Effect of Specific Versus General Hamstring Stretch on Clinical Outcomes in Patellofemoral Pain Syndrome (PFPS)

NCT ID: NCT07013617

Last Updated: 2025-06-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-14

Study Completion Date

2025-11-30

Brief Summary

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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

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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).

Conditions

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Hamstring Shortness Patellofemoral Pain Syndrome Hamstring Flexibility Patellofemoral Pain (PFPS)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
statistician

Study Groups

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Arm A (general hamstring stretch group)

* General hamstring Muscle energy technique (MET)
* TENS 20 min
* Hip/knee strengthening program

Group Type ACTIVE_COMPARATOR

Transcutaneous Electrical Nerve Stimulation Device

Intervention Type DEVICE

Each participant will receive 20 minutes of TENS, Electrodes will be positioned around the patella with a 5 - 7 cm distance in between, The TENS settings include a continuous asymmetric biphasic square-pulse wave, a pulse width of 120 microseconds, and a pulse rate of 180 Hz.

Strength exercises for lower limb

Intervention Type OTHER

Each participant will receive progressive strengthening program targeting the hip and knee, begin with 3 sets of 10 repetitions and progress to 3 sets of 20 repetitions.

Hamstring Stretch Muscle Energy Technique(MET) (General )

Intervention Type OTHER

The participant will be supine and the leg will be taken into hip flexion until a tightness is felt then patient will be asked to push down with his lower leg and hold the contraction for 10 seconds then relax for 2 to 3 seconds then the therapist will take the patient's leg into further flexion for 30 seconds this will be repeated for 3 times each session .

Arm B (medial hamstring stretch)

* Medial hamstring MET
* TENS 20 min
* Hip/knee strengthening program

Group Type ACTIVE_COMPARATOR

Transcutaneous Electrical Nerve Stimulation Device

Intervention Type DEVICE

Each participant will receive 20 minutes of TENS, Electrodes will be positioned around the patella with a 5 - 7 cm distance in between, The TENS settings include a continuous asymmetric biphasic square-pulse wave, a pulse width of 120 microseconds, and a pulse rate of 180 Hz.

Strength exercises for lower limb

Intervention Type OTHER

Each participant will receive progressive strengthening program targeting the hip and knee, begin with 3 sets of 10 repetitions and progress to 3 sets of 20 repetitions.

Medial Hamstring Muscle energy technique(MET) stretch

Intervention Type OTHER

The Participant will be supine' then the therapist will take his leg in flexion, abduction and external rotation at the same time until he feels tightness then he will ask the patient to push his leg down and in or toward him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more abduction 'external rotation and flexion for 30 seconds, this will be repeated for 3 times each session

Arm C (lateral hamstring stretch)

* Lateral hamstring MET
* TENS 20 min
* Hip/knee strengthening program

Group Type ACTIVE_COMPARATOR

Transcutaneous Electrical Nerve Stimulation Device

Intervention Type DEVICE

Each participant will receive 20 minutes of TENS, Electrodes will be positioned around the patella with a 5 - 7 cm distance in between, The TENS settings include a continuous asymmetric biphasic square-pulse wave, a pulse width of 120 microseconds, and a pulse rate of 180 Hz.

Strength exercises for lower limb

Intervention Type OTHER

Each participant will receive progressive strengthening program targeting the hip and knee, begin with 3 sets of 10 repetitions and progress to 3 sets of 20 repetitions.

Lateral hamstring Muscle Energy Technique(MET)Stretch

Intervention Type OTHER

The Participant will be supine' then the therapist will take his leg in flexion, adduction and internal rotation at the same time until he feels a tightness then he will ask the patient to push his leg down and out or away from him him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more adduction 'internal rotation and flexion for 30 seconds, this will be repeated for 3 times each session

Interventions

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Transcutaneous Electrical Nerve Stimulation Device

Each participant will receive 20 minutes of TENS, Electrodes will be positioned around the patella with a 5 - 7 cm distance in between, The TENS settings include a continuous asymmetric biphasic square-pulse wave, a pulse width of 120 microseconds, and a pulse rate of 180 Hz.

