Anterior Knee Pain in the Female Athlete

January 9, 2013

This is probably an exam we see often in athletic training or physical therapy. It’s something we as athletic trainers and those in the physical therapy world and fitness world must also be prepared to address. It’s time we “think outside the box” and look beyond the pain site.

Let me set up the patient for you:

  • She is an adolescent volleyball player who plays high school volleyball 4 months and club volleyball the other 8 months of the year. Very little rest time in her sports schedule.
  • She is in a weight lifting class in school which consists of squats, hex-bar deadlifts, and hang cleans.
  • She has had a meniscus surgery on one knee in the past.
  • Her pain started a few weeks ago and she complains of bilateral pain at and slightly above the tibial tuberosity on each side.

Palpation elicits mild discomfort at rest at her reported location of pain. She demonstrates good to excellent quadriceps flexibility and fair to poor hamstring length. Her active range of motion in the hip is good to excellent as well. Ankle mobility and range of motion were not tested. She does wear ankle braces during participation. Hamstring and quadriceps strength were both grossly adequate on both sides. Hip strength was good to fair.

With her specifically, the first thing we will address is hip strength. She was given a few home exercises that she is to incorporate into her weight training program. Also, she was instructed to ice massage both knees multiple times each day. Things to consider in the future may include therapeutic taping, soft tissue massage (such as Graston Technique), and exploring ankle mobility. hip-ext

Mike Boyle has talked before about anterior knee pain and basketball players. This has often been related to ankle taping/bracing and that loss of mobility. I would suspect this would also be true with our volleyball players because many of them wear big ankle braces when they play.

Many of my female athletes complain of knee pain and generally tend to be related to the patellar tendon, IT band, and hip strength. With these complaints of general chronic knee pain, I’ve all but quit looking at the knees. That may be where the pain is located, but in my (short) experience that’s not where the true dysfunction is at. This dysfunction seems to be in the hips or in the feet.

The discussion I often have with my female athletes is how their hips simply are not designed for sports. They’re not; their hips are wider than the male athlete so that they are able to have babies. That’s not to say they can’t play sports; it is just that we must recognize and address these differences in the hips structure. The Q-angle is wider for the female athlete than her male counterpart which leads a valgus position of the knees. This can be enhanced if they also have pronated feet.


So take-home for me after this evaluation: let’s make sure we check joints above and below pain site, recognize that pain site probably is NOT the source of the problem in a chronic injury, and you will suffer from a chronic injury at some point if you don’t take some time to rest!


One Response to “Anterior Knee Pain in the Female Athlete”

  1. […] I have actually posted my first installment of this new series. You can find it here: Anterior Knee Pain in the Female Athlete. […]

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