Strain Counterstrain and Muscle Energy Technique in Patients of Knee Osteoarthritis

NCT07066670 | Completed DMC

• 1 other identifier: Rec-UOL-/204/08/24
• Study Type: interventional
• Target: 76
• Locations: 1 country
• Sites: 1

Brief Summary

This study aimed to evaluate the comparative effects of Strain Counterstrain (SCS) and Muscle Energy Technique (MET) on pain, range of motion (ROM), and functional disability in patients with knee osteoarthritis (KOA). Conducted as a single-blinded randomized control trial at the University of Lahore Teaching Hospital, 76 participants were divided into two groups, receiving either SCS or MET alongside routine physical therapy. Outcome measures included pain intensity, ROM, and functional disability via KOOS.

Conditions

Stroke

Keywords

Knee Osteoarthritis; Strain Counterstrain; Muscle Energy Technique; Pain Management; Functional Disability

Outcome Measures

Primary Outcomes (1)

• Pain intensity reduction measured by Numeric Pain Rating Scale (NPRS)

  Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), a validated 0-10 scale where 0 indicates "no pain" and 10 indicates "worst possible pain." Assessments were conducted at baseline, 4 weeks, and 8 weeks. A lower score represents improvement.

  Baseline, Week 4, and Week 8

Secondary Outcomes (2)

• Improvement in range of motion (ROM) measured using goniometry

  Baseline, Week 4, and Week 8

• Change in functional disability measured by KOOS questionnaire

  Baseline, Week 4, and Week 8

Study Arms (2)

Strain Counterstrain with Routine Physical Therapy

EXPERIMENTAL

Participants in this arm received Strain Counterstrain (SCS) along with routine physical therapy. SCS involved identifying and holding tender points in positions of comfort for 90 seconds to relieve pain and improve range of motion. Routine physical therapy included TENS, infrared therapy, ultrasound, strengthening exercises (short arc quads, seated knee flexion/extension, terminal knee extension), and stretching exercises (straight leg raises, lying and sitting hamstring stretches). The intervention was delivered 5 days a week for 8 weeks. Education on weight management and joint protection strategies was also provided.

Behavioral: Strain Counterstrain with Routine Physical Therapy

Muscle Energy Technique with Routine Physical Therapy

EXPERIMENTAL

Participants in this arm received Muscle Energy Technique (MET) along with routine physical therapy. MET involved post-isometric relaxation and slow eccentric isotonic stretching techniques targeting hamstrings and quadriceps, helping to restore joint mobility and muscle flexibility. Routine physical therapy included TENS, infrared therapy, ultrasound, strengthening exercises (short arc quads, seated knee flexion/extension, terminal knee extension), and stretching exercises (straight leg raises, lying and sitting hamstring stretches). The intervention was administered 5 days per week over 8 weeks, along with patient education on lifestyle and joint care.

Behavioral: Muscle Energy Technique with Routine Physical Therapy

Interventions

Strain Counterstrain with Routine Physical Therapy BEHAVIORAL

This intervention involves applying the Strain Counterstrain (SCS) technique in combination with standard physical therapy. SCS targets tender points through passive positioning to reduce muscle tension and pain. The patient is positioned in a position of comfort for 90 seconds while monitoring the tender point. This is followed by gradual return to neutral. Routine physical therapy includes electrotherapy (TENS, IR, ultrasound), strengthening (short arc quads, terminal knee extension), and stretching exercises. The therapy is administered 5 days per week over 8 weeks.

Strain Counterstrain with Routine Physical Therapy

Muscle Energy Technique with Routine Physical Therapy BEHAVIORAL

This intervention combines Muscle Energy Technique (MET) with routine physical therapy. MET involves voluntary muscle contractions against resistance, followed by stretching to restore range of motion and relieve pain. Techniques include post-isometric relaxation and slow eccentric isotonic stretching, particularly targeting hamstring and quadriceps tightness. Routine physical therapy includes electrotherapy (TENS, IR, ultrasound), as well as structured strengthening and stretching exercises. The intervention was delivered 5 days a week for 8 weeks.

Muscle Energy Technique with Routine Physical Therapy

Eligibility Criteria

• Age: 45 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age between 45 to 65 years (Pandiselvi, 2019).
• Patients who were willing and able to comply with the study protocol and follow-up procedures (Arslan et al., 2022).
• Patients having Grade 2 knee OA Kellgren and Lawrence system. In this system, grade 2 signifies minimal severity of OA (Ratzlaff et al., 2018).

You may not qualify if:

• Congenital deformities (Deng et al., 2021).
• Having any tumor or related pathology such as cancer (Arslan et al., 2022).
• Patients having any previous knee surgery (Khan et al., 2023).
• Patients with isolated/predominantly patellofemoral symptomatic osteoarthritis, inflammatory diseases, joint effusion, or excessive knee deformity (Deng et al., 2021).

Sponsors & Collaborators

• University of Lahore: lead

Study Sites (1)

The University of Lahore Teaching Hospital

Lahore, 54590, Pakistan

Location

Related Publications (1)

• Ratzlaff C, Ashbeck EL, Guermazi A, Roemer FW, Duryea J, Kwoh CK. A quantitative metric for knee osteoarthritis: reference values of joint space loss. Osteoarthritis Cartilage. 2018 Sep;26(9):1215-1224. doi: 10.1016/j.joca.2018.05.014. Epub 2018 May 26.

  PMID: 29842940 BACKGROUND

MeSH Terms

Conditions

Stroke; Osteoarthritis, Knee; Agnosia

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Only the outcomes assessor was blinded to the participants' group assignments to ensure objective measurement of pain, ROM, and functional disability scores.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Student

Model Details: Two-arm parallel design where each group receives a distinct manual therapy intervention (SCS or MET) along with standardized physiotherapy. The study tracks changes in pain, ROM, and disability over 8 weeks.

Study Record Dates

• First Submitted: April 3, 2025
• First Posted: July 15, 2025
• Study Start: March 15, 2024
• Primary Completion: December 13, 2024
• Study Completion: February 20, 2025
• Last Updated: July 15, 2025

Record last verified: 2025-04

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)