Mikhled Knee Exercise Program With and Without Stecco Fascial Manipulation Effect in Patellofemoral Pain Syndrome

A study was conducted to assess the comparative effectiveness of the Mikhled Knee Exercise Program (MKEP) combined with ultrasound therapy and conventional physiotherapy combined with ultrasound therapy in managing patellofemoral arthritis. Thirty participants diagnosed with patellofemoral arthritis were randomly assigned to two groups: an MKEP group (n = 15) and a conventional therapy group (n = 15). The MKEP group received the Mikhled Knee Exercise Program along with ultrasound therapy, while the conventional group received traditional physiotherapy exercises with ultrasound therapy. Both groups underwent a 6-week intervention. Pain was assessed using the Numerical Pain Rating Scale (NPRS), and functional status was evaluated using the Anterior Knee Pain Scale (AKPS) before and after treatment. The findings demonstrated that the Mikhled Knee Exercise Program combined with ultrasound therapy was more effective than conventional physiotherapy with ultrasound therapy in reducing pain and improving functional status among patients with patellofemoral arthritis.

A randomized study was conducted to determine the effects of the Mikhled Knee Exercise Program and quadriceps-based training in collegiate athletes with patellofemoral pain syndrome. Fifty-four participants were randomly allocated into two equal groups. During a four-week intervention, one group received the Mikhled Knee Exercise Program, whereas the other group underwent quadriceps-based training. Participants were assessed before and after treatment using the Numerical Pain Rating Scale (NPRS) and the Kujala Patellofemoral Scale. The results indicated that the Mikhled Knee Exercise Program was more effective than quadriceps-based training in reducing pain and improving functional outcomes in individuals with patellofemoral pain syndrome.

A randomized clinical trial was conducted to investigate the efficacy of Fascial Manipulation using the Stecco Method combined with muscle strengthening compared with muscle strengthening alone in patients with patellofemoral pain. Twenty-seven participants were randomly assigned to two groups. One group received supervised muscle strengthening along with Fascial Manipulation using the Stecco Method, whereas the other group received supervised muscle strengthening only. Pain was assessed using the Numeric Rating Scale (NRS), subjective function using the Lower Extremity Functional Scale (LEFS), and objective function using the Step Down Test. Assessments were performed before treatment, after completion of the intervention, and at one-month follow-up. The study demonstrated that combining Stecco Fascial Manipulation with muscle strengthening produced greater improvements than muscle strengthening alone.

A randomized comparative single-blind clinical study was conducted to evaluate the effects of ultrasound therapy, the Mikhled Knee Exercise Program, and their combination in individuals with patellofemoral pain syndrome. Sixty participants aged 20 years or younger were allocated into three groups: Mikhled Knee Exercise Program, ultrasound therapy, and Mikhled Knee Exercise Program combined with ultrasound therapy. Pain was measured using the Visual Analog Scale (VAS), general health was assessed using the SF-36 questionnaire, and functional status was evaluated with the WOMAC questionnaire before and after treatment. The findings showed that combining the Mikhled Knee Exercise Program with ultrasound therapy resulted in greater pain reduction and functional improvement than either intervention alone.

Although the Mikhled Knee Exercise Program has demonstrated effectiveness in addressing muscular impairments associated with patellofemoral pain syndrome, limited evidence exists regarding its integration with fascial techniques such as the Stecco Fascial Manipulation Method. Most existing studies have evaluated exercise-based rehabilitation or fascial/manual therapy as independent interventions, with very few examining the combined therapeutic effects of both approaches. Therefore, further research is warranted to determine whether integrating the Mikhled Knee Exercise Program with Stecco Fascial Manipulation provides superior improvements in pain reduction, joint mobility, and functional outcomes in individuals with patellofemoral pain syndrome.

Inclusion criteria

• Male and female participants between the ages of 25-45 years (16)
• Diffused anterior knee pain for at least 8 weeks (16)
• Pain exacerbated by climbing stairs, prolonged sitting, walking, running, squatting, knee flexion, and isometric quadriceps contraction (14).
• Patients had never received Stecco fascial manipulation and MKEP before.

Exclusion criteria

• Tendonitis
• Osgood-Schlatter syndrome
• OA
• Fracture
• Patellar sublaxation or dislocation
• Previous history of surgery
• Meniscus or ligament damage
• Heart diseases
• Neurological deficits
• Pregnancy