Cause Of Knee Pain Research Articles

Knee pain in primary care medicine : diagnostic and therapeutic approach

Knee pain is one of the most common musculoskeletal complaints in primary care medicine. The leading causes of knee pain are osteoarthritis and musculoskeletal disorders. A careful history and a rigorous clinical examination usually enable a diagnosis to be made without the need for further investigations. A systematic search for red flags helps identify patients requiring urgent and specialized care. When necessary, X-rays and ultrasound are the first-line imaging tests to perform. The latter can be used to guide a joint puncture for diagnostic and therapeutic purposes. This article reviews the diagnostic approach and summarizes the management of the main pathologies encountered in the general practitioner's office.

Diagnostic Musculoskeletal Ultrasound for Medial Collateral Ligament Injuries: Applications in Rehabilitation.

Medial collateral ligament (MCL) injuries are prevalent in sports and other physical activities and constitute a significant cause of knee pain and dysfunction. Traditional diagnostic modalities such as magnetic resonance imaging (MRI) are often utilized for their detailed visualization capabilities. However, musculoskeletal ultrasound (MSK-US) has emerged as a pivotal diagnostic tool in the evaluation of MCL injuries due to its non-invasive nature, cost-effectiveness, and dynamic imaging capabilities. This article reviews the utility and advantages of MSK-US in diagnosing MCL injuries, with a specific focus on its implications for rehabilitation providers. We discuss the technical aspects of ultrasound (US) imaging, including the sonographic appearance of MCL injuries across various grades, and compare its diagnostic accuracy with other imaging modalities such as MRI. Additionally, the role of US in monitoring the healing process and guiding rehabilitation strategies is explored. This review emphasizes the practical application of MSK-US in clinical settings, offering rehabilitation providers a comprehensive understanding of how US can be integrated into patient management protocols to enhance outcomes in patients with MCL injuries.

9. Chronic knee pain.

Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee. The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments. Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary. When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery.

Surgical Therapy and Tissue Engineering for Meniscal Repair.

Meniscal damage is one of the prevalent causes of knee pain, swelling, instability, and functional compromise, frequently culminating in osteoarthritis (OA). Timely and appropriate interventions are crucial to relieve symptoms and prevent or delay the onset of OA. Contemporary surgical treatments include total or partial meniscectomy, meniscal repair, allograft meniscal transplantation, and synthetic meniscal implants, but each presents its specific limitations. Recently, regenerative medicine and tissue engineering have emerged as promising fields, offering innovative prospects for meniscal regeneration and repair. This review delineates current surgical methods, elucidating their specific indications, advantages, and disadvantages. Concurrently, it delves into state-of-the-art tissue engineering techniques aimed at the functional regenerative repair of meniscus. Recommendations for future research and clinical practice are also provided.

Remote Effect of Fascial Manipulation on Knee Pain: A Case Report

The study on the remote effect of fascial manipulation on knee pain presents a case report of a patient with knee pain who underwent a single session of fascial manipulation to reduce pain and improve daily activities. The report explains the anatomy of the knee joint and the potential causes of knee pain, including bony and soft tissue involvement. Fascial manipulation is a technique that involves applying mechanical force to areas of fascial dysfunction to stimulate the body’s natural inflammatory response. The therapy is based on applying physical friction to the densified connective tissue with an elbow or knuckle to raise the temperature and change the consistency of loose connective tissue rich in hyaluronic acid. The locations picked were proximal and distal to the problematic area, and no point was treated over the painful region, which is consistent with the notion of pain being caused by aberrant fascial tensions. Manipulation of the connective tissue is thought to cause mechanical stress and heat, resulting in less macromolecular crowding and defragmentation of the Hyaluronic Acid (HA) polymers and normalised fascial gliding across the connective tissue. Reduced discomfort and enhanced range of motion are two more regularly reported effects of Fascial Manipulation. The patient was urged to resume his everyday activities after each treatment session to favour typical physiological motions that would align collagen fibres along normal lines of force. The report concludes that fascial manipulation can be a beneficial technique for managing knee pain, and it can be complemented with exercises and stretches to improve outcomes.

The Efficacy of Intra-articular Platelet-Rich Plasma Injection Versus Corticosteroid Injection in the Treatment of Knee Osteoarthritis: A Prospective Comparative Analysis.

