Femoral Nerve Gliding Versus Lumbopelvic Manipulation in Management of Patellofemoral Pain Syndrome

NCT07712146 | Not Yet Recruiting DMC

• 1 other identifier: NO:P.T.REC/012/006289 6/1/2026
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The present study is the first one to compare the effectiveness of adding (FNG) versus (LPM ) to conventional exercise therapy in pain, knee functional abilities, hip extension ROM and femoral nerve electrophysiological studies among those with PFPS. This study will be conducted at the outpatient clinic of faculty of Physical Therapy, Cairo University Sixty patients with unilateral PFPS referred from an orthopaedic surgeon for selection criteria, will be included in the study. Measurement procedures, treatment procedures, and the study's goal will be explained to each patient before participation in the study. After being informed about the study aim, they will be asked to sign an informed consent for their approval to participate The study patients will be randomly assigned into three groups

• Group A: control group will receive conventional hip-knee focused exercises only.
• Group B: study group will receive FNG in addition to the same conventional hip-knee focused exercises.
• Group C: study group will receive LPM in addition to the same hip-knee focused exercises All patients will receive 2 sessions/week for 6 weeks (12 sessions). They will be instructed to do the conventional hip-knee exercises at least two times per day. Each session will last for 20-30 minutes. Patients diagnosed with unilateral PFPS will be screened based on the following inclusion and exclusion criteria A sample size of 60 participants will be appropriate. The computations will done using G\* Power version 3.1.9.2 (Franz Faul, Uni Kiel, Germany) Randomization and blinding will be accomplished through using selected types such as A 1:1:1 allocation ratio will be employed for randomization using the website http://www.randomization.com. Blinding will be done on the patients, assessor, and statistician. All patients will be blinded to the task assigned to their group by ensuring they will be unaware of the exercises that the other group will complete. To maintain blinding, the intervention sessions will be administered to each member of the treatment group separately. Before the trial began, an impartial research assistant who will not participating in the study and he will keep the allocation sequence a secret. It will be kept hidden in opaque, sealed envelopes that will not be opened until baseline data will be collected Outcome Measures:
• Knee Pain
• Knee function
• Electro-physiological studies including (sensory nerve conduction velocity and distal latency).
• Sagittal plane hip extension range of motion as a reference for femoral nerve mechanosensitivity changes - The outcomes will be measured at baseline (pre-test) and after 12sessions (after 6 weeks) (post-test) Then patients will receive 4 types of assessments step's including pain assessment using NRS then knee function assessment using arabic version of AKPS then hip extension ROM assessment using digital goniometer after that the electrophysiological studies including femoral nerve will be conducted using the computerized electromyography device for measuring selective parameters such nerve conduction velocity and its amplitude along with onset and peak latency.
• There will be no statistically significant effects of adding FNG to conventional exercises in patients with PFPS on:
• There will be no statistically significant effects of adding LPM to conventional exercises in patients with PFPS on:
• There will be no statistically significant difference between adding FNG versus LPM to conventional exercises in patients with PFPS on:

Conditions

Patello Femoral Pain Syndrome

Outcome Measures

Primary Outcomes (2)

• knee pain intensity

  Pain intensity will be measured by the Arabic version of the Numeric Rating Scale during the last 24 hours. The minimum is zero and the maximum highest pain score is 10. The assessment will be done at baseline and after the last treatment session after 6 weeks

  6 weeks

• functional disability

  functional disability will be measured by the Arabic version of Kujala anterior knee pain questionnaire; higher scores means higher disability

  6 weeks

Secondary Outcomes (2)

• femoral nerve conduction velocity by surface electromyography (sEMG).

  6 weeks

• Hip extension Rang of motion

  6 weeks

Study Arms (3)

group C will receive LPM in addition to hip-knee focused exercise.

ACTIVE COMPARATOR

Group C will start with stretching exercises for hamstrings ,calf \& the iliotibial band, and then they will receive LPM. Lumbopelvic manipulation consists of applying rotational glide forces to the ipsilateral lumbopelvic region of the involved knee. and the therapist stood contralateral to the side which was to be manipulated. They will passively move onto their side, toward the side to be manipulated, and then interlock their fingers behind their head. The researcher will passively rotate the patient and then deliver a quick thrust to the anterior superior iliac spine in a posterior and inferior direction. Each patient received a maximum of two manipulations on the same side as the symptomatic knee. and then will receive the hip knee strengthening exercises

Other: Lumbopelvic manipulation; Other: Exercises

Group B Patients will receive femoral nerve gliding in addition to exercises

EXPERIMENTAL

The patients only of group B will positioned on their asymptomatic side with their body in full flexion. The researcher then extended the patient's hip while keeping the knee flexed, holding the position for 2 seconds.when the patient reports soreness or pain. This mobilization technique will be repeated for 3 sets of 10 repetitions per session, with a total of 12 sessions over 6 weeks

