• Lionel Pannunzio PT / SCS

Anterior Knee Pain in Soccer Players - Patellofemoral Pain Syndrome (PFPS) | Weston | Florida


Introduction


Anterior Knee Pain or Runner’s knee are common terms used to describe any one of several conditions that cause pain around the kneecap, also known as the patella.


The two most common condition include

  • anterior knee pain syndrome also known as Patellofemoral Pain Syndrome (PFPS), patellofemoral malalignment, chondromalcia Patella

  • Illiotibial Band Syndrome ( ITBS)

Today I will share with you the latest research about Patellofemoral Pain Syndrome (PFPS) and we will talk about ITBS in the next couple of weeks.







What is Patello-Femoral Pain?


Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint.) Pain occurs when friction is created between the under surface of the kneecap and the thigh bone (femur). The pain also is usually accompanied by tenderness along the edges of the kneecap.





Incidence



PFPS is one of the most common knee injury in soccer players. It accounts for 13-26 % of the total




Causes of PFPS


Current research indicates that PFPS is an "overuse syndrome," which means that it may result from repetitive or excessive use of the knee.

Other contributing factors may include: - Weakness, tightness, or stiffness in the muscles around the knee and hip - An abnormality in the way the lower leg lines up with the hip, knee, and foot - Improper tracking of the kneecap

These conditions can interfere with the ability of the kneecap to glide smoothly on the femur (the bone that connects the knee to the thigh) in the femoral groove (situated along the thigh bone) during movement. The friction between the under surface of the kneecap and the femur causes the pain and irritation commonly seen in PFPS. PFPS often occurs in soocer players who have suddenly increased their level of activity (games and practices) too fast.




How does it fell ?


Besides the typical pain during games, Soccer Players with PFPS may also experience: Severe pain the day of the game or next day Pain while bending or straightening the knee on bed Pain when walking up or down stairs or hills Pain when walking on uneven surfaces Pain that increases with activity and improves with rest Pain that develops after sitting for long periods of time with the knee bent A "crack" or "pop" when bending or straightening the knee




Lower Extremity Alignment, Dynamic Valgus and PFPS



A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking and patellofemoral pain.

Dynamic Valgus happens during normal single leg activities. With poor mechanical control of the Pelvis and Lower Extremity the knee will go into an Excessive Dynamic Valgus . In this case the Patella will come under excessive stress. All these deviations are even more noticeable when striking on the foot during running.


Excessive Dynamic Valgus will create

  • Pelvis Drop

  • Femur rotates internally

  • Tibia also rotates internally

  • Foot collapses inwards (excessive pronation)

During excessive dynamic Valgus the Patella has no other option than follow the femur / tibia / foot deviations and it will track laterally creating more friction in the lateral side with the typical lateral-patella pain




Overuse: Too much load , too Fast as the cause of PFPS


Overuse, in this case means an overload to a dysfunctional Patellofemoral joint.


Think about building friction over time:


  • more training ( rapid increase in mileage ),

  • more intensity of the training (hill workouts , repetitive jumps)

  • more frequent races

  • Returning to run after a long period of inactivity

  • Too much Load, applied too fast...

In these situations, the kneecap will became irritated first and more painful over time. Runner will continue training at the beginning because pain usually goes away with warm up. As the condition progresses and the root of the problem is not solved , pain will continue increasing in intensity and it will not disappear with warm up, continuing getting worse till one day the athlete can not compete anymore.


So we as therapist will look for recent alterations in sporting activities. Any changes in the frequency, duration and intensity of training should be investigated in detail. The training program also should be appraised for errors, including increasing the exercise intensity too rapidly, inadequate recovery time and extreme hill workouts. It must be considered that PFP may present as an acute re-exacerbation of the chronic condition



Stay tuned for PART II when we discuss more in detail the defecits associated with this condition and how to address them





Conclusion:


  • Patellofemoral pain is very common in Soccer players.

  • The main symptom is pain in the anterior aspect of your knee

  • Pain is highly associated with the activity and epscially to a ramp-up in the activity like pre-season training or a rapid increase in the frequency and the intensity of the games or practices

  • A malaligment of the Lower extremity as a whole will cause the knee cap to friction excessively against the underneath Femur creating the pain and the irritation A good return-to-play training with field work is mandatory if you want to avoid another injury




Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages


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Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”








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