Patellafemoral Pain Syndrome Rehab

CRYSC Head Athletic Trainer, Julie Graves has seen an increase in Patellafemoral Pain Syndrome (PFPS) among adolescent athletes. This condition presents with general knee pain that can be sharp with certain movements and dull at other times. It normally is a gradual onset of pain without remembering a specific mechanism of injury or when the pain started. When diagnosed early, PFPS can be treated with at-home rehab or, if serious enough, formal physical therapy.

UCHealth + CU Sports Medicine and Orthopedics has a variety of different locations to help your child get back to the soccer field at 100%. If this is something you think your child may be dealing with, please reach out to our Head Athletic Trainer, Julie Graves, for assistance. Below is the at-home rehab program for PFPS.

Step 1: Foam Rolling

Foam rolling is KEY to muscle recovery and rejuvenation. I recommend foam rolling the whole lower body (quads, hamstrings, IT Band, glutes, and calves) to prevent injury and increase performance before and after practice or morning and night. A LAX ball, baseball, or softball is better for the calves and hamstrings as it has a smaller surface area.

• Note: It is very important when foam rolling to go slow and controlled. This should not be a quick, rushed motion. There are trigger points/knots/pain points in every muscle in our body so when you go over one of these knots/pain points, stop on them for at least 30 seconds to allow it to release. Then slowly roll down the muscle until the next one is found. This can be pretty uncomfortable/painful but it is GOOD pain!
• Heating before foam rolling is also beneficial to warm up the muscles. You can use an electric heating pad for 10-15 minutes or take warm Epsom salt bath for 15 minutes.

Step 2: Stretch

1. Quads/hip flexors: standing quad stretch, kneeling lunged hip flexor stretch. Make sure the knee does not go over the front toe and push your hips into the ground.

2. Hamstring stretch: keep your legs straight, bend over, and touch your toes.

3. Glutes: Sit on the ground, bend one leg, and put it over the knee in a figure 4 position. Reach your hands through and pull your legs toward your chest.

4. Calves: Put your foot on a wall with your heel still on the ground. Hold that with a straight leg for 30” and then bend the knee but keep the foot in place.

Step 3: Strengthening Exercises

1. Seated leg extensions with a 3-second hold 2-3 sets of 10-15 reps

2. Straight leg raise: lying on your back, flex your quad, and then raise the leg up straight to about 90 degrees and slowly bring it back down to the ground 3×10

3. Straight leg raise on your stomach: Lie on your stomach, and lift your leg straight up behind you (toward the ceiling), making sure your hips stay on the ground. Lift your toes about 15 centimeters off the floor, hold for about 6 seconds, then lower slowly.

4. Wall slide with ball squeeze: Stand with your back against a wall and with your feet about shoulder-width apart. Your feet should be about 30 centimeters away from the wall. Put a ball about the size of a soccer ball between your knees. Then slowly slide down the wall until your knees are bent about 20 to 30 degrees. Tighten your thigh muscles by squeezing the ball between your knees. Hold that position for about 10 seconds, then stop squeezing. Rest for up to 10 seconds between repetitions.

5. Body Weight Squats: 3×10

6. Clamshell exercise

7. Progression with bands

Step 4: Dry Needling

The technique uses a “dry” needle, one without medication or injection, inserted through the skin into areas of the muscle. Other terms commonly used to describe dry needling, include trigger point dry needling, and intramuscular manual therapy. Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles and is supported by research. Dry needling is done by physical therapists and chiropractors. If you need a recommendation on where to get dry needling, please reach out to Julie Graves.

Find out more about the CRYSC Sports Medicine Program by visiting our website. If you would like more information on natural solutions and the athlete, please don’t hesitate to reach out to CRYSC’s Head Athletic Trainer, Julie Graves, at [email protected].