Title :EFFECTIVENESS OF NEUROMUSCULAR CONTROL TRAINING EXERCISES ON PAIN, PROPRIOCEPTION, DYNAMIC BALANCE AND FUNCTIONAL STATUS IN YOUNG ADULTS WITH UNILATERAL CHRONIC PATELLOFEMORAL PAIN SYNDROME-A RANDOMIZED CONTROLLED TRIAL

Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition with a high incidence in young active adolescents, as well as in other age groups.
The  prevalence  of  PFPS is twice as high in women as in men, and this high prevalence imposes health care and socioeconomic costs on communities. Inflammation, stiffness, giving way, crepitation, and diffuse retro patellar pain during functional activities, such as stair climbing, are prevalent among these patients.

PFPS development is probably multifactorial with various functional disorders of the lower extremity. Several risk factors have been proposed as possible parameters involved in pathogenesis of PFPS. These risk factors are classified as intrinsic or extrinsic risk factors. Due to lack of proprioception inputs in patients with PFPS are prone for loss of balance and affect their overall function. Proprioceptive rehabilitation decreases the incidence of injury or improves the results of treatment. Proprioceptive deficiency has been shown to cause abnormal stress accumulation in the surrounding tissue by obstructing the movements and consequently contributes to the occurrence of further problems in the joint.

Neuromuscular Control Training Exercises On Sens balance Mini board (Sensa move, Netherlands)  The performance of the exercises, administered according to the standardized protocols will be recorded by the researcher. It needs to be explained and the feet positioning on the board is to be identified. Before the first testing takes place, there will be an implementation phase about five minutes, in which the participant explores each task for 30 seconds to get familiar with the equipment and to find out the best feet positioning. Before the patient gets on the balance board, the calibration of the device will be done for each patient in order to make sure that the red spot comes to the middle of the screen and the balance board is completely horizontal. Patients will be asked to take off their shoes and their feet were placed at the specific places of the round balance board indicated by the researcher. They will be allowed to hold the standing bars before the test starts. This will be very important because they could set their initial balance and get a confidence about the device. As the balance board is an unsteady surface, that will be important that the patients rely on the balance device, therefore the initial holding the standing bars will be very important and helpful. The patient will be in formed to release their hands when the test starts and trying not to hold and use the standing bars.

Conventional exercises will be given on daily basis (6 days/week) for 4 weeks. It includes semi squat, quadriceps isometric, terminal knee extension in supine position, terminal knee extension in sitting position, Clamshell exercise, Straight leg raise exercise and stretching of IT Band. TENS would be given for pain relief. This protocol will be followed for 4 weeks and progression will be done by adding weights as per patient’s tolerance.

Patients diagnosed with unilateral PFPS will be randomly allocated to two groups – Group 1 [Experimental] who will be administered Conventional exercises and Neuromuscular Control Training exercises on Sens balance Mini Board. Group2[Control],who will be administered only conventional exercises. Intervention duration will be of 4 weeks and outcome measures will be measured at the initiation of the study and at the end of 4th week. Intervention will be given on daily basis (6 days/week) for 4 weeks.

The patients will be screened on the basis of inclusion and exclusion criteria and their demographic data will be taken by an assessment performa . The researcher will ensure that the patient should not take any medications, is free from any injury, disease or symptoms that could affect the balance abilities and been a risk factor for the performances. Prior to the commencement of the study, detailed procedure of the study will be explained to the patients  and assigned informed consent form will be taken from them . Patients will be allocated to any of the two groups by random allocation using SNOSE method. Appropriate physiotherapy interventions will be applied to the patients in both groups and assessment of outcome measures will be done at the initiation and after 4 weeks. In experimental group, patients will receive Neuromuscular control training exercises on Sens balance Mini board in addition to the conventional therapy.