Soccer Players at Risk for Patellofemoral Pain
January 25, 2005
By: Steve Siwy for Knee1.com
Perhaps unsurprisingly, soccer players often suffer from pain around the front of the knee, also known as “patellofemoral” pain. Ballhandling, quick stops, and changes of direction place high amounts of stress on the joint and the soft tissue of the knee, and any existing misalignments of the kneecap can become a painful liability.
Many times this pain is the result of patellofemoral dysfunction, an injury that occurs in the cartilage at the interface between the patella (kneecap) and the femur (thigh bone). When the patella is subject to excessive pressure against the femur, or is aligned improperly with the groove at the end of the femur along which it slides (the trochlear groove), the cartilage can become irritated or wear away. This can lead to chondromalacia, in which the cartilage underlying the patella is softened or frayed, causing pain and inflammation in surrounding tissue.
Patellofemoral pain may also originate in the soft tissue surrounding the kneecap. The exertions of playing soccer may cause the athlete to strain the patellar tendon connecting the kneecap to the tibia (shinbone), the quadriceps tendon connecting the kneecap to the quadriceps muscle, or the retinaculum, which supports the kneecap on either side.
Depending on the nature of the symptoms and their underlying causes, doctors may prescribe various treatments for patellofemoral pain. As always, the best option for athletes is to attempt to prevent injury altogether (especially for women, whom studies have shown are twice as likely to be injured as male soccer players). Staying in condition, including during the off-season, has been shown to reduce an athlete’s chance of injury. In addition, the American Academy of Orthopaedic Surgeons advises athletes to be sure to warm up and stretch before any exercise, and to increase training gradually and avoid sudden changes in exercise intensity.
If patellofemoral pain does develop, acute treatment (i.e. first aid) begins with resting the knee, and avoiding activity that exacerbates symptoms (to keep an athlete in condition while avoiding high-impact or weight-bearing exercise, doctors often recommend swimming). Complementary treatments for symptoms might also include icing the knee, taking nonsteroidal anti-inflammatory medication, and perhaps a knee brace or other form of compression. Especially if the problem stems from a misaligned patella, a compression brace or sleeve, or tape may help symptoms by keeping the kneecap tracking properly in the trochlear groove.
Once pain and swelling are dealt with, further treatment may be necessary. The athlete may be advised to stretch the tendon and strengthen the muscles around the knee. In particular, hamstring stretches can be helpful, especially for young soccer players whose tendons may become tight as they grow. Exercise for the quadriceps muscle is also useful in conditioning the knee against patellofemoral pain. During any prescribed exercise or reconditioning, the doctor may find it appropriate (and the patient more comfortable) to continue to wear a knee brace, sleeve, or tape to stabilize or align the joint.
In extreme cases, of course, surgery may be necessary. If pieces of kneecap cartilage need to be removed, the surgeon will usually perform the procedure arthroscopically, with pencil-thin tools through a few, small incisions. If the patella is misaligned, the doctor may opt to expose the knee and realign it.