Activity and load modification is a successful treatment for patellofemoral pain in adolescents

Patellofemoral pain (PFP) has a relatively high prevalence in adolescent footballers, and the problem can be persistent and debilitating. Repetitive loading of the knee joint through training or game play, with insufficient recovery time can occur with team players. This prospective study evaluated a 12-week intervention (which included activity modification and reduced patellofemoral joint loading)1.

The vast majority of footballers with PFP have a “functional” problem with how they use their knee, and in adults the mainstay of treatment is exercise (mainly resistance) therapy. This management has lower rates of success in adolescents, and this study looks instead at activity modification treatment and load management specifically for the adolescent population.

The intervention in this study consisted of three blocks of four weeks of treatment. The first phase involved reducing sports participation (to reduce knee joint loads). The second phase involved home based exercises, while the final phase progressively returned the patient to activity. Participants could only progress to the next level of activity once they could perform the previous one with no pain. Outcomes were collected using self-reported measurements including the global rating of change (GROC) scale, Knee Injury and Osteoarthrirtis Outcome Score (KOOS), European Quality of Life 5 Dimensions (EQ-5D-Y) and other data collection questions. Hip and knee torque, sports participation, satisfaction with treatment and the use of painkillers were also evaluated.

A successful outcome (based on the GROC scale) was seen in 86% of adolescents with PFP at 12 weeks, and 81% at 52 weeks. The majority (68%) had returned to sport at 12 weeks, rising to 81% at 12 months. Self-reporting from the adolescents with PFP found large improvements in knee pain and function. There was no significant evidence for individual pain characteristics favouring a better outcome, indicating that a successful outcome can be achieved with this treatment in patients with differing levels of pain intensity. Objective measurements of hip and knee torque also improved after treatment.

This study indicates adolescent footballers with PFP may benefit from a specific targeted approach to reduce and then apply graduated re-loading of the knee joint. The high rates of success seen in this study is encouraging and supports this treatment strategy. The lack of a control group is however a clear limitation of the study.

To learn more about patellofemoral pain, and other knee injuries, including investigations and rehabilitation complete the Knee module in the FIFA Diploma in Football Medicine.

1Rathleff, M. S., Graven-Nielsen, T., Hölmich, P., Winiarski, L., Krommes, K., Holden, S., & Thorborg, K. (2019). Activity Modification and Load Management of Adolescents With Patellofemoral Pain: A Prospective Intervention Study Including 151 Adolescents. The American Journal of Sports Medicine, 47(7), 1629–1637.


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BangouraDr Steven Griffith Recent comment authors
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I have three teenage at the moment all over 12 months of care or more, for patella rehabilitation. Those first time injuries take at least 6 weeks to stabilise and 12 weeks to be pain free on all sports movements. Repetitive patella injury though is the norm and return with school holiday sports camps or national tournament schedules sees children return constantly after big sports competition. Sadly no quick fix I have seen in decades. Nor does any of the procedures work over the other, the best being working your fingers thru the damaged tissue to break up the tiny… Read more »


Les douleurs fémoro.patellaires.sonttres frequentes chez les adolescents.Elles sont dues le plus souvent à des charges physiques au niveau de l articulation du genou.
La modification de l activité et de la charge peut être un adjuvant au traitement de la douleur femoro parcellaire.
Le traitement.
Repos partiel
Séance de physiothérapie
Immobilisation par contention souple
Réduire la participation sportive afin de réduire les charges articulaires du genou.
Faire des exercices de renforcement
Faciliter le retour aux activités sportives