Strain Counterstrain Versus Graston Technique for Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal condition characterized by anterior knee pain, especially during activities like squatting, climbing stairs, or prolonged sitting. Conservative management through manual therapy is widely used, but comparative effectiveness of different techniques remains unclear.

This randomized clinical trial was designed to compare the effects of Strain Counterstrain (SCS) technique versus Graston Technique on pain intensity, knee range of motion, and functional status in patients diagnosed with patellofemoral pain syndrome.

A total of 60 participants diagnosed with PFPS were recruited and randomly allocated into two equal groups, with 30 patients in each group. Group A received Strain Counterstrain technique, which involves passive positioning of the affected tissue to achieve a position of comfort and reduce tender point sensitivity. Group B received Graston Technique, an instrument-assisted soft tissue mobilization (IASTM) therapy that uses specialized stainless steel instruments to detect and treat soft tissue restrictions, scar tissue, and fascial adhesions around the knee.

The intervention period lasted for 12 weeks with 3 sessions per week. Outcome measures were assessed at baseline and post-intervention. Pain was evaluated using the Kujala Anterior Knee Pain Scale, also known as the Kujala Scoring System, which is a validated tool for PFPS. Functional status was assessed using a substructural questionnaire evaluating daily activities. Knee range of motion was measured using a standard goniometer.

The primary objective of this study is to determine whether Strain Counterstrain or Graston Technique provides superior outcomes in terms of pain reduction, improved range of motion, and enhanced functional capacity in patients with patellofemoral pain syndrome. The findings will help clinicians select the most effective manual therapy approach for managing PFPS.

Inclusion criteria

• 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).

Exclusion criteria

• 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.