{"id":430,"date":"2010-01-06T08:53:57","date_gmt":"2010-01-06T15:53:57","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=430"},"modified":"2010-01-06T08:53:57","modified_gmt":"2010-01-06T15:53:57","slug":"case-study-knee-pain-in-a-club-female-soccer-player-part-1","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=430","title":{"rendered":"Case Study: Knee Pain in a Club Female Soccer Player (Part 1)"},"content":{"rendered":"

I have posted on the perils of patello-femoral pain<\/a> in the past on this blog.\u00a0 Today, I will share how surgery to fix one knee problem\u00a0may lead to a new problem.\u00a0 For privacy reasons, I will refer to my client as player x.\u00a0<\/p>\n

History: Player x is a 15 y\/o healthy female soccer player who suffered a lateral menscus tear in the summer of 2009.\u00a0 She had arthroscopic repair followed by a brief stint (4-6 weeks) of rehab.\u00a0 Surgery went well, but she did not regain full extension in rehab (she has about 5 degrees of hyper extension naturally).<\/p>\n

Prior to fall high school season, player x came to me for sport reconditioning.\u00a0 She had obvious quad atrophy (particularly the VMO) and lacked speed and explosiveness.\u00a0 She worked with me 1-2x\/week for 4-6 weeks and made good progress but did note some mild persistent soreness in her knee.<\/p>\n

She played the entire fall season without injury\/limitation but continued\u00a0to have the same mild persistent knee pain.\u00a0 The first week she began club practice (fall high school season had ended), her club coach had the players do a lot of plyometrics.\u00a0 The exercises did not seem hazardous, but player x immediately had a significant increase in knee pain.<\/p>\n

Her mother contacted me and she recently came back in for an assessment.\u00a0 Ironically enough, her single leg squat and single leg broad jump were within 90% of her uninvolved leg.\u00a0 However, she had mild swelling, Quad atrophy (about a 1 1\/2 inch deficit) and she had significant pain with lateral movement to the side of her involved knee and could not decelerate without pain.<\/p>\n

Hmmm…..\u00a0\u00a0 So what is the issue here?\u00a0 After carefully evaluating her and performing functional testing I was able to rule out quadriceps tendinitis.\u00a0 Her pain occurs primarily at or beneath the superioir and lateral portion of the knee cap at 30-40 degrees of flexion when she is weight-bearing.<\/p>\n

I am fairly confident she has patello-femoral joint irritation with excess compression along the lateral facet.\u00a0 Why?<\/p>\n

    \n
  1. Perhaps the slight extension deficit allowed her to run more on a slightly bent knee (more PF force)<\/li>\n
  2. Weak VMO is overpowered by the vastus lateralis creating abnormal lateral translation of the patella<\/li>\n
  3. Pain is worse with deceleration and eccentric strength exercise going past (greater quad pull and patellar compression occurs with these activities)<\/li>\n
  4. Pain with lateral movement and change of direction suggest lack of proper medial stability and dynamic control of femoral internal rotation which would subject the kneecap to abnormal joint reaction forces especially laterally where her pain is felt<\/li>\n
  5. No pin point tenderness consistent with soft tissue inflammation<\/li>\n<\/ol>\n

    The entire scenario has\u00a0likely been perpetuated\u00a0by the volume of training\/running in soccer and was then exacerbated by the plyometrics.\u00a0 She compensated and ignored the mild pain all fall, but the knee finally reached a breaking point with the plyos (keep in mind\u00a0she did no plyos in the high school fall season).<\/p>\n

    I see patello-femoral pain all the time in female year-round soccer players.\u00a0 What is the solution?\u00a0 Stay tuned as I will share more details about patella balancing training and\u00a0my corrective exercise program for player x in the next post.<\/p>\n","protected":false},"excerpt":{"rendered":"