Background Knee osteoarthritis (KOA) is the most typical cause of knee pain and impairment worldwide. It is typified by slow and progressive degeneration of the articular cartilage of the knee joint. Although KOA is being managed with a variety of therapies, the comparison of the effectiveness of different intra-articular injections in KOA treatment in Pakistan is still not thoroughly investigated. Therefore, the purpose of this current study is to compare the efficacy of intra-articular administration of platelet-rich plasma (PRP) and corticosteroids (CSs) in the treatment of KOA. Methods This prospective comparative study was performed among one hundred patients diagnosed with KOA in Benazir Bhutto Hospital, Rawalpindi, for one year from April 2022 to March 2023. Specified inclusion and exclusion criteria were employed for patient enrollment. Patients were divided into two equal groups through simple random sampling. Group A patients received an intra-articular injection of PRP solution whereas group B patients received an intra-articular injection of CSs. Informed consent and ethical approval were also acquired prior to data collection. A self-designed proforma based on interviews was used to collect data. The data analysis in Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) was carried out via descriptive statistics and an independent t-test. Results Women (N=71, 71%) had a higher prevalence of KOA than men (N=29, 29%). The means of study variables like age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 56.10 ± 8.70 years, 8.08 ± 1.6, and 70.08 ± 8.76 respectively. The frequency of KOA on the right side was 62% (N=62) while it was 38% (N=38) on the left side. In the study population,69% (N=69) patients had grade II KOA, and 31% (N=31) patients had grade III KOA. At the first-month, second-month, and third-month follow-up visits, there were statistically significant differences in the mean scores of the WOMAC and VAS between the study groups. However, at the first-month follow-up visit, mean scores of VAS and WOMAC were lower in group B than in group A while these were lower in group A as compared to group B, at the second-month and third-month follow-up appointments. Conclusions Intra-articular infiltration of both PRP and CSs was efficacious in the treatment of KOA-related pain and functional limitations; however, overall improvement in the PRP group was higher than CSgroup.

Efficacy of Isometric Exercises and Somatosensory Training for Pain, Proprioception, and Balance in Runners with Patellofemoral Pain Syndrome.

Background A significant cause of knee pain is patellofemoral pain syndrome (PFPS). Young adults are the most common population to be impacted, and this condition appears to affect both sexes. Patellofemoral joint (PFJ) compression, which is felt around the patella during any physical or athletic activity, usually causes patients to experience pain in the anterior part of the knee. Physiotherapy is essential for patients suffering from this illness, as it can improve their everyday activities and ability to return to their sport. Methodology The study's main goal was to evaluate the effectiveness of somatosensory training and isometric exercises for pain, proprioception, and balance in runners with PFPS. Before- and after-test approaches were used in the investigation. Eighty-five people made up the study, with the inclusion and exclusion criteria used to determine eligibility. Isometric exercises and somatosensory training were given to every individual; the group was not randomly assigned. The patient's diagnosis was made using the patellar grind test. Participants received 30-45 minutes of isometric exercises and 15 minutes of somatosensory training every four days. The visual analog scale, joint position sense test, and Y-balance test were taken as outcome measures to measure PFPS before and after the intervention. Results The result revealed significant (p=0.0001) improvement in PFPS following the intervention. Both the isometric exercises and somatosensory training were found to be significant in reducing the intensity of the pain and improving the proprioception and balance of the individuals. Conclusion Both treatment approaches were beneficial in lowering pain in the joints, developing balance, and helping the patient perceive the position of the joint. Individuals can use both therapy methods to improve their running abilities, and they should become ingrained in daily practice.

Primary B cell lymphoma of the patella presenting as anterior knee pain: A case report

CaseA 76-year-old female with a history of multiple falls on the patella presented with worsening knee pain, swelling, and reduced range of motion. Radiographs revealed tricompartmental osteoarthritis and subtle erosion of the posterior cortex of the patella that was missed by the referring orthopedist and radiologist. Her persistent pain prompted an MRI, revealing a mass later confirmed to be primary diffuse large B-cell lymphoma of the patella after biopsy and appropriate metastatic workup. ConclusionPrimary B-cell patellar lymphoma is a rarely described cause of knee pain requiring broad differential diagnosis and multidisciplinary workup in order to avoid erroneous treatment and ensure prompt oncologic treatment.

