Comparison of GT With TF Technique in Patient With Post-Operative Knee Stiffness

NCT07204119 | Recruiting DMC

• 1 other identifier: Riphah/RCRS/REC/02181
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study was to compare the effects of Graston Technique and Tissue Flossing Technique in patients with post-operative knee stiffness on pain, range of motion, and functional outcomes. A randomized controlled trial was conducted at Benazir Bhutto Hospital, Rawalpindi. The total sample size was 48, divided into three groups. The study duration was six months. Purposive sampling was applied for recruitment, and group randomization was performed by lottery method. Only patients with post-operative knee stiffness meeting the inclusion criteria were enrolled. Outcome measures included goniometer, Functional Independence Measure (FIM), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. Data was collected at baseline and after interventions, and analysis was performed using SPSS version 23.

Conditions

Post-operative Knee Stiffness

Keywords

Post-operative knee stiffness; Graston Technique; Range of Motion; Tissue Flossing

Outcome Measures

Primary Outcomes (1)

• Range of Motion:

  Range of motion (ROM) is the extent of movement possible at a joint or body part. It's the arc of motion a joint can travel, typically measured in degrees using a goniometer. Healthy ROM allows for comfortable movement, while limitations can lead to pain and reduced function.

  2 weeks

Secondary Outcomes (3)

• Numerated Pain Rating Scale:

  2 weeks

• Western Ontario and McMaster Universities Osteoarthritis Index

  2 weeks

• Functional Independence Measure:

  2 weeks

Study Arms (3)

Tissue Flossing Technique

EXPERIMENTAL

Hot pack: 10 minutes, PNF (hold-relax with agonist contraction), CPM: 10 minutes, Self-stretching: End range position for 30 seconds, repeat twice. 1 to 2 minutes for Tissue Flossing Technique Description: Active and passive movement with knee wrapped in a high-quality floss band (208×5×0.15 cm), Wrapped from upper gastrocnemius to lower quadriceps and hamstring muscles using a 50% overlapping pattern with a 25% elongation stretch, Series of active and passive exercises (knee flexion and extension) with 3 repetitions.

Other: Tissue Flossing Technique

Graston Technique

EXPERIMENTAL

Hot pack: 10 minutes, PNF (hold-relax with agonist contraction), CPM: 10 minutes, Self-stretching: End range position for 30 seconds, repeat twice. 2 minutes for Graston Technique Technique Description: Participant lies supine with hip and knee straight, Water-based gel used to reduce friction. Superior and inferior longitudinal strokes delivered with GT-4 instrument at a 45° angle to soft tissues Sequence includes strokes from above patella to anterior inferior iliac spine (AIIS) and back, maintaining a 2-second cadence

Other: Graston Technique

Control group

ACTIVE COMPARATOR

Hot pack: 10 minutes * PNF (hold-relax with agonist contraction): Gentle stretch of knee muscle for 10 seconds Isometric contraction for 6 seconds. Flex knee with therapist assistance. Hold position for 10 seconds, repeat 3 times * CPM: 10 minutes * Self-stretching: End range position for 30 seconds, repeat twice

Other: Control group

Interventions

Tissue Flossing Technique OTHER

Hot pack: 10 minutes, PNF (hold-relax with agonist contraction), CPM: 10 minutes, Self-stretching: End range position for 30 seconds, repeat twice. 1 to 2 minutes for Tissue Flossing Technique Description: Active and passive movement with knee wrapped in a high-quality floss band (208×5×0.15 cm), Wrapped from upper gastrocnemius to lower quadriceps and hamstring muscles using a 50% overlapping pattern with a 25% elongation stretch, Series of active and passive exercises (knee flexion and extension) with 3 repetitions.

