Patellofemoral pain syndrome (PFPS) is one of the most common knee disorders among the active population. It is characterized by peripatellar pain during activity, descending stairs or with prolonged sitting. All of these tasks sound like a typical day for an adolescent student-athlete. The patellofemoral joint consists of the patella and its approximation within the distal femoral groove. The patella can become irritated if it is pulled out of alignment either by abnormal foot mechanics, tight muscles, weakness, muscle imbalance around the hip or due to core/pelvic instability.
As adolescent athletes go through growth spurts they become more susceptible to injuries. Some of this is due to growth plate stress, flexibility restrictions, core & pelvic weakness and difficulty with body awareness. This simple stretching and core routine can help to relieve stress on growth plates and tendon attachments, improve core/pelvic stability, create midline awareness, strengthen hip & upper thigh musculature and integrate the full body with the central nervous system & joint proprioceptors.
Below is a general home exercise program to begin 3-5x/week with your MDs approval. This is not a comprehensive program but rather something to get your young athlete started after having seen a Pediatric Orthopedic MD that has diagnosed PFPS or anterior knee pain.
2-3 reps of 20-30 second holds
Glutes- Pull the knee to your chest, side and across the body. If you notice that your opposite leg starts to rise off the table it may be due to tight hip flexors on the opposite side.
Hip flexors– Make sure the knee is behind the hip and avoid excessive lumbar arching. A good cue is to tighten your abs and glutes. Rotate and tilt to find tight areas.
Hamstrings– Focus should be on flexing at the hip, not reaching for the foot with the hands. Remember to rotate the leg to get all three hamstring muscles.
IT Band– In this photo we are stretching the Right leg. The Left leg is bent the Right is straight, both feet are flat and facing forward. Foam rolling along the IT Band can also be helpful.
Quads– Can also be done in standing, avoid excessive lumbar arching, sometimes a pillow needs to be placed under the stomach.
Gastroc/Soleus/Plantar– Add trunk rotation to find additional tight areas in all three positions.
Basic hip & core/pelvic strengthening
1-2 sets of 10 reps
These are some simple but effective exercises that I often prescribe after manual therapy prior to initiating our functional movement prep. They are fairly easy to perform correctly and take very little time. Start with 1-2 sets of 10 reps and progress from there. Make sure to avoid excessive lumbar sagging in the elevated positions, before adding sets or reps.
Bridging: Double leg– Lift the hips to equal height and lower slowly.
Bridging: Single leg– Make sure the opposite hip stays level, weight-bearing shin stays vertical. This will also provide active mobility for the hip flexors on the weight-bearing leg as the hips are pushed to full extension.
Clam shell: Side-lying– Rotate the top leg up without rolling the hips backward.
Clam shell: Bridging– Adds core activation on the weight-bearing side, keep the pelvis squared avoid over rotating the top hip.
Prone plank + alternating leg lift– Maintain a neutral lumbar spine to avoid sagging before initiating alternating leg lifts. Leg lift only needs to be a few inches off the ground. Stop if you are unable to maintain core control.
Full Body Integration of systems
1-2 sets of 10 reps
It is important to integrate the injured joint or muscle with rest of the body in functional movements. Our muscles need to be able to load and unload force in a weight-bearing tri-planar environment. Isolated exercises can be therapeutic but don’t always yield functional gains. The exercises above do not mimic any functional activity or sporting movement, however they can train and teach the athlete how to activate under utilized muscles, control pelvic position and begin to create basic strength without irritating the knee. The exercises below are just two of the many movements we use to train the entire system to work in unison by controlling body weight transfer against gravity while mimicking more functional and athletic positions.
Split stance diagonal reaching + weight transfer– This should be a smooth consistent speed reach across the body to about 8-12 inches in front of the opposite knee followed by a reversal of weight shifting to the rear leg reaching up and back. There should be knee flexion in each position that does not exceed the toe. Repeat in the opposite stance.
Single leg diagonal reach– A similar movement in single leg stance. This is not a deep knee squat, make sure that the knee does not travel inward past the medial part of the shoe (valgus) or outward past the lateral part of the shoe (varus thrust). Repeat in the opposite stance
These are just a few of the exercises we use at Catz Physical Therapy & Sports Performance to retrain and rehab our young athletes as well as adults to get them back to their desired performance arena. For more info call for an appointment (626) 356-0599