Gastrocnemius Myofascial Release in Females With Knee Osteoarthritis

Inclusion Criteria: * Patients' ages ranged between 45 and 55 years . * BMI ≤35 * Patients with a diagnosis of primary KOA according to the American College of Rheumatology classification at the screening visit . * Onset of symptomatic knee osteoarthritis of ≥3 months * Patients with grade II and III OA of the Kellgren and Lawrence system for classification of osteoarthritis . * At least one active trigger point in GM * If both knees were diagnosed as OA, the most affected one was selected. * Current pain intensity on the Visual Analogue Scale (VAS) ≥4/10. * Subjects have sufficient cognition that enables them to understand the requirements of the study, comply with the study procedures, and visit schedule. * Diagnostic Criteria of KOA A diagnosis of knee osteoarthritis was made when knee pain is present, plus Osteophytes on radiographs, plus at least 1 of the following 3: * Age \> 50 years * Morning stiffness \< 30 minutes * Crepitus on active motion Exclusion Criteria: * Patients with any previous knee surgeries or lower limb fractures. * Chronic inflammatory diseases such as rheumatoid arthritis. * Signs of moderately significant knee synovitis include a warm and swollen (red) knee * History and/or physical examination findings compatible with knee internal derangement (e.g, positive Thessaly test). * Pregnancy * Patients who had undergone arthroscopy or treatment with intra-articular hyaluronic acid during the previous 6 months . * Use of NSAIDs one week before the screening visit . * Orthopedic diseases, or congenital musculoskeletal deformities, or neurological disorders that may affect or interfere with the therapeutic effect. * Participated in other intervention studies (strength training program or physiotherapy treatment for knee osteoarthritis) in the current period and the past 6 months . * Habitual use of psychotropic or narcotic analgesics for ≥1 week within 8 weeks prior to screening .