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Our high school girls' soccer team took the state championship last year. We'd like to repeat that success this year. But several of our players are on the bench with knee problems. They've been told by the doctor they have patellofemoral pain syndrome. What causes this problem and what can we do to get them back in the game?

The patella, or kneecap, can be a source of knee pain when it fails to function properly. Alignment or overuse problems of the patella can produce pain, weakness, and swelling of the knee joint. Several different problems can affect the patella and the groove it slides through over the femur (thigh bone). Patellofemoral pain syndrome (PFPS) is one of these problems. PFPS can affect people of all ages but is most common among young athletes. Physicians in sports medicine clinics report it accounts for up to 10 per cent of all visits. There are several possible reasons why PFPS develops. The first is overloading the patellofemoral joint. Heavy competition in sports has been a potential cause of this overload. And overload combined with malalignment of the quadriceps tendon as it pulls on the patella during extension of the knee is another probable cause of PFPS. Both of these factors lead to dysfunction of the extensor (quadriceps) mechanism. If one part of this four-part muscle pulls unevenly, the patella doesn't track up and down correctly over the knee joint. That's when pain and swelling start to develop. Alignment or overuse problems of the patella can also lead to wear and tear of the cartilage behind the patella. This can cause another problem called chondromalacia. Studies show that exercise works well to manage PFPS. A progressive program of strengthening and stretching helps balance the muscle pull and knee alignment. Most often, it's best to have an individual program to address each athlete's unique anatomy and biomechanics. An athletic trainer or physical therapist can help you with this. For those girls who are out of the game, a rehab program is advised. This is to prevent the same problem from occurring when they do resume sports activity. It only takes 10 to 20 minutes daily to effectively manage PFPS. Most athletes are already spending a great deal of time engaged in exercise and activity. This isn't a significant burden on their time. And the benefits pay off in the end with pain free sports participation.

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