Effects of Mulligan Technique With or Without Diclofenac Phonophoresis on Patellofemoral Pain Syndrome.

NCT06439251 | Completed Phase 1 DMC

• 1 other identifier: REC-UOL-546-10-2023
• Study Type: interventional
• Target: 68
• Locations: 1 country
• Sites: 1

Brief Summary

The patellofemoral pain syndrome (PFPS) is a common cause for "anterior knee pain" and mainly affects young women. the effectiveness of Mulligan technique with or without diclofenac phonophoresis on pain, range of motion and functional disability of knee joint in patients with patellofemoral pain syndrome is known little. This study, ethically approved, focused on patients with anterior knee pain referred to the Physical Therapy Department from Lahore General Hospital. After eligibility assessments and consent, participants were randomly assigned to Group A (Experimental) or Group B (Control). Over four weeks, three sessions per week, routine physiotherapy and specific exercises will be administered, with Group A receiving additional Phonophoresis using ultrasound and diclofenac gel. Outcome variables (Numeric Pain Rating Scale, KOOS-PF, Universal Goniometer) will be assessed by a blinded assessor at baseline and study completion.

Conditions

Patellofemoral Pain Syndrome

Keywords

Patellofemoral Pain Syndrome,; Mulligan mobilization; Phonophoresis; diclofenac

Outcome Measures

Primary Outcomes (3)

• Numeric Pain Rating Scale

  The Numerical Pain Rating Scale (NPRS) is a subjective measure in which individuals rate their pain on an eleven-point numerical scale. The scale is composed of 0 (no pain at all) to 10 (worst imaginable pain).

  4 weeks

• KOOS-PF Scale

  KOOS-PF is a subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) that specifically measures symptoms and function related to patellofemoral pain and osteoarthritis. It was developed to provide a more detailed assessment in this specific knee condition. The score is a percentage score from 0 to 100, 0 representing extreme problems and 100 representing no problems. This direction, 100 indicating no problems.

  4 weeks

• Universal Goniometer

  It has a scale for the measurement of the angle. The scale can extend from 0 to 180 degrees for half-circle models or 0 to 360 degrees for full-circle models.

  4 weeks

Study Arms (2)

Diclofenac Phonophoresis

EXPERIMENTAL

The participants randomly allocated in Group A were receive the Phonophoresis (Ultrasound with Diclofenac gel for 5 minutes and intensities 1 MHz and 1.5 W/cm² pulsed waves was used in the therapy sessions on affected knee with diclofenac gel on ultrasound head) as experimental technique

Combination Product: Group 1

Mulligan Technique

ACTIVE COMPARATOR

The treatment involved routine physiotherapy with TENS at 80 Hz and a pulse duration of 50-100 μs, followed by a 15-minute hot pack. It also included stretching exercises for the hamstring and calf muscles, isometric strengthening of the quadriceps and VMO, straight leg raises with traction, and tibial gliding techniques. The MWM technique consisted of SLR with traction, repeated 10 times with 3 sets and a 1-minute interval in between.

Combination Product: Group 2

Interventions

Group 1 COMBINATION_PRODUCT

The treatment included TENS therapy, hot pack application, stretching exercises, isometric strengthening, straight leg raises with traction, and tibial gliding techniques. Participants in Group A also received Phonophoresis as an experimental technique.

Diclofenac Phonophoresis

Group 2 COMBINATION_PRODUCT

The treatment included routine physiotherapy with TENS, hot pack application, stretching exercises, isometric strengthening, straight leg raises with traction, and tibial gliding techniques.

Mulligan Technique

Eligibility Criteria

• Age: 20 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Patients of age range 20-45 years and both genders (Rehman, 2021 #171)
• Unilateral anterior knee pain persisting for over two months, referred by orthopedic (Rehman, 2021 #171)
• Pain scoring rate on numeric pain rating scale (NPRS) \>3 during at least two activities (Rehman, 2021 #171)
• Patients with positive Clarke's test/ Patellar grind test (Rehman, 2021 #171)
• Pain while going up and down stairs, when sitting with knees flexed and with squatting, kneeling or returning from squat. (Powers, 2017 #172)

You may not qualify if:

• Patients with other knee pathologies; meniscus tears, bursitis, patellar tendon injury, ligamentous injury
• Degenerative joint disorders; knee osteoarthritis, rheumatoid arthritis etc.
• Patellofemoral dislocation and / or frequent subluxation.
• Patients having undergone lower extremity surgery
• Those taking any pain medications

Sponsors & Collaborators

• University of Lahore: lead

Study Sites (1)

Lahore General Hospital

Lahore, Punjab Province, 57000, Pakistan

Location

MeSH Terms

Conditions

Patellofemoral Pain Syndrome

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases

Study Officials

• Zunaira Saeed, Masters

  University of Lahore

  PRINCIPAL INVESTIGATOR

• Umber Nawaz, PhD Scholar

  University of Lahore

  PRINCIPAL INVESTIGATOR

• Ashfaq Ahmad, PhD

  University of Lahore

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: February 27, 2024
• First Posted: June 3, 2024
• Study Start: October 18, 2023
• Primary Completion: June 15, 2025
• Study Completion: July 20, 2025
• Last Updated: August 8, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: After the completion of the study, tentatively in 2025
• Access Criteria: by email

Locations

PA (1)