Adult Knee Pain - The Diagnostic Dilemma

Knee pain is one of the frequent reasons adult patients seek care in primary care clinics. The cause of knee pain varies, from overuse syndrome to inflammatory diseases. The Osgood-Schlatter Disease (OSD) is one of the overuse syndromes, a condition of proximal tibial apophysitis commonly seen among physically active boys, particularly young athletes aged 10-14 years, during the highest growth spurt. The common presenting symptoms are intermittent or continuous knee pain while walking or playing the sport that involves jumping or running. This condition is self-limiting, resolves within 6-18 months after the growth plates close, and responds well with conservative treatment. However, few patients might have long term sequelae that persist into adulthood. The case report presents a case of recurring knee pain in a 35-year-old man upon his re-engagement with active sports. Clinical assessment and radiological investigation confirm his condition to be consistent with OSD. The diagnosis of OSD in this patient may be another rare case of the recurrence of the childhood condition in a skeletally mature adult.
 
 Keywords: Osgood-Schlatter Disease, adult, knee pain.

PATELLOFEMORAL INSTABILITY MANAGEMENT IN A PROSPECTIVE PAEDIATRIC COHORT IN EDINBURGH

Patellofemoral instability (PFI) is a common cause of knee pain and disability in the paediatric population. Patella alta, lateralised tibial tubercle, medial patellofemoral ligament (MPFL) deficiency, genu valgum and trochlear dysplasia are well known risk factors.A prospective database was created including patients referred through our physiotherapy pathway following first-time patella dislocation. Patella alta and lateralisation of the tibial tuberosity was treated with a Fulkerson-type tibial tubercle osteotomy(TTO). Medial patellofemoral ligament was reconstructed using quads tendon autograft pull-down technique. A modified Sheffield protocol was used postoperatively allowing weightbearing in a hinged knee brace.Forty patients were identified with 8 patients having bilateral presentations. Male to female ratio was 12:28 with an age range of 4–17 years. Eight patients had congenital PFI, five patients acquired PFI through traumatic patella dislocation and twenty-seven patients developed PFI from recurrent dislocations. Structural abnormalities were found in 38(95%) of patients. Patella alta (Caton-Deschamps index >1.2) was identified in 19(47%) patients, genu valgum in 12(30%) patients, increased tibial tubercle-trochlear groove distance(TT-TG>20mm) was present in 9(22.5%) patients and persistent femoral anteversion(> 20 deg) in 7(17%) patients.Eight patients were treated with TTO and MPFL reconstruction, three patients with MPFL reconstruction alone and five patients had guided growth for genu valgum correction. Ten patients are awaiting surgery. No postoperative patients had recurrence of PFI at their latest follow up.PFI is a common problem in the adolescent paediatric population with identifiable structural abnormalities. Correcting structural pathology with surgery leads to predictable and safe outcomes.

In-Office Needle Arthroscopy with Meniscal Repair for Meniscal Lesions of the Knee

Meniscal injuries are a common cause of knee pain and are often an indication for knee arthroscopy, the most common orthopedic surgical procedure in the United States. In-office needle arthroscopy (IONA) is a described technique with the ability to diagnose and treat meniscal injuries in the office. IONA allows for diagnosis and treatment at a significantly deceased cost, with both quicker patient recovery, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing in-office needle arthroscopy for meniscal injuries of the knee, including the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

Medial Knee Joint Space in Relation to Joint Function and Early Knee Pain in 20-45-Year Adults: A Cross Sectional Study.

Anterior knee pain is very common in the young and active age groups but there are no significant studies on the normal population. Therefore, the objective of the study was to understand the relation between medial knee joint space to the development of knee pain and functional disability with special reference to the 20-45-year age group. 250 cases with mean age of 36.36years presenting with knee pain for at least 1month were included in this prospective study (July 2021 and June 2022) and were asked to self-complete questionnaires on knee pain which included KNEST, AKPQ, VAS and IPAQ. Patients underwent X-rays of bilateral knees in AP view with weight bearing and then medial and lateral knee joint spaces were calculated. There was a higher incidence of knee pain in women compared to men. The average medial and lateral joint space widths (MJSW and LJSW) of the right knee were 4.22mm and 4.57mm, respectively. For the left knee it was 4.19mm and 4.42mm, respectively. There is a decrease in MJSW with increasing age, level of pain and BMI. Also, with an increase in physical activity, there was a higher incidence of knee pain. Overuse injuries are the main cause of knee pain in this age group. There is a significant association between medial joint space width and age, gender, level of pain, and BMI. Rising BMI patterns at a young age, leads to an increase in physical activity, which in turn leads to early knee pain and also predisposes to osteoarthritis.