Other: Femoral nerve gliding technique; Other: Exercises

Group A control group will receive exercises only

ACTIVE COMPARATOR

Group A is a control group will receive only stretching exercises for hamstrings, calf\& iliotibial band and then hip knee strengthening exercises

Other: Exercises

Interventions

Lumbopelvic manipulation OTHER

Patients if group C will receive lumbopelvic manipulation, which consists of applying rotational glide forces to the ipsilateral lumbopelvic region of the involved knee. Patients will lay supine and the therapist stood contralateral to the side which was to be manipulated. They will passively move onto their side, toward the side to be manipulated, and then interlocked their fingers behind their head. The researcher will passively rotate the patient, and then delivered a quick thrust to the anterior superior iliac spine in a posterior and inferior direction. Each patient received a maximum of two manipulations on the same side as the symptomatic knee

group C will receive LPM in addition to hip-knee focused exercise.

Femoral nerve gliding technique OTHER

The patients only of group B will be positioned on their asymptomatic side with their body in full flexion. The researcher then extended the patient's hip while keeping the knee flexed, holding the position for 2 seconds. when the patient reports soreness or pain. This mobilization technique will be repeated for 3 sets of 10 repetitions per session, with a total of 12 sessions over 6 wks

Also known as: Neural mobilization

Group B Patients will receive femoral nerve gliding in addition to exercises

Exercises OTHER

For control group (A) will start with the stretching exercises then starting with the hip extensors, then the hip abductors, and finally the hip external rotators. Next, knee strengthening exercises will be carried out, beginning with mini wall squats using a theraband around the distal thigh, followed by terminal knee extension exercise from a standing position, and finishing with seated knee extension exercise from 90° to 45° knee flexion.

Group A control group will receive exercises only; Group B Patients will receive femoral nerve gliding in addition to exercises; group C will receive LPM in addition to hip-knee focused exercise.

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age of the subjects is between 18-35 years.
• BMI will be from 18.5 to ≤ 29.5 Kg/m2
• Anterior or retro patellar knee pain either on the dominant or non- dominant leg for at least 6 weeks duration .
• Worst pain level in the previous month of up to 3cm on a 10cm numerical rating scale (NRS)
• Per or retropatellar pain during at least 2 of the following activities: squatting, prolonged sitting, kneeling, running, jumping and climbing stairs
• Showing 2 or more positive signs on the following clinical tests: Clarke's sign, Waldron test, active patellar grind test, patellar compression test, and palpation of the medial/lateral articular border of the patella .
• Patients had positive femoral slump test with limited active lumber ROM.

You may not qualify if:

• History of previous knee surgery and any knee pathology (meniscus tear, patellar tendinopathy, ligament sprain and osteoarthritis) .
• Any systemic diseases and/or connective tissue disorders .
• Bursitis and ligament tears .
• Lower back dysfunction such as disc lesion, sciatica or spondylolisthesis.
• participants that had undergone physiotherapy during the preceding 3 month.
• Pregnant women.
• Osteoporosis or recent fracture of the hip or spinal joints.• . Radiographic evidence or medical diagnosis of spinal instability (Grade II spondylolithesis or greater), spondyloarthritides, or severe spinal misalignment
• Nervous system disease or disorder
• Lumbosacral nerve root compression (any of the following signs present) a. Positive straight leg raise (SLR) test less than 45°, marked paresis (\<3/5 on manual muscle testing) involving a major muscle group of the lower extremity, diminished, and asymmetric (lower than uninvolved side), lower extremity muscle stretch reflex and diminished or absent sensation to pinprick in any lower extremity dermatome (D'Agati M 2022).

Sponsors & Collaborators

• Marihan Aziz Zakaria: lead

Study Sites (1)

Faculty of physical therapy-Cairo University

Cairo, Egypt

Location

MeSH Terms

Interventions

Exercise

Intervention Hierarchy (Ancestors)

Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Ramez Fady Fahim, Msc orthopedic PT

  Cairo University

  PRINCIPAL INVESTIGATOR

• Marihan Zakaria Aziz, PhD orthopedic physical therap

  Faculty of physical therapy-cairo university ( department of physical therapy for musculoskeletal disorders and its surgeries)

  STUDY DIRECTOR

• Alshaymaa Shaaban Abdelazeim, PhD in physical therapy

  Faculty of physical therapy-cairo university ( department of basic science)

  STUDY DIRECTOR

• Enas Fawzy Youssif, PhD physical therapy

  Faculty of physical therapy-cairo university ( department of physical therapy for musculoskeletal disorders and its surgeries)

  STUDY DIRECTOR

Central Study Contacts

Ramez Fady Fahim, Master degree of orthopedic PT

CONTACT

0201211553069; Ramezfahim1993@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Senior orthopedic physical therapist at Cairo University Hospitals

Study Record Dates

• First Submitted: July 11, 2026
• First Posted: July 17, 2026
• Study Start: July 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): April 1, 2027
• Last Updated: July 17, 2026

Record last verified: 2026-06

Locations

EG (1)