Popliteus Muscle Release Versus Patellofemoral Mobilization in Patellofemoral Pain Syndrome

The gradual development of diffuse anterior knee pain is characteristic of patellofemoral pain (PFP), which is made worse by activities that put stress on the patellofemoral joint, such as running, stair climbing, and squatting. While 23% of the overall population has PFP, athletes can have a prevalence of 35%.Patellofemoral pain syndrome (PFPS) is a widespread disease with a significant impact on society, with a 22.7% prevalence in the general population.The patella is the largest sesamoid bone in the body and acts as a fulcrum to improve the mechanical advantage of the quadriceps. In full knee extension the patella does not articulate with the femoral condyles, and related to the lack of articular congruency, is able to glide more freely. The inferior patellar facet first contacts the femoral condyle around 20-30o of knee flexion.The popliteus tendon is a primary stabilizer of external knee rotation and has been described as the "fifth ligament of the knee." Injuries involving the posterolateral corner of the knee commonly involve the popliteus tendon; isolated injury to the popliteus tendon is relatively rare and usually involves a rotatory injury mechanism and symptoms of instability and pain.Myofascial release has been shown to improve pain, range of motion, and functional outcomes in individuals with knee disorders. By targeting fascial restrictions around the quadriceps, hamstrings, iliotibial band, and peri-patellar tissues, myofascial techniques help reduce tissue stiffness and abnormal tension that may contribute to altered patellar tracking and joint loading.Patellofemoral mobilization is considered an important intervention in the management of PFPS, particularly in patients presenting with pain, stiffness, or altered patellar tracking.Although both techniques are used to reduce anterior knee pain and improve function, current evidence is insufficient to determine which intervention is more effective. Therefore, further randomized controlled trials are needed to compare their effects on pain and functional outcomes in individuals with PFPS.

Inclusion criteria

• Male and female participants aged 18-30 years.
• minimum history of 3 months of unilateral PFP.
• pain intensity score of ≥3 on a 10-cm Visual Analog Scale (VAS) for worst pain experienced during the previous week.
• Pain reproduced during at least two of the following functional activities: stair ascent or descent, running, hopping, prolonged sitting, squatting, or kneeling.
• Presence of pain on at least one of the following clinical tests: patellar compression test or palpation of the patellar facets.

Exclusion criteria

• Clinical, x-ray, or MRI findings indicative of other specific pathology including osteoarthritis, meniscal, ligament or cartilage injury, apophysitis.
• Recurrent patellar subluxation or dislocation.
• Cortisone use over an extended period of time.
• Previous surgery to the knee joint; trauma to the knee joint affecting the presenting clinical condition.
• Lower limb deformities.