A postpartum phase begins shortly after birth and lasts around one and a half months. Women's bodies alter dramatically during pregnancy. As a result of these changes, both joints experience tension and sagging support structures caused by the actions of the relaxing hormone. Together with the physiological¹. Knee pain can develop during pregnancy due to several changes that occur during the pregnancy. In pregnancy, there is an average weight gain of 0.29 kilograms per week in the lower trunk, which may be one of the most significant factors. Age increases the prevalence of knee pain, but it can occur at any age. Known risk factors for knee pain include genetic predisposition, female gender, advanced age, traumatic injury, obesity, and muscle weakness ². During pregnancy, knee pain, including patellofemoral disorders, is not uncommon. In motor activities, the part of the body most commonly affected by knee pain is exposed to high-shear forces ³. Changes in posture, weight gain, and lax ligaments can cause knee pain. Four months after delivery, knee pain symptoms have improved. The Patellofemoral disease causes back pain across the patella, especially when seated for long periods ⁴. Several factors contribute to this, including the increased weight of the foetus and placenta and hormonal changes that alter ligament laxity ⁵. A unique sense of anticipation and transformation characterizes the postpartum period. It is typical for triathletes to undergo a range of alterations in their lifestyle, as well as physiological and physical adjustments ⁶. In both genders, obesity and poor biomechanics increase the risk of knee osteoarthritis ⁷. Knee pain is prevalent among pregnant and postpartum populations. Biomechanical factors are deemed to play a more significant role compared to hormonal influences. Notably, regular exercise does not significantly contribute to either protection or vulnerability to lower extremity discomfort during pregnancy ⁸. Several research investigations revealed that pregnant females frequently experienced pronounced knee dysfunction linked to intensified levels of physical activity, comparatively young age, augmented body mass index ⁹, and a previous medical history of knee complications ¹⁰. It may carry out to the postpartum hence our objective was to evaluate the effectiveness of Manual Therapy and Electrotherapy in treating postpartum knee joint pain in women by comparing their effects and differences. Both therapies have different mechanisms of action and there is a need to investigate the effect. The manual soft tissue release technique creates localized microtrauma, stimulating an inflammatory response that promotes healing and tissue remodelling. Additionally, it facilitates the mobilization of fascia, which can alleviate restrictions contributing to knee pain. The mechanical electrotherapy modalities help to modulate pain perception and promote healing. Electrotherapy can stimulate the release of endorphins and other neurotransmitters, which help in reducing pain perception and it can enhance cellular metabolism and regeneration, aiding in the recovery of damaged tissues as well.

The study aimed to compare the effectiveness of manual soft tissue release vs mechanical electrotherapy modalities in improving the pain and ADL outcomes among postpartum knee pain individuals.

Seventy‑three subjects were enrolled; upon screening based on the eligibility criteria, only sixty members were included in the study. The mean age of the subjects in the study was 28.5 ± 2.1, Group - A mean 28.5 ± 2.1, and Group - B mean 27.2 ± 2.1, respectively (Table 1).

The result of the study revealed that the subscales of KOOS pain, symptoms, and ADL have significantly improved in both groups (p < 0.05) (Table 2). however, in between group analyses, it is found that group A had greater significant improvements (p < 0.05) in all three sub-scales pain (12.56), symptom (12.8) and ADL (11.6) than group B. on comparing the sub-scales the KOOS- symptom showed greater differences between the group (effect size- 0.81) relatively to KOOS-pain (effect size- 0.73), and KOOS- ADL (effect size- 0.70) (Table 3). A statistically significant difference exists in postpartum knee joint pain, symptoms, and ADL (P < 0.05). This means that manual physiotherapy is more efficient and effective than mechanical physiotherapy.

Table 1 indicates the mean age of participants involved in manual physiotherapy and mechanical physiotherapy in this study.

Table 2 indicates the KOAS Score of participants involved in manual physiotherapy and mechanical physiotherapy in this study.

Table 3 indicates the KOAS Score of post-therapy in manual physiotherapy and mechanical physiotherapy groups.

In 2021, Stein BP discovered that anterior laxity increased only in the frontal plane during the second trimester and vice versa. As a result of pregnancy, the foot undergoes structural changes, including a decrease in arch height and an increase in foot length and arch drop. Structural changes can influence changes in lower limb biomechanics in the foot and knee ligaments. ¹¹ Ericsson YB(2021) investigated the relationship between thigh muscle strength and knee pain in young women. The Spearman correlation was also used to estimate the relationship between body composition, muscle strength, knee pain, and physical activity. Weight-adjusted thigh muscular strength was lower in obese women than in normal-weight women (p≤0.001) ¹². In 2018, Zhou M conducted a cross-sectional study to investigate the impact of hormonal, reproductive, and obesity factors on the incidence of knee osteoarthritis in females of Chinese ethnicity. The research comprised a cohort of 7510 female participants with a mean age of 62.6 ± 8.6 years. The manifestation of obesity can potentially amplify the influence of reproductive and hormonal factors on Knee Osteoarthritis (KOA). Several independent risk factors have been identified for knee osteoarthritis (KOA), including but not limited to having multiple pregnancies, utilizing oral contraceptives, and engaging in hormone therapy (HT). Obesity and oral contraceptives are associated with knee discomfort ¹³. As a component of the research endeavour, Jafarian conducted an assessment of the efficacy of a more extensive lumbar support intervention as a prompt rehabilitative measure aimed at alleviating posterior pelvic pain among women who have recently given birth and contrasted the results with those of a group subjected to a narrower pelvic support regimen. Based on their findings, the authors have determined that the provision of comprehensive lumbar support leads to more effective pain management, reduced disability, and an enhanced ability to engage in daily activities among expectant mothers ¹⁴. It has been demonstrated that the central posterior-anterior (PA) mobilization significantly affects pain intensity and EMG activity of the erector spinal muscle in postnatal females suffering from mechanical low back pain and that functional capacity has also been increased ^{13. A}n increase in trunk flexion strength and a positive change in body image can be expected due to physiotherapy interventions. Despite the feasibility of conducting a clinical trial to investigate these interventions, it is recommended that further preliminary studies be conducted 14. Modifications in mechanical loading patterns can heighten the likelihood of developing osteoarthritis. The potential influence of decreased knee moments on the mechanical stimulation of cartilage in postpartum women warrants further investigation in the context of measures of cartilage health, with the ultimate goal of establishing any potential associations with the onset of osteoarthritis 11. Andersen presented findings on the efficacy of physical therapy interventions in addressing sacroiliac joint pain in a postpartum patient who met the diagnostic criteria for the Laslett cluster. A multimodal approach that combines pelvic floor muscle exercise and manual therapy has demonstrated a favourable effect on various outcome measures, such as pain levels, perceived disability, and perceived rating of change, in postpartum patients suffering from sacroiliac joint pain. Physical therapists can reduce pain and disability in postpartum clients with pelvic girdle pain by implementing a number of evidence-based interventions ¹⁵. According to the study of Çapik et al., postpartum women reported a moderate level of comfort. As a precaution, midwives and nurses should determine the needs and expectations of mothers during the postpartum period as well as provide quality postpartum care ¹⁶.

The main finding of this study is that the mechanical physiotherapy results were beneficial for days, and the patient received relief. However, compared to other treatments, the results of this study provide further evidence that patients treating postpartum knee joint pain can achieve more benefits from manual therapy than mechanical physiotherapy. This study may help clinicians and physical therapists select and rehabilitate a particular population.