Comparison of conventional and cooled radiofrequency treatment of the genicular nerves versus sham procedure for patients with chronic knee pain: protocol for a multicentre, double-blind, randomised controlled trial (COGENIUS)

IntroductionThe prevalence of chronic knee pain is increasing. Osteoarthritis (OA) and persistent postsurgical pain (PPSP) are two important causes of knee pain. Chronic knee pain is primarily treated with medications,...

Proximal to distal posture correction protocol for IT band friction syndrome in female amateur runners

Iliotibial band friction syndrome is an overuse knee injury that is more common in runners. In IT band syndrome, pain, and tenderness are present over the lateral aspect of the knee. It is more common in females because of physiological and anatomical factors. The objective of this research was to determine and compare the effect of proximal to distal postural correction protocol with conventional physiotherapy program for IT band friction syndrome in female amateur runners. This study included 150 female amateur runners with IT band friction syndrome based on inclusion and exclusion criteria. Then the subjects were randomly allocated into group A and group B by simple random sampling method. Group A was given proximal to distal postural correction protocol and for group B conventional physiotherapy exercise program was given. Outcome measures used were a visual analog scale, postural assessment, tenderness assessment by palpation and Ober’s test. Pre and post-assessment of the above measures was taken to conform the results. The results showed a statistically significant effect of the proximal to distal postural correction protocol as compared to a conventional exercise program for IT band friction syndrome in female amateur runners. There was a significant reduction in pain (<0.0001) in individuals in group A than the group B. Postural abnormalities in IT band friction syndrome were also significantly (<0.0001) resolved and the Ober’s test came as 76% negative out of 100%positive patients. Based on results, it was concluded that the proximal to distal postural correction protocol is effective in female amateur runners.

Curve-on-curve technique does not improve tibial coverage in total knee arthroplasty in comparison to tibial tuberosity technique with use of anatomical implants: randomized controlled trial

IntroductionDuring the last years, main attention while performing total knee replacement was paid to femoral component alignment; however, there is still lack of studies concerning tibial baseplate rotational alignment, especially in terms of anatomical designs of knee prosthesis. Some recent studies proved that tibial baseplate malrotation might be a cause of knee pain and patients’ dissatisfaction. The aim of this study was to compare tibial component rotation and its coverage on the tibial plateau achieved with curve-on-curve and tibial tuberosity techniques (t-t technique) with use of anatomic knee designs with asymmetric tibial baseplate.Materials and methodsA total of 88 patients were randomly assigned in a 1:1 ratio to undergo total knee arthroplasty with use of the PERSONA PS (Zimmer Biomet) knee design with an asymmetric baseplate. The rotation of the tibial component was assessed and performed with two different techniques: curve-on-curve technique and tibial tuberosity technique. Tibial component rotation was measured on computed tomography (CT) scans using the method suggested by Benazzo et al. and designed for asymmetrical implants. For the measurement of the tibial bone coverage, the component surface area was outlined and measured on a proper CT section, then the tibial cut surface area was outlined and measured on a section just below the cement level. Pre- and post-operative range of motion was measured by another independent researcher 12 months post-operatively during follow-up visit.ResultsThere was a statistically significant difference between both groups in median value of tibial rotation angle: 7° (interquartile range (IQR) = 0–12) in curve-on-curve technique group vs 2° (IQR-1–7) in tibial tuberosity technique group, probability value (p) = 0.0041, with values above 0 meaning external rotation of the component. There was no statistically significant difference between both groups in terms of range of motion (ROM) with average values of 124.3° ± 13.0° for curve-on-curve technique and 125.6° ± 12.8° for t-t technique with p = 0.45. There was a statistically insignificant difference between both groups in terms of coverage percentage in slight favor for curve-on-curve technique (85.9 ± 4.2 vs 84.5 ± 4.8, p = 0.17).ConclusionIn this study, no difference between the groups in terms of tibial bone coverage and range of motion was proved, even though both techniques differed significantly with values of tibial rotation. Future studies should be focused on influence of specific values of tibial rotation on patient-reported outcomes and survivorship of anatomic knee implants.

