Strain Counterstrain Versus Graston Technique for Patellofemoral Pain Syndrome

NCT07589933 | Completed DMC

• 1 other identifier: GIU/REC/26-28
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

This clinical trial compares the effects of Strain Counterstrain technique versus Graston Technique on pain and range of motion in patients with patellofemoral pain syndrome. Adults with patellofemoral pain syndrome were included in this study. A total of 60 participants were divided into two groups with 30 patients in each group. One group received Strain Counterstrain technique and the other group received Graston Technique. Pain was assessed using the Kujala Scoring System and functional status was measured using a substructural questionnaire. Range of motion was also evaluated before and after treatment. The main goal of this study is to determine which technique is more effective in reducing pain and improving knee function in patients with patellofemoral pain syndrome.

Conditions

Patellofemoral Pain Syndrome

Keywords

Strain Counterstrain; Graston Technique; Manual Therapy; Patellofemoral Pain Syndrome; Knee Pain; Range of Motion; Kujala Scale; Physical Therapy; Anterior Knee Pain; Randomized Clinical Trial

Outcome Measures

Primary Outcomes (1)

• Change in Pain and Function using Kujala Anterior Knee Pain Scale

  The Kujala Anterior Knee Pain Scale, also known as Kujala Scoring System, was used to assess pain and functional limitations related to patellofemoral pain syndrome. This is a 13-item self-administered questionnaire evaluating symptoms such as pain during walking, stair climbing, squatting, running, and prolonged sitting. The total score ranges from 0 to 100 points, where 0 represents complete disability and 100 represents no disability. A higher score indicates less pain and better knee function. Change from baseline was calculated to determine treatment effectiveness.

  Baseline and 12 weeks post-intervention

Secondary Outcomes (2)

• Change in Knee Range of Motion

  Baseline and 12 weeks post-intervention

• Change in Functional Status

  Baseline and 12 weeks post-intervention

Study Arms (2)

Strain Counterstrain Group

EXPERIMENTAL

Participants in this arm received Strain Counterstrain technique for patellofemoral pain syndrome. This technique involves identifying tender points and passively positioning the affected tissue to a position of comfort to reduce pain and muscle spasm. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group.

Procedure: Strain Counterstrain

Graston Technique Group

EXPERIMENTAL

Participants in this arm received Graston Technique, an instrument-assisted soft tissue mobilization (IASTM) therapy. This technique uses specialized stainless steel instruments to detect and treat soft tissue restrictions, scar tissue, and fascial adhesions around the knee. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group.

Procedure: Graston Technique

Interventions

Strain Counterstrain PROCEDURE

Strain Counterstrain is a manual therapy technique that involves identifying tender points in muscles and fascia. The therapist passively positions the patient's body to a position of comfort that reduces or eliminates the tenderness. This position is held for 90 seconds to allow neuromuscular reset, followed by slow return to neutral. The technique aims to reduce muscle spasm, normalize proprioceptive activity, and decrease pain in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks.

Also known as: Positional Release Therapy, SCS

Strain Counterstrain Group

Graston Technique PROCEDURE

Graston Technique is an evidence-based form of instrument-assisted soft tissue mobilization (IASTM). It uses six specialized stainless steel instruments to scan, detect, and treat soft tissue lesions, scar tissue, and fascial restrictions. The instruments are used by trained clinicians to apply controlled microtrauma to affected areas around the knee, promoting tissue healing and remodeling. The goal is to break down adhesions, reduce pain, and improve range of motion and function in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks.

Also known as: Instrument-Assisted Soft Tissue Mobilization, IASTM

Graston Technique Group

Eligibility Criteria

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

You may qualify if:

• Age 18-45 years.
• Anterior or peripatellar knee discomfort reproduced by a minimum of two aggravating exercises (e.g., squatting, stairs, running, prolonged sitting).
• No history of trauma.
• On the Numerical Pain Rating Scale (NPRS), pain severity is ≥3/10 at baseline.
• Symptom duration ≥2 months.
• Ability to understand instructions and provide informed consent (or parental consent for minors).

You may not qualify if:

• Individuals who have had lower limb surgery within the previous 12 months
• Existence of other knee pathologies (e.g., meniscal tear with locking, tibiofemoral osteoarthritis, inflammatory arthritis).
• Skin infection, open wound, or dermatological condition at the treatment site.
• Use of anticoagulants/bleeding disorders or recent corticosteroid injection within 3 months.
• Receipt of manual therapy (SCS, IASTM/Graston) to the affected knee within the past 4 weeks.

Sponsors & Collaborators

• Green International University: lead
• Sir Ganga Ram Hospital: collaborator

Study Sites (1)

Sir Ganga Ram Hospital, Department of Physical Therapy

Lahore, Punjab Province, 54000, Pakistan

Location

MeSH Terms

Conditions

Patellofemoral Pain Syndrome

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: This is a randomized, parallel-group interventional study. Participants with patellofemoral pain syndrome were randomly assigned in a 1:1 ratio to one of two treatment arms. Group A received Strain Counterstrain technique and Group B received Graston Technique. Both interventions were administered for the specified treatment period to compare their effectiveness on pain reduction and improvement in knee range of motion.

Study Record Dates

• First Submitted: May 10, 2026
• First Posted: May 15, 2026
• Study Start: November 2, 2025
• Primary Completion: April 29, 2026
• Study Completion: May 5, 2026
• Last Updated: May 15, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: It will be available after the completion of the study.
• Access Criteria: Data requests should be sent to the corresponding author. Access will be granted to qualified researchers for approved research proposals. Data will be de-identified before sharing.

Locations

PA (1)