• Lionel Pannunzio PT / SCS

Patellofemoral Pain Syndrome (PFPS) in Soccer Players - Part II | Weston | Florida


Introduction


Last week we talked about the generalities of Anterior Knee Pain. Today we will try to explain the causes of Patellofemoral Pain syndrome ( PFPS). Addressing the root (s) of the problem is the only real solution if you want to resolve this pain forever.







What is Wrong with my Knee you may ask...


There are many potential factors. (see picture below)



1️. Core weakness can contribute to the development of Patellofemoral Pain Syndrome (PFPS).


Core muscles control the position of the pelvis and in conjunction with the hip muscles maintain proper alignment of this area. Weakness in core musculature could result in too much anterior or lateral ( or both) tilt of the pelvis forcing the lower extremity to deviate from normal positions. Sometimes we find poor core endurance which is an inability of the core to sustain a work load for long periods of time. The player is ok for some time but then when core muscles fatigue, this person will start showing these abnormalities we just mentioned.




2️. Internal rotation of the femur


Internal rotation of the femur can cause poor tracking of the patella in the trochlear groove of the femur. This could be due to weak core musculature, weak hip extensors or weak external rotators allowing the femur to deviate internally while under weight-bearing




3️. ITB tightness


This “abnormal” position of the femur will increase tension in the ITB creating pain. The ITB is also connected to the patella so tension in this muscle will track the patella laterally as well




4️. Quadriceps Strength


Research shows that Quadriceps size is highly related with patellofemoral pain. A decrease in the size of the Quadriceps is always found in players with long standing Anterior Knee Pain. Besides the quadriceps weakness as a whole, some researches like to link weakness in the vastus medialis ( one of the four muscle of the quadriceps) with Patellar pain . When the VMO muscle is too weak, the vastus lateralis will create a lateral (outwards) patellar tilt.




5️. Foot position


Foot positioning is also a risk factor for developing PFPS, too much pronation of the foot will contribute to the misalignment of the tibia and femur creating uneven friction in the Patellofemoral Joint






Principles of Treatment - Treat the cause, not the symptoms


When treating Soccer Players with PFPS all these factors mentioned above must be taken into account in order to successfully return these athletes to sports participation: Too much training, too quick ? … Weak hip muscles ?... lack of flexibility in the thigh? … flat foot?....

That’s why a comprehensive assessment followed by a treatment tailored to the findings with emphasis on addressing and /or correcting the deficits this athlete may have is my opinion the best way to recover from this condition

A comprehensive rehabilitation must include

  • proximal (trunk and hip) Approach and

  • local (knee) Approach,

  • distal (foot) Approach as well as

  • Education with emphasis on load management

1️. Proximal Approach: Restore muscle strength of the Core and the Hip


Hip dominant exercises to increase strength of Hip extensor and Hip External rotators muscles







2️. Local Approach


Release any tension in ITB and lateral side of the thigh and knee

Restore Muscle Strength and size of quadriceps with emphasis on Vastus Medialis Obliquus





3️. Distal Approach


Passive treatment: Foot orthotics and Knee Taping or Knee Braces may also have a role in helping with the alignment part of the problem. Research supports all three for short term pain control.






Conclusion:


  • Patellofemoral pain is a complex condition.

  • Solving this condition requires a comprehensive approach to correct all deficits that can be causing the anterior knee pain .

  • Research shows that a combination of Hip and Knee Strengthening exercises is the best approach to PFPS

  • Taping and Orthotics are secondary tools that can be using in the treatment of PFPS.



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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