Patellofemoral Pain SyndromeSCS-GRAS-PFPSNCT07589933
Strain Counterstrain Versus Graston Technique for Patellofemoral Pain Syndrome
A study testing Strain Counterstrain and Graston Technique in people with Patellofemoral Pain Syndrome, run by Green International University at 1 site in Pakistan.
Trial summary
This clinical trial compares the effects of Strain Counterstrain technique versus Graston Technique on pain and range of motion in patients with patellofemoral pain syndrome. Adults with patellofemoral pain syndrome were included in this study. Read more about this study
- Who is it for?
- Ages 18 to 45 years
- Conditions the study is for
- Patellofemoral Pain Syndrome
- What is being tested?
- Strain Counterstrain and Graston Technique
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 sitePakistan
- Study dates
- 2 Nov 2025to 5 May 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 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).
Who cannot join
- 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.
Trial locations and contacts
1 site in 1 country.
Pakistan1 site
Sir Ganga Ram Hospital, Department of Physical Therapy
Lahore, Punjab Province, 54000
About this study
Official title: Immediate Effects of Strain CountetStrain Versus Graston Technique on Pain and Range of Motion in Patients With Patellofemoral Pain Syndrome: A Randomized Clinical Trail.
This clinical trial compares the effects of Strain Counterstrain technique versus Graston Technique on pain and range of motion in patients with patellofemoral pain syndrome.
Adults with patellofemoral pain syndrome were included in this study. A total of 60 participants were divided into two groups with 30 patients in each group.
Read more
One group received Strain Counterstrain technique and the other group received Graston Technique. Pain was assessed using the Kujala Scoring System and functional status was measured using a substructural questionnaire. Range of motion was also evaluated before and after treatment.
The main goal of this study is to determine which technique is more effective in reducing pain and improving knee function in patients with patellofemoral pain syndrome.
Read the detailed description
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.
- Conditions
- Patellofemoral Pain Syndrome
- Being tested
- Strain Counterstrain, Graston Technique
- Keywords
- Strain Counterstrain, Graston Technique, Manual Therapy, Patellofemoral Pain Syndrome, Knee Pain, Range of Motion, Kujala Scale, Physical Therapy, Anterior Knee Pain, Randomized Clinical Trial
- Medical subject headings
- Patellofemoral Pain Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Strain CounterstrainProcedure or surgery
Also called Positional Release Therapy, SCS
Strain Counterstrain is a manual therapy technique that involves identifying tender points in muscles and fascia. The therapist passively positions the patient's body to a position of comfort that reduces or eliminates the tenderness. This position is held for 90 seconds to allow neuromuscular reset, followed by slow return to neutral. The technique aims to reduce muscle spasm, normalize proprioceptive activity, and decrease pain in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks.
Graston TechniqueProcedure or surgery
Also called Instrument-Assisted Soft Tissue Mobilization, IASTM
Graston Technique is an evidence-based form of instrument-assisted soft tissue mobilization (IASTM). It uses six specialized stainless steel instruments to scan, detect, and treat soft tissue lesions, scar tissue, and fascial restrictions. The instruments are used by trained clinicians to apply controlled microtrauma to affected areas around the knee, promoting tissue healing and remodeling. The goal is to break down adhesions, reduce pain, and improve range of motion and function in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks.
| Study group | Role | What they receive |
|---|---|---|
| Strain Counterstrain Group | Experimental | Participants in this arm received Strain Counterstrain technique for patellofemoral pain syndrome. This technique involves identifying tender points and passively positioning the affected tissue to a position of comfort to reduce pain and muscle spasm. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group. Receives: Procedure: Strain Counterstrain |
| Graston Technique Group | Experimental | Participants in this arm received Graston Technique, an instrument-assisted soft tissue mobilization (IASTM) therapy. This technique uses specialized stainless steel instruments to detect and treat soft tissue restrictions, scar tissue, and fascial adhesions around the knee. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group. Receives: Procedure: Graston Technique |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Pain and Function using Kujala Anterior Knee Pain Scale
The Kujala Anterior Knee Pain Scale, also known as Kujala Scoring System, was used to assess pain and functional limitations related to patellofemoral pain syndrome. This is a 13-item self-administered questionnaire evaluating symptoms such as pain during walking, stair climbing, squatting, running, and prolonged sitting. The total score ranges from 0 to 100 points, where 0 represents complete disability and 100 represents no disability. A higher score indicates less pain and better knee function. Change from baseline was calculated to determine treatment effectiveness.
Measured: Baseline and 12 weeks post-intervention
Secondary outcomes (2)
Change in Knee Range of Motion
Knee flexion and extension range of motion was measured using a standard universal goniometer. Active range of motion was recorded in degrees. Increased range of motion indicates improvement in knee function.
Measured: Baseline and 12 weeks post-intervention
Change in Functional Status
Functional status was assessed using a substructural questionnaire evaluating the impact of patellofemoral pain syndrome on daily activities such as walking, stair climbing, squatting, and prolonged sitting. Higher scores indicate better functional capacity.
Measured: Baseline and 12 weeks post-intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 May 2026
- Study start2 Nov 2025
- Primary completion29 Apr 2026
- Study completion5 May 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Patellofemoral Pain SyndromeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- This is a randomized, parallel-group interventional study. Participants with patellofemoral pain syndrome were randomly assigned in a 1:1 ratio to one of two treatment arms. Group A received Strain Counterstrain technique and Group B received Graston Technique. Both interventions were administered for the specified treatment period to compare their effectiveness on pain reduction and improvement in knee range of motion.
