When you consider the amount of wear and tear place on the knee during the fast-paced, highly physical game of soccer, knee problems come as no surprise. One of the most common locations of knee pain in soccer players is the front of the knee, often referred to as the patella or "kneecap."
"This is called patellofemoral pain," explains Gehron Treme, MD, orthopaedic surgeon and sports medicine specialist with the Center for Orthopaedics. "Ball handling, quick stops, directional changes as well as long periods of running place high amounts of stress on the joint and the soft tissue around knee. Any existing malalignment of the kneecap or weakness in its supporting structures can increase the risk of pain and injury."
Dr. Treme says this problem is even more common in females. "Studies have shown that female soccer players are more likely to experience knee pain and injuries than their male counterparts."
The pain can be caused by several different factors. One of the most common is patellofemoral dysfunction, an injury that occurs in the cartilage between the patella and the femur, or thigh bone. Dr. Treme says when the patella is subject to excessive pressure against the femur, or is aligned improperly with the groove at the end of the femur along which it slides, the cartilage can become irritated or wear away. This can lead to chondromalacia, a condition in which the cartilage underlying the patella is softened or frayed, causing pain and inflammation in surrounding tissue.
Patellofemoral pain may also originate in the soft tissue surrounding the kneecap. Dr. Treme says the exertion of playing soccer may cause the athlete to injure the supporting and stabilizing structures of the kneecap.
Depending on the nature of the symptoms and their underlying causes, Dr. Treme says the treatment prescribed may vary for patellofemoral pain. "Recommended treatment often begins with 'R.I.C.E.' - rest, ice, compression and elevation. Players should also avoid activity that aggravates symptoms until the pain is gone."
In addition, nonsteroidal anti-inflammatory medication, and perhaps a knee brace or other form of compression during physical activity may be recommended. "In cases where the problem originates from a misaligned patella, a compression brace or sleeve, or taping before play, may help symptoms by keeping the kneecap in the proper position," say Dr. Treme.
Once pain and swelling are dealt with, Dr. Treme says further treatment may be necessary in some cases. The athlete may be advised to stretch the tendon and strengthen the muscles around the knee. In particular, hamstring stretches can be helpful, especially for young soccer players whose tendons may become tight as they grow. Exercise for the quadriceps muscle is also useful in conditioning the knee against patellofemoral pain.
Rarely, in extreme cases, surgery may be necessary. "If pieces of kneecap cartilage need to be removed, we can usually take care of this arthroscopically, with pencil-thin tools through a few, small incisions. If the patella is misaligned, surgery may be required to realign it," says Dr. Treme.
He says the best advice is to focus on overall conditioning, even during the off-season, to reduce the chance of injury. In addition, athletes should warm up and stretch before any physical activity, increase training gradually and avoid sudden changes in exercise intensity.