Severe osteoarthritis at unexpected age

Abstract Introduction Acromegaly is a rare chronic endocrine disease caused by a growth hormone (GH) – producing adenoma, resulting in elevated GH and insulin-like growth factor-1 (IGF-1) concentrations. GH and IGF-1 are essential for normal growth, differentiation, and repair of cartilage and bone; however, excess GH and IGF-1, which are characteristic of acromegaly, lead to an arthropathy that resembles osteoarthritis. Patients with acromegaly, whether it's surgically treated or biochemically controlled, still have a high risk of developing arthropathy. Clinical Case A 49-year-old woman presents to the university hospital for a visit with a complaint of knee pain. Her medical history reveals that she received an acromegaly diagnosis in 2010 and had been treated with surgery. However, she was not remission after the surgery; the patient's IGF-1 level was 686 ng/ml (Normal range: 109–284) when she presented. Her medical history reveals that she has been taking analgesics for the last four years. She has received octreotide (once-monthly 10 mg) and cabergoline (once-weekly 1 mg). The last laboratory results showed that her IGF-1 level had decreased dramatically; to 125 ng/ml. Based on the complaint of knee pain, imaging studies, including an X-ray, showed severe osteoarthritis. Conclusion Acromegalic arthropathy is one of acromegaly's most critical functional disabilities. In our case, radiographic imaging studies at joint sites show severe osteoarthritis. Considering the patient's medical history, the cause of knee pain is osteoarthritis, which is also caused by acromegaly. We should also be aware that; long-term biochemical control of acromegaly may not prevent the progression of acromegalic arthropathy in many patients. The prevalence of clinical and radiological acromegalic osteoarthritis of the hip, hand and knee reaches even up to 80%.

Crystal deposition disease as an unusual cause of knee pain in an adult male: Report of a rare case

Abstract Gout is a monosodium urate crystal deposit disease which generally occurs in middle aged male and post-menopausal females. It is typically characterized by episodic acute and chronic arthritis due to deposition of monosodium urate crystals in joints and connective tissue. Palpable deposits of crystals known as tophi may form particularly around joints but also elsewhere. This is a single case based prospective work-up and follow up study done at our institute of a middle-aged male having chronic right knee pain since 1 year year. Meticulous history and clinical examination ,laboratory investigations were done like ESR (erythrocyte sedimentation rate) and CRP (c- reactive protein) and radiological investigation including plain radiograph and MRI (Magnetic resonance imaging) right knee was done and was suggestive of giant cell tumor of patella. Excision and curettage of the lesion was done and sample was sent for HPE (histopathological examination) which showed fibrocartilaginous tissue with features of gouty arthritis. Serum uric acid was done which came out to be raised (10.14 mg/dl). At final follow-up patient had satisfactory outcome. It is important to have in mind that tophus of patella can cause chronic knee pain in patients with gouty arthritis. Early diagnosis and treatment are essential. Patients with tophaceous gout require strict disease control and close follow-up.

Impact of soft tissue around the knee on the efficacy of extracorporeal shockwave therapy in knee osteoarthritis

Knee osteoarthritis (KOA) is the leading cause of knee pain in middle-aged and older individuals. Extracorporeal shockwave therapy (ESWT) has been applied to treat patients with KOA to reduce pain and improve function. Patients (n = 123) diagnosed with KOA who received ESWT were selected to participate in this study, and were grouped according to their body mass index (BMI). The treatment parameters were as follows: 8000 pulses, 2.0 bar, 0.25 mJ/mm2, and 6 Hz/s once per week for 8 weeks. The visual analog scale (VAS), Lequesne index, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were measured to assess knee pain and functional recovery according to BMI groups. Radiographs were used to measure the richness of the soft tissue around the knee joint. The correlation between the distribution of tissue, pain, and functional improvement was analyzed using the receiver operator characteristic curve. All the patients showed a reduction in pain after treatment compared to that before treatment (P < .01). As measured by the VAS, the Lequesne and WOMAC indexes, after the intervention, the pain and functional index of the overweight and above BMI group improved to a greater extent than that of the normal or below normal BMI group (P < .01). The area under the curve showed, with VAS as the demarcation criterion, when the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio exceeded 1.538, 1.534, and 1.296, respectively, the patient's pain relief was more pronounced the ESWT treatment was better. With pain in WOMAC as the demarcation criterion, the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio also are positively correlated with pain relief in patients. When the Lequesne and WOMAC scores were the demarcation criteria, the patients' function improved significantly when the patella apical soft tissue ratio exceeded 2.401 and 2.635, respectively. ESWT can effectively alleviate pain and improve knee function in patients with KOA, and the soft tissue around the knee joint should also be an important reference factor in KOA treatment.