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Outcomes assessor
- Enrolment
- 60 participants (actual)
Sponsor and investigators
- Lead sponsor
- Green International University
- Sponsor type
- University, hospital or other
- Collaborators
- Sir Ganga Ram Hospital
- Responsible party
- Principal investigator, Saman Bukish Cheema, Green International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07589933
- Sponsor's protocol ID
- GIU/REC/26-28
- Acronym
- SCS-GRAS-PFPS
- Status last verified
- May 2026
- First submitted
- 10 May 2026
- Last updated
- 15 May 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Only IPD used in the results publication will be shared.
Study at a glance
From the registry record, last updated by the sponsor on 15 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Immediate Effects of Strain CountetStrain Versus Graston Technique on Pain and Range of Motion in Patients With Patellofemoral Pain Syndrome: A Randomized Clinical Trail.
- ClinicalTrials.gov ID
- NCT07589933
- Acronym / sponsor ID
- SCS-GRAS-PFPS / GIU/REC/26-28
- Conditions
- Patellofemoral Pain Syndrome
- Keywords
- Strain Counterstrain, Graston Technique, Manual Therapy, Patellofemoral Pain Syndrome, Knee Pain, Range of Motion, Kujala Scale, Physical Therapy
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 60 participants (actual)
- Lead sponsor
- Green International UniversityUniversity, hospital or other
- Collaborators
- Sir Ganga Ram Hospital
- Study start
- 2 Nov 2025 (actual)
- Primary completion
- 29 Apr 2026 (actual)
- Study completion
- 5 May 2026 (actual)
- First posted
- 15 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This clinical trial compares the effects of Strain Counterstrain technique versus Graston Technique on pain and range of motion in patients with patellofemoral pain syndrome.
Adults with patellofemoral pain syndrome were included in this study. A total of 60 participants were divided into two groups with 30 patients in each group.
One group received Strain Counterstrain technique and the other group received Graston Technique. Pain was assessed using the Kujala Scoring System and functional status was measured using a substructural questionnaire. Range of motion was also evaluated before and after treatment.
The main goal of this study is to determine which technique is more effective in reducing pain and improving knee function in patients with patellofemoral pain syndrome.
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, outcomes assessor)
- Number of arms
- 2
- Model description
- This is a randomized, parallel-group interventional study. Participants with patellofemoral pain syndrome were randomly assigned in a 1:1 ratio to one of two treatment arms. Group A received Strain Counterstrain technique and Group B received Graston Technique. Both interventions were administered for the specified treatment period to compare their effectiveness on pain reduction and improvement in knee range of motion.
| Arm | Type | Receives |
|---|---|---|
| Strain Counterstrain Group | Experimental | Procedure: Strain CounterstrainParticipants in this arm received Strain Counterstrain technique for patellofemoral pain syndrome. This technique involves identifying tender points and passively positioning the affected tissue to a position of comfort to reduce pain and muscle spasm. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group. |
| Graston Technique Group | Experimental | Procedure: Graston TechniqueParticipants in this arm received Graston Technique, an instrument-assisted soft tissue mobilization (IASTM) therapy. This technique uses specialized stainless steel instruments to detect and treat soft tissue restrictions, scar tissue, and fascial adhesions around the knee. Treatment sessions were administered 3 times per week for 12 weeks. 30 participants were assigned to this group. |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- 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.
Key exclusion criteria (5 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Strain CounterstrainAlso: Positional Release Therapy, SCSStrain Counterstrain is a manual therapy technique that involves identifying tender points in muscles and fascia. The therapist passively positions the patient's body to a position of comfort that reduces or eliminates the tenderness. This position is held for 90 seconds to allow neuromuscular reset, followed by slow return to neutral. The technique aims to reduce muscle spasm, normalize proprioceptive activity, and decrease pain in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks. | Procedure or surgery | Strain Counterstrain Group |
| Graston TechniqueAlso: Instrument-Assisted Soft Tissue Mobilization, IASTMGraston Technique is an evidence-based form of instrument-assisted soft tissue mobilization (IASTM). It uses six specialized stainless steel instruments to scan, detect, and treat soft tissue lesions, scar tissue, and fascial restrictions. The instruments are used by trained clinicians to apply controlled microtrauma to affected areas around the knee, promoting tissue healing and remodeling. The goal is to break down adhesions, reduce pain, and improve range of motion and function in patients with patellofemoral pain syndrome. Sessions were administered 3 times per week for 12 weeks. | Procedure or surgery | Graston Technique Group |
Primary outcome
Change in Pain and Function using Kujala Anterior Knee Pain Scale
Time frame: Baseline and 12 weeks post-intervention
The Kujala Anterior Knee Pain Scale, also known as Kujala Scoring System, was used to assess pain and functional limitations related to patellofemoral pain syndrome. This is a 13-item self-administered questionnaire evaluating symptoms such as pain during walking, stair climbing, squatting, running, and prolonged sitting. The total score ranges from 0 to 100 points, where 0 represents complete disability and 100 represents no disability. A higher score indicates less pain and better knee function. Change from baseline was calculated to determine treatment effectiveness.
2 secondary outcomes
Change in Knee Range of Motion
Time frame: Baseline and 12 weeks post-intervention
Change in Functional Status
Time frame: Baseline and 12 weeks post-intervention
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 May 2026.
- Individual participant dataSharing planned: Yes. Only IPD used in the results publication will be shared.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Strain Counterstrain and Graston Technique in people with Patellofemoral Pain Syndrome, run by Green International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 15 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Pain and Function using Kujala Anterior Knee Pain Scale (time frame: Baseline and 12 weeks post-intervention). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 May 2026.