Patellofemoral Pain Syndrome
A pain condition around or behind the kneecap that usually develops gradually. It is common in physically active adolescents and may occur when the load placed on the knee exceeds the body's ability to adapt.
- •Mild pain around or behind the kneecap
- •Pain mainly occurs during running, jumping, or repeated squatting
- •Discomfort when climbing stairs or after prolonged sitting
- •Mild stiffness after exercise
- •Strength and range of motion are largely preserved
- •Symptoms usually have little impact on daily activities
PFSS har sällan en enda orsak. Det utvecklas oftast genom en kombination av faktorer där knäleden utsätts för mer belastning än den hinner anpassa sig till. Vanliga bidragande faktorer är:
- •Snabb ökning av träningsmängd eller intensitet
- •Mycket löpning, hopp, accelerationer och riktningsförändringar
- •Upprepad belastning med böjt knä
- •Nedsatt styrka eller uthållighet i lår- och höftmuskulatur
- •Bristande kontroll av knä och höft vid exempelvis landning och riktningsförändring
- •För lite återhämtning mellan träningar och matcher
- •Tillväxt och förändringar i kroppen under tonåren kan påverka belastning och rörelsekontroll
Hos unga fotbollsspelare är belastning, återhämtning och neuromuskulär kontroll därför viktiga delar att ha koll på.
Det viktigaste är inte att undvika löpning eller hopp — utan att bygga upp spelarens kapacitet så att kroppen klarar den belastning som fotbollen kräver. Bra förebyggande strategier:
- •Öka träningsbelastningen gradvis
- •Undvik stora plötsliga ökningar av mängden löpning, hopp och explosiva moment
- •Planera in tillräcklig återhämtning
- •Träna styrka för quadriceps, säte och höft
- •Träna kontroll vid enbensövningar, landningar och riktningsförändringar
- •Variera belastningen mellan hårdare och lättare träningsdagar
- •Behåll styrketräning även under matchsäsong
- •Var extra uppmärksam på återhämtning och belastning under perioder av snabb tillväxt
- •Reagera tidigt på återkommande knäsmärta istället för att låta spelaren fortsätta genom ökande smärta
Det finns också stöd för att strukturerad träning som förbättrar styrka och neuromuskulär kontroll kan bidra till att minska skaderisk hos unga fotbollsspelare.
- •Temporarily reduce activities that clearly aggravate the pain
- •In particular, reduce jumping, sprinting, and deep squatting if these increase symptoms
- •Maintain physical activity that can be performed with little or no pain
- •Avoid prolonged complete rest from all activity
- •Begin gentle strengthening of the thigh and hip muscles
- •Gradually increase loading as symptoms allow
Progressive quadriceps strengthening
Strengthening of the hip and gluteal muscles
Train knee and hip control during single-leg exercises
Gradually increase loading through squats, lunges, and other functional exercises
Gradually reintroduce jumping and landing
Then progress to running, acceleration, and changes of direction
Adjust training load according to symptoms and recovery
- Able to perform daily activities without significant pain
- Able to perform strengthening without significant worsening
- Able to jog without significant pain
- Able to jump and land with good control
- Able to accelerate and decelerate without significant symptom increase
- Able to perform changes of direction
- Able to participate in football-specific drills with gradually increasing intensity
- Symptoms are not significantly worse the day after loading
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Patellofemoral Pain Syndrome
A pain condition around or behind the kneecap that usually develops gradually. It is common in physically active adolescents and may occur when the load placed on the knee exceeds the body's ability to adapt.