Tissue Flossing Technique

Graston Technique OTHER

Hot pack: 10 minutes, PNF (hold-relax with agonist contraction), CPM: 10 minutes, Self-stretching: End range position for 30 seconds, repeat twice. 2 minutes for Graston Technique Technique Description: Participant lies supine with hip and knee straight, Water-based gel used to reduce friction. Superior and inferior longitudinal strokes delivered with GT-4 instrument at a 45° angle to soft tissues Sequence includes strokes from above patella to anterior inferior iliac spine (AIIS) and back, maintaining a 2-second cadence

Graston Technique

Control group OTHER

Hot pack: 10 minutes, PNF (hold-relax with agonist contraction): Gentle stretch of knee muscle for 10 seconds Isometric contraction for 6 seconds. Flex knee with therapist assistance. Hold position for 10 seconds, repeat 3 times, CPM: 10 minutes, Self-stretching: End range position for 30 seconds, repeat twice

Control group

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age group between 20 to 40 years.
• Both male and female.
• Patients with 6 weeks post-operative following open reduction and internal fixation (ORIF) of femur, tibia, or fibula shaft fracture
• Decreased in knee Flexion \& Extension (A minimum of 20° or above).

You may not qualify if:

• Those patients who have allergies to latex
• Malignant or metabolic cause of knee fracture
• Venous Thrombotic disease/ Varicose veins.
• Cardiopulmonary illness and hypertension.
• Skin diseases/ metabolic disorders.
• Patient with arthroplasty and arthroscopy.
• Patellar fracture/ ACL/ PCL/ MCL/ LCL rupture/ injuries.
• Any pathological condition having effects on knees.

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Banazir Bhutto Hospital,

Rawalpindi, Punjab Province, 46000, Pakistan

RECRUITING

Related Publications (18)

• Manrique J, Gomez MM, Parvizi J. Stiffness after total knee arthroplasty. J Knee Surg. 2015 Apr;28(2):119-26. doi: 10.1055/s-0034-1396079. Epub 2014 Dec 16.

  PMID: 25513992 BACKGROUND

• Galvez-Sirvent E, Ibarzabal-Gil A, Rodriguez-Merchan EC. Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management. EFORT Open Rev. 2022 Aug 4;7(8):554-568. doi: 10.1530/EOR-22-0004.

  PMID: 35924649 BACKGROUND

• Wu SY, Tsai YH, Wang YT, Chang WD, Lee CL, Kuo CA, Chang NJ. Acute Effects of Tissue Flossing Coupled with Functional Movements on Knee Range of Motion, Static Balance, in Single-Leg Hop Distance, and Landing Stabilization Performance in Female College Students. Int J Environ Res Public Health. 2022 Jan 27;19(3):1427. doi: 10.3390/ijerph19031427.

  PMID: 35162447 BACKGROUND

• Pirato F, Rosso F, Dettoni F, Bonasia DE, Bruzzone M, Rossi R. How to manage a native stiff knee. EFORT Open Rev. 2024 May 10;9(5):363-374. doi: 10.1530/EOR-24-0034.

  PMID: 38726987 BACKGROUND

• Phruetthiphat OA, Zampogna B, Vasta S, Tassanawipas B, Gao Y, Callaghan JJ. TKR after posttraumatic and primary knee osteoarthritis: a comparative study. J Orthop Surg Res. 2021 Mar 4;16(1):173. doi: 10.1186/s13018-021-02322-8.

  PMID: 33663576 BACKGROUND

• Mckivigan JM, Tulimero G. An Analysis Of Graston Technique® For Soft-Tissue Therapy. Rehabilitation Science. 2020;5(4):31. 2020.

  BACKGROUND

• 26, Kangra Rm. Effectiveness Of Instrument Assisted Soft Tissue Mobilization (Iastm) On Post-Operative Knee Stiffness: A Case Study. International Journal Of Scientific Research. 2024 Jun; 13(5).

  BACKGROUND

• Lee JH, Lee DK, Oh JS. The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. J Phys Ther Sci. 2016 Jun;28(6):1852-5. doi: 10.1589/jpts.28.1852. Epub 2016 Jun 28.

