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IRCT20250629066291N2 IRCT 2026-04-25 Shiraz University of Medical Sciences Added Value of Diaphragm Myofascial Release in Improving Pain, Function and Balance in Females With Patellofemoral Pain Added Value of Diaphragm Myofascial Release in Improving Pain, Function and Balance in Females With Patellofemoral Pain A Randomized Clinical Trial 2026-05-10 anticipated 20 Recruiting https://irct.ir/trial/88926 interventional Randomization: Randomized, Blinding: Single blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Randomization description: Participants will be randomly assigned into two groups using block randomization with a block size of six, Blinding description: It is important to note that the examiners will be blinded to the randomization process, which will be carried out by an independent individual. Moreover, evaluation and intervention procedures will be conducted by two separate physiotherapists to minimize bias. N/A Patellofemoral pain. Intervention 1: Intervention Group: Diaphragmatic Myofascial Release and Exercise Therapy. Participants in the intervention group received diaphragmatic myofascial release combined with therapeutic exercises. For diaphragmatic release, the patient was positioned in supine. The therapist stood at the head of the table and placed bilateral manual contact beneath the lower costal cartilages (ribs 5–10) using the hypothenar eminence and the last three fingers of both hands. During inspiration, gentle traction was applied in a cephalad and slightly lateral direction while simultaneously facilitating rib elevation. During expiration, the therapist gradually deepened the manual contact toward the inner costal margins, following tissue relaxation. Each session of diaphragmatic release lasted approximately 5 minutes. Intervention 2: Control Group: Therapeutic Exercise. Participants in the control group received therapeutic exercises only. Yes - There is a plan to make this available What will be shared: Information collection form including primary and secondary outcomes, informed consent form and SPSS file When: After publication the results of the study To whom: Researchers working in academic and scientific institutions Conditions: Only for recording information in scientific databases Where to obtain: Correspondence with the project manager by email. Haghighat_fa@yahoo.com How to obtain: Maximum one month after sending the request by email Comments:
public Farzaneh Haghighat
Mehr Building, Shahid Chamran Hospital, Shahid Chamran Boulevard
Shiraz Iran (Islamic Republic of) 7194815644 +98 71 3624 0101 haghighat_fa@yahoo.com Shiraz University of Medical Sciences scientific Farzaneh Haghighat
Mehr Building, Shahid Chamran Hospital, Shahid Chamran Boulevard
Shiraz Iran (Islamic Republic of) 7194815644 +98 71 3624 0101 haghighat_fa@yahoo.com Shiraz University of Medical Sciences Iran (Islamic Republic of) Diagnosis of unilateral PFP by a qualified physician or physiotherapist Females between ۱۸ and ۳۵ years Presence of anterior or retro patellar knee pain during at least two of the following activities: squatting, kneeling, ascending/descending stairs, prolonged sitting with flexed knee, running, jumping pain on palpation of the medial or lateral patellar facet, or the anterior aspect of the medial or lateral femoral condyle. Duration of symptoms for more than ۸ weeks Pain intensity of ≥۳ on the NRS (numerical rating scale) during the week before assessment scoring less than ۸۵ out of ۱۰۰ on the Kujala anterior knee pain scale (AKPS) positive patellar apprehension test (sensitivity: ۸۶.۷%, specificity: ۸۶.۷%) Willingness to participate and provide informed consent 18 years 35 years Female History of knee surgery, trauma, or patellar dislocation Evidence of other knee pathologies (e.g., meniscal tear, ligament injury, or osteoarthritis) Active inflammatory conditions affecting the lower limb Neurological, systemic musculoskeletal and metabolic disorders (e.g., multiple sclerosis, rheumatoid arthritis and diabetes respectively) History of fracture, dislocation or surgery of lower limb or any condition affecting gait Marked structural deformity and known pathological condition of back, hip, and ankle Respiratory disorders that could influence diaphragm function (e.g., COPD, asthma) Cardiovascular disorders metabolic disorders Professional athlete (an individual who regularly participates in a specific sport at least three times per week for a minimum of two hours) Participation in other physiotherapy treatments or structured exercise programs in the past ۶ months Pregnancy the patient should not be in the menstrual phase at the time of assessment Body Mass Index (BMI) > ۳۰ M22.2 Patellofemoral disorders Treatment - Other Treatment - Other Intervention Group: Diaphragmatic Myofascial Release and Exercise Therapy. Participants in the intervention group received diaphragmatic myofascial release combined with therapeutic exercises. For diaphragmatic release, the patient was positioned in supine. The therapist stood at the head of the table and placed bilateral manual contact beneath the lower costal cartilages (ribs 5–10) using the hypothenar eminence and the last three fingers of both hands. During inspiration, gentle traction was applied in a cephalad and slightly lateral direction while simultaneously facilitating rib elevation. During expiration, the therapist gradually deepened the manual contact toward the inner costal margins, following tissue relaxation. Each session of diaphragmatic release lasted approximately 5 minutes. Control Group: Therapeutic Exercise. Participants in the control group received therapeutic exercises only. Pain intensity. Timepoint: Before intervention; One day after intervention period. Method of measurement: Numerical pain rating scale. Physical function. Timepoint: Before intervention; One day after intervention period. Method of measurement: The Kujala Anterior Knee Pain Scale (KANPS). Dynamic balance. Timepoint: Before intervention; One day after intervention period. Method of measurement: Modified star excursion test. Shiraz University of Medical Sciences Approved 2025-12-17 Ethics committee of Shiraz University of Medical Sciences Ethics committee, Research and Technology Vice-Chancellor, 7th floor, Central building of Shiraz University of Medical Sciences, Zand Street Shiraz Fars Iran (Islamic Republic of)