Mild — 4–8 veckor
Symptoms
- Mild pain around or behind the kneecap
- Pain mainly occurs during running, jumping, or repeated squatting
- Discomfort when climbing stairs or after prolonged sitting
- Mild stiffness after exercise
- Strength and range of motion are largely preserved
- Symptoms usually have little impact on daily activities
Acute Treatment
- Temporarily reduce activities that clearly aggravate the pain
- In particular, reduce jumping, sprinting, and deep squatting if these increase symptoms
- Maintain physical activity that can be performed with little or no pain
- Avoid prolonged complete rest from all activity
- Begin gentle strengthening of the thigh and hip muscles
- Gradually increase loading as symptoms allow
Rehabilitation
Progressive quadriceps strengthening
Strengthening of the hip and gluteal muscles
Train knee and hip control during single-leg exercises
Gradually increase loading through squats, lunges, and other functional exercises
Gradually reintroduce jumping and landing
Then progress to running, acceleration, and changes of direction
Adjust training load according to symptoms and recovery
Return to Play
- ☐ Able to perform daily activities without significant pain
- ☐ Able to perform strengthening without significant worsening
- ☐ Able to jog without significant pain
- ☐ Able to jump and land with good control
- ☐ Able to accelerate and decelerate without significant symptom increase
- ☐ Able to perform changes of direction
- ☐ Able to participate in football-specific drills with gradually increasing intensity
- ☐ Symptoms are not significantly worse the day after loading
Moderate — 8–12 veckor
Symptoms
- Clear pain around or behind the kneecap
- Pain during running, jumping, acceleration, or changes of direction
- Pain during squatting and stair climbing
- Discomfort after prolonged sitting with the knee bent
- Stiffness or pain after exercise
- Symptoms affect football training or matches
- Pain may persist after activity has stopped
Acute Treatment
- Reduce training load so that symptoms remain under control
- Temporarily reduce or pause activities that clearly increase pain
- Maintain alternative exercise that is tolerated by the knee
- Avoid continuing to play through clearly increasing pain
- Begin structured strengthening of the quadriceps and hip muscles
- Physiotherapy assessment is recommended for persistent or significant symptoms
Rehabilitation
Progressive strengthening of the quadriceps and hip muscles
Use loading that can be performed with controlled symptoms
Gradually increase strength and endurance of the leg muscles
Train knee and hip control during single-leg exercises
Progress to functional exercises such as squats, lunges, and step-downs
Introduce jumping and landing when strength and symptoms allow
Progress running from low to higher intensity
Gradually introduce acceleration, deceleration, and changes of direction
Gradually return to full football training
Return to Play
- ☐ Daily activities can be performed without significant pain
- ☐ Good quadriceps and hip strength
- ☐ Able to perform strengthening without significant worsening the following day
- ☐ Able to run at higher speeds without significant symptoms
- ☐ Able to perform repeated jumps and landings
- ☐ Able to accelerate and decelerate without significant pain
- ☐ Able to perform rapid changes of direction
- ☐ Able to participate in high-intensity football-specific training
- ☐ Able to increase training load without clear day-to-day deterioration
Severe — 3–6+ månader
Symptoms
- Clear and persistent pain around or behind the kneecap
- Pain limits both training and daily activities
- Pain during stair climbing, standing up, or prolonged sitting
- Significant pain during running, jumping, or squatting
- Clearly reduced tolerance to loading
- Symptoms persist despite reduced loading
- Knee pain significantly affects the player's ability to participate in football
Acute Treatment
- Reduce or pause activities that clearly aggravate the pain
- Avoid repeated jumping, sprinting, and other high knee loads until symptoms are controlled
- Maintain alternative physical activity that is tolerated
- Do not aggressively train through significant pain
- Physiotherapy assessment is recommended
- Other causes of knee pain should be considered when symptoms are atypical or persistent
Rehabilitation
Individualized load management is central
Progressive strengthening of the quadriceps and hip muscles
Gradual increase in loading and range of motion
Train knee and hip control during functional movements
Progress to explosive strengthening once basic strength has recovered
Gradually return to jumping and plyometric training
Progress to running, sprinting, acceleration, and changes of direction
Football-specific loading is reintroduced progressively
Continue strengthening after return to sport to maintain load capacity
Return to Play
- ☐ Daily activities can be performed without significant pain
- ☐ Full or near-full knee range of motion
- ☐ Good or restored quadriceps and hip strength
- ☐ Able to perform heavy strengthening without significant worsening
- ☐ Able to run at high speed without significant symptoms
- ☐ Able to repeatedly accelerate and decelerate
- ☐ Able to jump and land with good control
- ☐ Able to perform rapid changes of direction
- ☐ Able to perform football-specific explosive activities
- ☐ Able to complete full training without significant worsening afterwards
- ☐ Able to tolerate training load consistently across multiple sessions
When to Seek Medical Care
- Seek medical care if knee pain is severe or clearly limits daily activities
- See a physiotherapist if symptoms persist despite reduced loading and structured rehabilitation
- Seek care if pain progressively worsens despite reducing training load
- Seek care for significant swelling, locking, or a feeling of instability in the knee
- Seek medical care after sudden severe pain or an injury caused by clear trauma
- In children and adolescents, persistent or significant knee pain should be assessed because several other conditions can cause similar symptoms