<b>Immediate Effects of Strain Counter-Strain Versus Graston Technique on Pain and Range of Motion in Patients with Patellofemoral Pain Syndrome</b>

Background: Patellofemoral pain syndrome is a common knee disorder characterized by anterior or peripatellar pain aggravated by activities that load the patellofemoral joint, including squatting, stair climbing, running, and prolonged sitting. Manual therapy techniques such as Strain Counterstrain and the Graston Technique are used clinically to reduce pain and improve mobility, but direct comparative evidence remains limited. Objective: To compare the short-term effects of Strain Counterstrain and the Graston Technique on pain intensity and knee range of motion in patients with patellofemoral pain syndrome. Methods: This assessor-blinded, parallel-group randomized controlled trial was conducted at the Department of Physiotherapy, Sir Ganga Ram Hospital. Ethical approval for this study was obtained from the Ethics Committee of Green International University under approval number NTC 07589933, Sixty participants with patellofemoral pain syndrome were allocated equally to Strain Counterstrain or Graston Technique groups. Both groups received 12 treatment sessions over four weeks. Pain was assessed using the Numerical Pain Rating Scale, and knee flexion and extension range of motion were assessed clinically. Data were analyzed using SPSS version 26. Because outcome variables were not normally distributed, Wilcoxon signed-rank and Mann-Whitney U tests were used. Results: Pain improved significantly in both groups, with large within-group effects for the Graston Technique (r = 0.90) and Strain Counterstrain (r = 0.89). Extension range of motion also improved significantly in both groups. Between-group analysis favored Strain Counterstrain for pain change (U = 12.00, p < 0.001) and extension change (U = 24.00, p < 0.001), while flexion change favored the Graston Technique (U = 63.00, p < 0.001). Conclusion: Both interventions produced short-term improvement in patellofemoral pain syndrome, with Strain Counterstrain showing stronger effects for pain reduction and extension recovery, and the Graston Technique showing comparative advantage for flexion change.