{"id":433,"date":"2010-01-12T10:31:54","date_gmt":"2010-01-12T17:31:54","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=433"},"modified":"2010-01-12T10:31:54","modified_gmt":"2010-01-12T17:31:54","slug":"case-study-knee-pain-in-a-club-female-soccer-player-part-2","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=433","title":{"rendered":"Case Study: Knee Pain in a Club Female Soccer Player (Part 2)"},"content":{"rendered":"

In the last post, I identified the issue I believed to be going on with player x.\u00a0 Keep in mind the player returned\u00a0to \u00a0see me\u00a0the week of 12\/15 intially.\u00a0 The first line of treatment for PF issues in most clinical scenarios involves the following:<\/p>\n

    \n
  1. Rest<\/li>\n
  2. Ice<\/li>\n
  3. Stretching (quads, hamstrings, IT band and hip musculature)<\/li>\n
  4. Straight leg raises<\/li>\n
  5. Short arc quads (mini-knee extensions from 30-0 degrees if you will on a bolster) although I am not a huge fan of these<\/li>\n
  6. Mini-squats<\/li>\n
  7. Calf raises<\/li>\n<\/ol>\n

    I advocated relative rest, ice and stretching with my athlete\u00a0in addition to the following exercises initially:<\/p>\n

      \n
    1. Single leg step-downs (side progressing to front version) in pain free range<\/li>\n
    2. Single leg stiff legged dead lifts<\/li>\n
    3. Single leg bent knee floor hamstring bridges<\/li>\n
    4. Lateral ankle band walks for gluteus medius work<\/li>\n
    5. Multi-planar lunges in pain free range of motion<\/li>\n<\/ol>\n

      She did well with all of the exercises after week one but noted pain with front step-downs and deeper lunges.\u00a0 On 12\/22 I made a significant discovery: she had adopted a compensatory hip strategy to avoid normal knee kinematics with deceleration.\u00a0 What am I referring to?\u00a0 I call it a quad avoidance lunge pattern.\u00a0 She would shift her trunk into extension with foot contact when lunging onto the affected knee as a result of anticipation of pain. (See video clip below as I show a normal lunge pattern, a quad avoidance lunge pattern and the exericse I use to break it)<\/p>\n

      \"Video<\/a><\/p>

      Click to play this video.<\/a><\/p><\/div><\/p>\n

      To help break this cycle, I used an 18 inch box to elevate her unaffected foot and force her into more normal hip flexion on the affected side in a pain free range.\u00a0 This seemed to work so we added this to the home program using a stair step and eliminated front step-downs altogether, choosing instead to focus on the side step-down in the 40-0 range if you will.\u00a0 I also added single leg soccer kicks (no ball) forward and in a crossing fashion to work on stability, strength and proprioceptive control.<\/p>\n

      The athlete returned on 12\/31 and seemed to be progressing but still had discomfort with running.\u00a0 So, I felt she was not ready for full go as of yet.\u00a0 She also still had discomfort with short and long shuffles moving to the involved side.\u00a0 At this point, her mom wanted to know what I thought. about practice.<\/p>\n

      I advised her that player x needed to continue with strengthening 3x\/week and try to ease back into jogging as able.\u00a0 She said the first indoor practice was coming up the week of 1\/4.\u00a0 My thoughts? Indoor soccer fields and PF pain are a bad fit – period.\u00a0 But, I told her\u00a0to let her daughter warm-up and do a few drills to get a feel for things.<\/p>\n

      The verdict?\u00a0 I got an email on Saturday saying she could not practice due to the same discomfort.\u00a0 Her next stop is back at the surgeon’s office for a closer look at the knee tomorrow.\u00a0 I will keep you posted on the diagnosis and treatment as this is an issue that all of us\u00a0who work with athletes face and struggle with.\u00a0 Finding the right balance and progression between rest, rehab and return to play is tricky.\u00a0 So stay tuned for more details.<\/p>\n","protected":false},"excerpt":{"rendered":"

      In the last post, I identified the issue I believed to be going on with player x.\u00a0 Keep in mind the player returned\u00a0to \u00a0see me\u00a0the week of 12\/15 intially.\u00a0 The first line of treatment for PF issues in most clinical scenarios involves the following: Rest Ice Stretching (quads, hamstrings, IT band and hip musculature) Straight […]<\/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":[9,53,52,54,432],"class_list":["post-433","post","type-post","status-publish","format-standard","hentry","category-knee","category-rehab","category-soccer","tag-add-new-tag","tag-knee-injury","tag-knee-pain","tag-patellofemoral-pain","tag-soccer"],"yoast_head":"\nCase Study: Knee Pain in a Club Female Soccer Player (Part 2) - 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=433\" \/>\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 2) - 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