Effects of Instrumented Assisted Soft Tissue Mobilization (IASTM) Technique Versus Stretching on Ililotibal Band in Patients with Anterior Knee Pain

Background: Anterior knee pain is caused by many factors iliotibial band tightness is one of cause of knee pain. The repeated hip abduction or postural imbalance usually results in contracture and tightness of the iliotibial band. Soft tissue mobilization is hypothesized as one of effective treatment. Instrumented assisted soft tissue (IASTM) technique is a soft tissue mobilizing technique and have remarked effects. Objective: This study's objective was to assess how well IASTM improved hip adduction range of motion (ROM). Methodology: This study was quasi experimental trial. And duration for this study was 6 month after the approval of synopsis. Sample of total 46 with knee pain was recruited in two groups. Non- probability convenience sampling technique was used. Total sample size was 30(15 each group). Subjects were allocated into 02 Groups. Inclusion criteria were Age 25 to 50 years and patients with Anterior Knee Pain, Patients of both genders. One group received IASTM and other group received self stretching for flexor group. Outcome was measured on NPRS, goiniomere and lower extremity function scale (LEFS) and values were be taken at baseline and after one week of treatment and then at third week of treatment. The data was analyses using SPSS v 25. Results: The results shows no significant improvement in pain, LEFS and hip abduction range between both groups comparison but both treatments IASTM and stretching exercises shows significant results within each group.The individuals in the GT group showed better hip abduction strength after three treatment sessions. Furthermore, after the one-month follow up, the gain in strength persisted. HoweverThere was no significant difference statistically in hip adduction ROM or VAS scores for pain and function between both the control group and graston (GT) group. Practical application :This study is going to help physical therapist and instrumented assisted soft tissue mobilization practitioners that how Graston technique and stretching effective in terms of decreasing pain, improving flexibility and lower extremity functions in patient with illiotibal band tightness having anterior knee pain. Conclusion: IASTM technique and stretching was equally effective in terms of decreasing pain, improving flexibility and lower extremity functions in patient with illiotibal band tightness having anterior knee pain. Keywords: instrumented assisted soft tissue mobilization, iliotibial band, ant knee pain, soft tissue mobilization.

Prevalence of Patellofemoral Pain and Knee Pain in the General Population of Saudi Arabia.

Background Patellofemoral pain (PFP) is a common cause of knee pain. This condition can restrict daily activities by trying to avoid activities that aggravate their pain. This study aimed to determine the prevalence of PFP and knee pain and its associated factors among Saudi young adults. Methods A descriptive cross-sectional study was conducted in Saudi Arabia. A validated translated Arabic questionnaire was used. Data was collected through an online self-administered questionnaire. Saudi young adults of both genders aged between (18 to 40 years) were included. The mean ±SD was described for continuous variables, whereas categorical variables were reported using frequencies and percentages. The chi-square test was used for descriptive analysis. Results A total of 1558 subjects were enrolled in the current study. About 663 (42.6%) were males and 895 (57.4%) were females. Of the total participants, 718 (46%) were within the age group of 18 to 25.The overall prevalence of PFP among the current study participant was found to be 30.3%. The prevalence of PFP among males was found to be 31.4% and the prevalence of PFP among females was found to be 29.5%. The overall prevalence of knee pain among study participants was found to be 13.2% as 205 of the participants reported knee pain. The prevalence of knee pain among males was found to be 14% and the prevalence of knee pain among females was found to be 12.3%. The multivariate analysis included the following variables: age, gender, and marital status. The following factors predicted higher rate of PFP: being 18 to 25 years old (p-value < 0.001, odds ratio = 1), being 26 to 35 years old (p-value = 0.001, odds ratio = 1.689). Conclusion The prevalence of PFP and knee pains was found to be relatively high in Saudi Arabia. Age less than 40 years old was found to be associated with a higher prevalence of PFP and knee pain when compared to other age groups.