Intervention Type DEVICE

Strength exercises for lower limb

Each participant will receive progressive strengthening program targeting the hip and knee, begin with 3 sets of 10 repetitions and progress to 3 sets of 20 repetitions.

Intervention Type OTHER

Hamstring Stretch Muscle Energy Technique(MET) (General )

The participant will be supine and the leg will be taken into hip flexion until a tightness is felt then patient will be asked to push down with his lower leg and hold the contraction for 10 seconds then relax for 2 to 3 seconds then the therapist will take the patient's leg into further flexion for 30 seconds this will be repeated for 3 times each session .

Intervention Type OTHER

Medial Hamstring Muscle energy technique(MET) stretch

The Participant will be supine' then the therapist will take his leg in flexion, abduction and external rotation at the same time until he feels tightness then he will ask the patient to push his leg down and in or toward him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more abduction 'external rotation and flexion for 30 seconds, this will be repeated for 3 times each session

Intervention Type OTHER

Lateral hamstring Muscle Energy Technique(MET)Stretch

The Participant will be supine' then the therapist will take his leg in flexion, adduction and internal rotation at the same time until he feels a tightness then he will ask the patient to push his leg down and out or away from him him and hold the contraction for 10 seconds then relax for 2 to 3 seconds then therapist will take the patient's leg in more adduction 'internal rotation and flexion for 30 seconds, this will be repeated for 3 times each session

Intervention Type OTHER

Other Intervention Names

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TENS Non-Specific hamstring stretch MET specific medial hamstring MET stretch Specific lateral hamstring MET stretch

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Maximum Eligible Age

37 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cairo University

OTHER

Sponsor Role lead

Responsible Party

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Amna Ibrahim Mahmoud Mohammed Shemila

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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faculty of physical therapy Cairo university

Giza, Giza Governorate, Egypt

Site Status

Countries

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Egypt

Central Contacts

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Amna Ibrahim Shemila, BSc

Role: CONTACT

201157072513

Ahmed Omar Abdelnaeem, lecturer

Role: CONTACT

201140736820

Facility Contacts

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Amna Ibrahim Shemila, BSc

Role: primary

201157072513

Ahmed Omar Abdelnaeem, lecturer

Role: backup

2011407368020

References

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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.

Reference Type BACKGROUND

Lopes HS, Waiteman MC, Priore LB, Glaviano NR, Bazett-Jones DM, Briani RV, Azevedo FM. There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. J Sport Health Sci. 2024 Jul;13(4):521-536. doi: 10.1016/j.jshs.2023.08.004. Epub 2023 Sep 3.

Reference Type BACKGROUND
PMID: 37669706 (View on PubMed)

Wallis JA, Roddy L, Bottrell J, Parslow S, Taylor NF. A Systematic Review of Clinical Practice Guidelines for Physical Therapist Management of Patellofemoral Pain. Phys Ther. 2021 Mar 3;101(3):pzab021. doi: 10.1093/ptj/pzab021.

Reference Type BACKGROUND
PMID: 33533400 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 30316659 (View on PubMed)

John Gibbons. (2022). Muscle energy techniques: a practical guide for physical therapists / JOHN GIBBONS (second edition). Lotus publishing / North Atlantic book

Reference Type BACKGROUND

Puig-Divi A, Escalona-Marfil C, Padulles-Riu JM, Busquets A, Padulles-Chando X, Marcos-Ruiz D. Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. PLoS One. 2019 Jun 5;14(6):e0216448. doi: 10.1371/journal.pone.0216448. eCollection 2019.

Reference Type BACKGROUND
PMID: 31166989 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 31846113 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 34985237 (View on PubMed)

Other Identifiers

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P.T.REC/012/005812

Identifier Type: -

Identifier Source: org_study_id

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