Patello-femoral pain is an irritation or inflammation of the tissues under or surrounding the kneecap. This condition is often inaccurately referred to as "chondromalacia". Chondromalacia is a diagnosis that should be reserved for cases where there is actual damage to the articular cartilage on the underside of the patella. This is not always the case in patello-femoral pain. But chondromalacia may arise from chronic patello-femoral pain.

Mechanism of Injury

The following causes the kneecap to be squeezed excessively against the lateral femoral condyle.

• overuse
• a blow (i.e. from a tackle by an opposing player)
• structural defect
• gastrocnemius, hamstring, quadriceps or iliotibial band tightness
• generalized ligamentous laxity
• deficient hamstring or quadriceps strength
• hip musculature weakness
• an excessive quadriceps (Q) angle
• patellar compression or tilting

Signs and Symptoms

• Pain (in and around the kneecap, usually on the lateral side) with kicking, running, jumping or tackling.
• "Achiness" while sitting for extended periods.
• A grinding sensation can sometimes be felt.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury (i.e. McConnell taping, neoprene sleeve with hole for patella). REST the area to promote healing. ICE the area 10-20 minutes every 1.5 to 2 hours for 2-3 days until pain has gone away. Some COMPRESSION will help move inflammation away from the area. ELEVATE the area to promote circulation to the heart, this can be done during icing. 

Referral. A physician should be seen to rule out any other problems. They may also prescribe anti-inflammatory medication.

Rehabilitation. Work on range of motion and strengthening exercises for the hip and knee. With all squating and lunging activities be sure that the knee is in line with the toe and NOT past it. If pain persists, seek the advice and treatment of a sports medicine practitioner.

Return to Activity. Exercises to strengthen the quadriceps muscles and to stretch the hamstring muscles are essential prior to returning to soccer activity. Commercially available neoprene knee sleeves with a hole for the patella offer support to assist the patella to properly "track" in the femoral condyle groove.

Prevention. To avoid developing this condition, soccer players should ensure good strength of the quadricep muscles. This will help pull the patella into the proper tracking alignment.

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