    I have posted on the perils of patello-femoral pain in the past on this blog.\u00a0 Today, I will share how surgery to fix one knee problem\u00a0may lead to a new problem.\u00a0 For privacy reasons, I will refer to my client as player x.\u00a0 History: Player x is a 15 y\/o healthy female soccer player who […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31,8,35],"tags":[53,52,54,432],"class_list":["post-430","post","type-post","status-publish","format-standard","hentry","category-knee","category-rehab","category-soccer","tag-knee-injury","tag-knee-pain","tag-patellofemoral-pain","tag-soccer"],"yoast_head":"\nCase Study: Knee Pain in a Club Female Soccer Player (Part 1) - Brian Schiff's Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=430\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Case Study: Knee Pain in a Club Female Soccer Player (Part 1) - Brian Schiff's Blog\" \/>\n<meta property=\"og:description\" content=\"I have posted on the perils of patello-femoral pain in the past on this blog.\u00a0 Today, I will share how surgery to fix one knee problem\u00a0may lead to a new problem.\u00a0 For privacy reasons, I will refer to my client as player x.\u00a0 History: Player x is a 15 y\/o healthy female soccer player who […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blog.brianschiff.com\/?p=430\" \/>\n<meta property=\"og:site_name\" content=\"Brian Schiff's Blog\" \/>\n<meta property=\"article:published_time\" content=\"2010-01-06T15:53:57+00:00\" \/>\n<meta name=\"author\" content=\"Brian Schiff\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Brian Schiff\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blog.brianschiff.com\/?p=430\",\"url\":\"https:\/\/blog.brianschiff.com\/?p=430\",\"name\":\"Case Study: Knee Pain in a Club Female Soccer Player (Part 1) - Brian Schiff's Blog\",\"isPartOf\":{\"@id\":\"https:\/\/blog.brianschiff.com\/#website\"},\"datePublished\":\"2010-01-06T15:53:57+00:00\",\"dateModified\":\"2010-01-06T15:53:57+00:00\",\"author\":{\"@id\":\"https:\/\/blog.brianschiff.com\/#\/schema\/person\/d7ecfca77bb5641821016294c8190473\"},\"breadcrumb\":{\"@id\":\"https:\/\/blog.brianschiff.com\/?p=430#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blog.brianschiff.com\/?p=430\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blog.brianschiff.com\/?p=430#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blog.brianschiff.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Case Study: Knee Pain in a Club Female Soccer Player (Part 1)\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blog.brianschiff.com\/#website\",\"url\":\"https:\/\/blog.brianschiff.com\/\",\"name\":\"Brian Schiff's Blog\",\"description\":\"Injury Prevention, Sports Rehab & Performance Training Expert\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blog.brianschiff.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blog.brianschiff.com\/#\/schema\/person\/d7ecfca77bb5641821016294c8190473\",\"name\":\"Brian Schiff\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/blog.brianschiff.com\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/cfb4d8d97e576039b5949885812b9a4199eafdf93f5da9ccf83f9b671aac22f2?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/cfb4d8d97e576039b5949885812b9a4199eafdf93f5da9ccf83f9b671aac22f2?s=96&d=mm&r=g\",\"caption\":\"Brian Schiff\"},\"sameAs\":[\"http:\/\/www.brianschiff.com\"],\"url\":\"https:\/\/blog.brianschiff.com\/?author=2\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Case Study: Knee Pain in a Club Female Soccer Player (Part 1) - Brian Schiff's Blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blog.brianschiff.com\/?p=430","og_locale":"en_US","og_type":"article","og_title":"Case Study: Knee Pain in a Club Female Soccer Player (Part 1) - Brian Schiff's Blog","og_description":"I have posted on the perils of patello-femoral pain in the past on this blog.\u00a0 Today, I will share how surgery to fix one knee problem\u00a0may lead to a new problem.\u00a0 For privacy reasons, I will refer to my client as player x.\u00a0 History: Player x is a 15 y\/o healthy female soccer player who […]","og_url":"https:\/\/blog.brianschiff.com\/?p=430","og_site_name":"Brian Schiff's Blog","article_published_time":"2010-01-06T15:53:57+00:00","author":"Brian Schiff","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Brian Schiff","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/blog.brianschiff.com\/?p=430","url":"https:\/\/blog.brianschiff.com\/?p=430","name":"Case Study: Knee Pain in a Club Female Soccer Player (Part 1) - Brian Schiff's Blog","isPartOf":{"@id":"https:\/\/blog.brianschiff.com\/#website"},"datePublished":"2010-01-06T15:53:57+00:00","dateModified":"2010-01-06T15:53:57+00:00","author":{"@id":"https:\/\/blog.brianschiff.com\/#\/schema\/person\/d7ecfca77bb5641821016294c8190473"},"breadcrumb":{"@id":"https:\/\/blog.brianschiff.com\/?p=430#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blog.brianschiff.com\/?p=430"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blog.brianschiff.com\/?p=430#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blog.brianschiff.com\/"},{"@type":"ListItem","position":2,"name":"Case Study: Knee Pain in a Club Female Soccer Player (Part 1)"}]},{"@type":"WebSite","@id":"https:\/\/blog.brianschiff.com\/#website","url":"https:\/\/blog.brianschiff.com\/","name":"Brian Schiff's Blog","description":"Injury Prevention, Sports Rehab & Performance Training Expert","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blog.brianschiff.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/blog.brianschiff.com\/#\/schema\/person\/d7ecfca77bb5641821016294c8190473","name":"Brian Schiff","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blog.brianschiff.com\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/cfb4d8d97e576039b5949885812b9a4199eafdf93f5da9ccf83f9b671aac22f2?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/cfb4d8d97e576039b5949885812b9a4199eafdf93f5da9ccf83f9b671aac22f2?s=96&d=mm&r=g","caption":"Brian Schiff"},"sameAs":["http:\/\/www.brianschiff.com"],"url":"https:\/\/blog.brianschiff.com\/?author=2"}]}},"_links":{"self":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts\/430","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=430"}],"version-history":[{"count":2,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts\/430\/revisions"}],"predecessor-version":[{"id":432,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts\/430\/revisions\/432"}],"wp:attachment":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=430"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=430"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=430"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}