Inclusion criteria:
Athlete 18 to 45 years old with patellofemoral pain syndrome who exercise regularly (at least three times per week)
Complain of anterior knee pain at least in 2 of the following activity: sitting for long periods of time, going up and down stairs, squatting, kneeling, jumping and running
Pain report when touching internal and external of patella surface and positive clarke test in knee extended and sitting
At least be positive result of one of the three following tests:Positive vastus medialis co-ordination test Positive 20 cm going down stair test Positive Patellar apprehension test
Gradual start of symptoms without history of trauma or injury for at least past 3 months
kujala score level 40 to 70
At least 3 out of 10 score level of NPRS in past tree weeks
Exclusion criteria:
Existence of other pathologies of knee joint such as rupture of meniscus or knee ligaments, knee joint wear, tendon problems, patellar dislocation or partial dislocation, Sinding-Larsen disease, Osgood-Schlatter disease and Plica syndrome, ankle and knee injuries.
Pathologies of the hip such as rupture of the ligaments of the thigh, joint wear and tear, tendon problems, dislocation or partial dislocation and injury of the thigh.
Structural and biomechanical problems such as: valgus and varus in the knee or femoral anterior
Radicular pain in the lumbar region and neurological symptoms (diagnosis with the help of history and lower limb percussion test, dural stretch test)
Previous knee surgery
Neurological disorders affecting balance
Contraindications to using dry needles such as: Existence of metabolic diseases including diabetes, rheumatic diseases To. Pregnancy. Respiratory and cardiovascular problems (Peripheral vascular disease), cancer and any malignancy. Immune system defects. Menstruation. Needle phobia. Bleeding disorders and taking anticoagulants. Liver and kidney diseases