  PMID: 27390432 BACKGROUND

• Bhosale P, Kolke Pt S. Effectiveness of instrument assisted soft tissue mobilization (IASTM) and muscle energy technique (MET) on post-operative elbow stiffness: a randomized clinical trial. J Man Manip Ther. 2023 Oct;31(5):340-348. doi: 10.1080/10669817.2022.2122372. Epub 2022 Sep 28.

  PMID: 36171728 BACKGROUND

• Lim, J.-Y., Nam, S.-H., & Kim, K.-D. (2022). Effect of Active Stretching and Instrument-Assisted Soft Tissue Mobilization on the Hip Joint Range of Motion and Stiffness of the Tensor Fascia Lata in Subjects with Shortened Tensor Fascia Lata. Journal of Musculoskeletal Science and Technology, 6(2), 43-50.

  BACKGROUND

• Stanek J, Sullivan T, Davis S. Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion. J Athl Train. 2018 Feb;53(2):160-167. doi: 10.4085/1062-6050-386-16. Epub 2018 Jan 26.

  PMID: 29373060 BACKGROUND

• Jianhong, G., Seng, T. J., Samsudin, S., Soon, C. C., & Zaremohzzabieh, Z. (2021). The Effect of Tissue Flossing Technique on Sports and Injury Prevention and Rehabilitation: A Systematic Review of Recent Research. International Journal of Human Movement and Sports Sciences, 9(6), 1157-1173.

  BACKGROUND

• Mills B, Mayo B, Tavares F, Driller M. The Effect of Tissue Flossing on Ankle Range of Motion, Jump, and Sprint Performance in Elite Rugby Union Athletes. J Sport Rehabil. 2020 Mar 1;29(3):282-286. doi: 10.1123/jsr.2018-0302.

  PMID: 30676229 BACKGROUND

• Cheatham SW, Kolber MJ, Mokha M, Hanney WJ. Concurrent validity of pain scales in individuals with myofascial pain and fibromyalgia. J Bodyw Mov Ther. 2018 Apr;22(2):355-360. doi: 10.1016/j.jbmt.2017.04.009. Epub 2017 Apr 27.

  PMID: 29861234 BACKGROUND

• Hancock GE, Hepworth T, Wembridge K. Accuracy and reliability of knee goniometry methods. J Exp Orthop. 2018 Oct 19;5(1):46. doi: 10.1186/s40634-018-0161-5.

  PMID: 30341552 BACKGROUND

• Danish M, Thakare AE, Salkar PS, Wakode SL. Clinical Utility of Blood Pressure Measurement Using the Newer Palpatory Method for Both Systolic and Diastolic Blood Pressure. Adv Biomed Res. 2020 Sep 30;9:51. doi: 10.4103/abr.abr_254_19. eCollection 2020.

  PMID: 33457334 BACKGROUND

• Impellizzeri FM, Mannion AF, Leunig M, Bizzini M, Naal FD. Comparison of the reliability, responsiveness, and construct validity of 4 different questionnaires for evaluating outcomes after total knee arthroplasty. J Arthroplasty. 2011 Sep;26(6):861-9. doi: 10.1016/j.arth.2010.07.027. Epub 2010 Nov 12.

  PMID: 21074964 BACKGROUND

• Gkouma A, Theotokatos G, Geladas N. Validity and Reliability Evidence of the Functional Independence Measurement (FIM) for individuals with Neurological Disorders in Greece. J Med-Clin Res & Rev. 2022;6(5):1-1.

  BACKGROUND

MeSH Terms

Interventions

Control Groups

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• Lal Gul Khan, MS

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

imran amjad, PhD

CONTACT

03324390125; imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 25, 2025
• First Posted: October 2, 2025
• Study Start: February 12, 2025
• Primary Completion: December 15, 2025
• Study Completion: December 25, 2025
• Last Updated: October 2, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)