Comparison between Effect of Myofascial Release and Foam Roller on Pain, Range of Motion of Knee Joint, Flexibility of Hamstring and Iliotibial Band in Patients with Patellofemoral Pain Syndrome: An Experimental Study

This study aims to compare the effectiveness of Myofascial Release and Foam Rolling techniques in patients with Patellofemoral Pain Syndrome. Participants will be randomly assigned to either the Myofascial Release group or the Foam rolling group. Both interventions target the soft tissues around the knee, hamstring, and iliotibial band to reduce pain and tightness.

Outcome Measures:

1. Visual Analogue Scale - It measures the amount of pain that patient feels. The ends are defined as the extreme limits of pain oriented from left (worst) to the right (best)

2. Range of Motion of Knee Joint- Goniometer will be used to measure the range of motion of Knee Joint.

3. 90-90 Straight Leg Raise Test  - This test is used to assess the flexibility of Hamstring.

4. Modified Ober’s Test – This test is used to assess the flexibility of Ilio-Tibial Band.

Pre-intervention screening and assessment will be done.

GROUP A: Myofascial release and Conventional physiotherapy

(MFR for hamstring)

• Patient position: Prone lying

• Hamstring area was exposed

• Light stroking using hand over hamstring muscle from proximal to distal of the hamstring (2-3 minutes)

• Compression of the posterior thigh (2-3 minutes)

Cross hand release technique for hamstring 120seconds, 5 repetition/session.

• Myofascial release is given with ulnar border from proximal to distal direction with light gentle pressure over the hamstring muscle until the slack in the skin is loosened.

(MFR for iliotibial band)

• Patient position- side lying on unaffected side with hip and knee 30 degree flexed

• Technique- soft fist or elbow used to engage the fasciae at the greater trochanter.

• Then sustain gentle pressure in inferior direction at the line with the fibers of IT band from femur towards the knee.

• This pressure then should be held for 90 seconds followed by 60 seconds of rest period and repeated for 5 minutes.

• Neuromuscular technique (longitudinal stroke)- the thumb is placed over the taut band and longitudinal strokes are applied slowly with moderate pressure; this technique is applied for 3 minutes.

Group B: Foam Rolling and Conventional Physiotherapy

(Foam Rolling for Ilio-Tibial Band)

• With a roller you can be extremely targeted on the spots that are hot and work up and down its entire length.

• Sit sideways on your roller, then rest your upper bodyweight on your hands.

• Bend the non-rolling leg so the lower section is touching the floor, then slightly straighten it so that the roller moves down from your hip towards your knee.

• This may be the most painful of all the moves you do, but try to keep the roller moving super slow so that you get a prolonged period of squeezing against the muscle.

• When you get close to the bony section of the knee, change direction and repeat.

(Foam Rolling for Hamstring)

• Sit on top of the roller, with pressure on one leg.

• Your starting point is on the outside of the leg that you are rolling, just behind the knee.

• Place your hands behind you for balance and, as you start the movement, push downwards with your arms.

• Your aim is to let the roller move halfway up the back of your thigh, then as you roll back down towards the start position, make sure you have a subtle corkscrew action so you finish at the outside of your knee.

Conventional Physiotherapy

• Stretching of hamstrings, plantar flexors, quadriceps, iliotibial band 3 reps with 30 second each.

• Iliopsoas strengthening in non weight bearing 3 sets with 10 reps each.

• Seated knee extension 90-45 degree 3 sets with 10 reps each.

• Leg press and squatting 0-45 degree 3 sets with 10 reps each.

• Hip abduction against elastic band(standing) & with weights (side-lying) 3 sets with 10 reps each.

• Hip external rotation against elastic band(sitting) 3 sets with 10 reps each

• Side-stepping against elastic band 3 sets with 10 reps each.

• Maximum resistance will be given that enables 10 repetitions

• Load was 70% of the 1-repetition maximum.

Treatment will be given for 3 days in a week for a period of 4 weeks, total 12 sessions.

Post-Intervention assessment will be done.

Data collected will be analysed and results will be drawn. Based on the results, a conclusion will be given.