonged sitting.
* BMI range from 18.5 - 24.9 kg/m² .
* Not receiving previously knee physiotherapy.
* Insidious onset of symptoms unrelated to trauma.
* Patellar compression test positive.
* Clarke's test positive.
* Snapps questionnaire score 6 or greater.
Exclusion criteria
Exclusion Criteria:
* Age \> 40 years old.
* Knee joint effusion .
* BMI \< 18 \& \> 29 kg/m².
* Any other significant injury that affect lower limb .
* Any history of previous knee surgery.
* Having referred pain from the lumbar, hip, ankle, feet, and SIJ .
* Any history of knee pathology, including OA, meniscus injury, ligament injury, tendon injury, cartilage injury, iliotibial band involvement, intra articular pathology, patellar instability, osgood-schlatter syndrome, pes anserine pain, RA of knee .
* Any history of neurological condition .
* Pregnant females .
* Any condition affected muscle strength, i.e., gout, DM, RA .
* History of head injury, vestibular disorder within 6 months.
* Any history of patellar dislocation or subluxation .
* Signs and symptoms \< 1 month.
* Use of corticosteroids, anti-inflammatory \& intra-articular injections.
* Heart condition that precluded performing exercises.
Primary outcomes
[{"measure":"Pain Intensity","timeFrame":"Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)"},{"measure":"Knee Function","timeFrame":"Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)"},{"measure":"Vastus Medialis Oblique Strength","timeFrame":"Baseline (week 0, before first intervention session), mid-intervention; week 3, after 9th session, and post-intervention (week 6, within 48 hours after the final intervention session)"}]
Locations
- Department of Rehabilitation Sciences, The University of Faisalabad, Faisalabad, Pakistan
Publications
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- Bolgla L, Gibson H, Hannah D et al. (2023) Comparison of the frontal plane projection angle and the dynamic valgus index to identify movement dysfunction in females with patellofemoral pain. International Journal of Sports Physical Therapy 18(3): 619. Chamorro C, Armijo-Olivo S, De La Fuente C et al. (2017) Absolute reliability and concurrent validity of hand held dynamometry and isokinetic dynamometry in the hip, knee and ankle joint: A systematic review and meta-analysis. Open Medicine 12(1): 359-375. Chang W, Huang W and Lai P (2015) Muscle activation of vastus medialis oblique and vastus lateralis in sling-based exercises in patients with patellofemoral pain syndrome: A cross-over study. Evidence-Based Complementary and Alternative Medicine 2015(1): 740315. Crossley K, Callaghan M and Van Linschoten R (2016a) Patellofemoral pain. British Journal of Sports Medicine 50(4): 247-250. Crossley K, Van Middelkoop M, Callaghan M et al. (2016b) Patellofemoral pain consensus statement from t
- Alrshood A, El Alwani A, Amein NE et al. (2017) A systematic review of the effect of open and closed kinetic chain exercises on the vastus medialis oblique and vastus lateralis muscles of patients with patellofemoral pain syndrome. International Journal of Orthopaedics 3(1): 152-161.
- Ismail M, Gamaleldein M, Hassa K et al. (2013) Closed kinetic chain exercises with or without additional hip strengthening exercises in management of patellofemoral pain syndrome: A randomized controlled trial. The European Journal of Physical and Rehabilitation Medicine 49(5): 687-698. Ittenbach RF, Huang G, Barber Foss KD et al. (2016) Reliability and validity of the anterior knee pain scale: Applications for use as an epidemiologic screener. Plos One 11(7): e0159204. Jamaludin NI, Sahabuddin FNA, Rasudin NS et al. (2022) The concurrent validity and reliability of single leg squat among physically active females with and without dynamic knee valgus. International Journal of Sports Physical Therapy 17(4): 574. Kim H (2025) Effects of selective training on the vastus medialis oblique in patients with patellofemoral pain syndrome. Physical Therapy Rehabilitation Science 14(1): 91-101. Llurda-Almuzara L, Pérez-Bellmunt A, Lopez-De-Celis C et al. (2020) Normative data and correlation betw
- Alba-Martin P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Nunez-Nagy S, Pecos-Martin D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Phys Ther Sci. 2015 Jul;27(7):2387-90. doi: 10.1589/jpts.27.2387. Epub 2015 Jul 22.
- Petersen W, Ellermann A, Gösele-Koppenburg A et al. (2014) Patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy 22(10): 2264-2274. Powers CM (2003) The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective. Journal of Orthopaedic & Sports Physical Therapy 33(11): 639-646. Scholtes SA and Salsich GB (2017) A dynamic valgus index that combines hip and knee angles: Assessment of utility in females with patellofemoral pain. International Journal of Sports Physical Therapy 12(3): 333. Scholtes SA and Salsich GB (2020) Consistency of dynamic knee valgus kinematics and pain across functional tasks in females with patellofemoral pain: A cross-sectional study. International Journal of Sports Physical Therapy 15(6): 985. Sheehan FT, Derasari A, Fine KM et al. (2010) Q-angle and j-sign: Indicative of maltracking subgroups in patellofemoral pain. Clinical Orthopaedics and Related Research® 468(1): 266-275. Skouras AZ,
- Ayık B, Armağan O and Bakılan F (2025) Comparison of open and closed kinetic chain exercises on vastus medialis and vastus medialis oblique in patellofemoral pain syndrome: A randomized single-blinded, prospective study. Turkish Journal of Physical Medicine & Rehabilitation (2587-1250) 71(2): 216-225. Balci P, Tunay V, Baltaci G et al. (2009) The effects of two different closed kinetic chain exercises on muscle strength and proprioception in patients with patellofemoral pain syndrome. Acta Orthopaedica Et Traumatologica Turcica 43(5): 419-425. Baldon RDM, Serrão FV, Scattone SR et al. (2014) Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: A randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy 44(4): 240-251. Begum MR and Hossain MA (2019) Validity and reliability of visual analogue scale (VAS) for pain measurement. Journal of Medical Case Reports and Reviews 2(11): 2589-8647.
- Almeida GP, Silva AP, Franca FJ, Magalhaes MO, Burke TN, Marques AP. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Rev Bras Ortop. 2016 Feb 9;51(2):181-6. doi: 10.1016/j.rboe.2016.01.010. eCollection 2016 Mar-Apr.
- Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G et al. (2015) Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: A systematic review. Journal of Physical Therapy Science 27(7): 2387-2390. Almeida G, Silva A, França F et al. (2016) Q-angle in patellofemoral pain: Relationship with dynamic knee valgus, hip abductor torque, pain and function. Revista Brasileira De Ortopedia 51(2): 181-186. Alrshood A, El Alwani A, Amein NE et al. (2017) A systematic review of the effect of open and closed kinetic chain exercises on the vastus medialis oblique and vastus lateralis muscles of patients with patellofemoral pain syndrome. International Journal of Orthopaedics 3(1): 152-161. Arhos E, Lang C, Steger-May K et al. (2021) Task-specific movement training improves kinematics and pain during the Y-balance test and hip muscle strength in females with patellofemoral pain. Journal of International Society Arthroscopy Knee Surgery and Orthopaedic Sports Me
- Arhos EK, Lang CE, Steger-May K, Van Dillen LR, Yemm B, Salsich GB. Task-specific movement training improves kinematics and pain during the Y-balance test and hip muscle strength in females with patellofemoral pain. J ISAKOS. 2021 Sep;6(5):277-282. doi: 10.1136/jisakos-2020-000551. Epub 2021 May 17.
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