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.
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. https://doi.org/10.1177/0363546519843915