When soccer players suffer from pain around the front of their knee, they are likely experiencing a condition known as patellofemoral pain. This pain may be caused by soft cartilage under the kneecap (patella), referred pain from another area such as the back or hip, or soft tissues around the front of the knee.
Among soccer players, soft tissue pain in the anterior or front portion of the knee is fairly common. This pain may result when soccer players strain their patellar tendon, which connects the kneecap to the lower leg bone, the quadricep tendon above the kneecap or the retinaculum (which supports the kneecap on both the left and right sides). These tissues can be injured directly or become painful due to overuse.
Some patellofemoral pain can result if a soccer player's kneecap is abnormally aligned. If the patella is not correctly aligned, it may come under excessive stress, particularly with vigorous activities. Improper alignment also can cause excessive wear on the cartilage of the kneecap, which can result in chondromalacia (a condition in which the cartilage softens). This condition may cause the athlete to feel a painful sensation in the underlying tissue or irritation of the synovium (joint lining).
Treating Patellofemoral Pain
Treatment depends on the specific problem causing the pain. If the soft tissues (retinaculum, tendon or muscle) are the source of the pain, then stretching and strengthening can be helpful to make the support structures more resilient and flexible. Strengthening the quadriceps muscle group also is very important in controlling the knee cap and treating anterior knee pain. Hamstring stretching (rear thigh) also can be helpful, especially among young soccer players. These tendons often become tight during growth, which increases pain above the kneecap.
Other treatments for soccer players experiencing this type of pain may involve exercises to build the quadriceps muscle, taping the patella, or using a specially designed brace, which provides support specific to the problem. Using ice and non-steroidal anti-inflammatory medications also can be helpful. Soccer players may need to temporarily modify physical activities until the pain decreases.
In more extreme situations, a specific surgical procedure may be needed to help relieve the pain. If the cartilage under the soccer player's kneecap is fragmented and causing mechanical symptoms and swelling, arthroscopically removing the fragments may be helpful. If the patella is badly aligned, however, a surgical procedure may be needed to place the kneecap back into proper alignment, thereby reducing abnormal pressures on the cartilage and supporting structures around the front of the knee. Some soccer players, particularly those who have had previous knee surgery, may experience pain in the soft tissue around the patella, which may require resection (removal).
Controlling or Preventing Patellofemoral Pain
Conducting good general conditioning is important. Soccer players should remember to stretch to keep the supporting structures around the front of the knee flexible and less likely to be irritated with exercise. Proper training, without sudden increases of stress to the front of the knee, will help avoid pain. Soccer players who are prone to anterior knee pain should avoid running stadium steps or hills, exercising on the Stairmaster and doing squats with high flexion (bend) to help prevent injury.
Peter H. Edwards, Jr., M.D. is an orthopedic sports medicine specialist at the Ohio Orthopedic Center of Excellence in Columbus, Ohio. He specializes in lower extremity sports medicine with an emphasis on soccer injuries.
