Patellofemoral pain

What it is

The kneecap slides in a groove at the end of the thigh bone, and patellofemoral pain is pain coming from that joint. Unlike a tendon problem there is usually no single damaged structure to point at. It is a load-sensitive joint that has been asked for more than it currently has capacity for, often with some contribution from how well the hip and quadriceps are controlling the leg. It is extremely common and it responds well to the right loading, but it is stubborn and it takes months rather than weeks.

How volleyball causes it

Volleyball loads this joint through repeated deep knee bend. The kneecap is squashed into its groove hardest between roughly 30 and 90 degrees of bend, which is exactly the ready position, the drop into a passing platform, the squat and rise of blocking footwork, and the absorption phase of every landing. Liberos and setters who live in a low crouch through long rallies, and blockers doing repeated shuffle-squat-jump sequences, accumulate an enormous amount of it. The important distinguishing feature is the pattern of pain: jumper's knee is a pinpoint spot that fades once you are warm, while this is a vaguer ache around or behind the kneecap that often stays or grows across a session and is at its worst after sitting still.

PassingDefenseBlockingAttacking

What it feels like

• A vague ache around the front of the knee that you cannot pin down with one finger, often described as behind or all around the kneecap
• Worse after sitting for a long time with the knee bent, in a car, a classroom or a bus
• Worse going down stairs than going up
• Grinding, creaking or a gritty feeling as the knee bends and straightens
• Pain that stays level or climbs during a session rather than warming up and fading
• Sometimes mild puffiness at the front, but not a joint that fills up with fluid

Stop and get it seen if

• A joint that genuinely fills with fluid, especially after a specific incident. That points to something structural rather than simple patellofemoral pain and needs assessing.
• The kneecap has visibly slipped sideways at some point, or you have had a frank dislocation. That is a different problem with a different plan.
• The knee locks, catches or gives way underneath you.
• Pain that is present at rest and wakes you at night, particularly alongside fever, feeling unwell, or unexplained weight loss.
• In a teenager, knee pain accompanied by a limp, thigh or groin pain, or restricted hip rotation. Hip problems refer pain to the knee and some of them are time-critical, so a limping adolescent with knee pain needs the hip examined.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Take the sting out

   1 to 3 weeks

   Reduce the specific loading that provokes it, usually repeated deep knee bend under load, while continuing to train in modified form.

   • Stairs and long periods of sitting are less provocative
   • Can complete a modified session without the pain climbing through it
   • The background daily ache is lower
   • You know which positions and volumes the knee currently tolerates

2. 2. Build hip and quadriceps capacity

   6 to 12 weeks

   Strengthen the quadriceps and hips through progressively greater depth, and improve control of the knee over the foot.

   • Strength work at increasing depth is tolerated without a flare
   • Descending stairs no longer provokes it
   • Single-leg squat looks controlled with less inward collapse of the knee
   • Can sit through a long journey or class without the ache building

3. 3. Return to full court demands

Ready to play again when

• Going down stairs is comfortable
• Long periods of sitting no longer build an ache
• Can hold a low defensive position for a full rally, repeatedly, through a session
• Pain no longer climbs across a session or lingers into the next day

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Squats and split squats through the full range you actually use on court, built up gradually rather than added all at once. Deep range capacity is what the joint lacks.
• Hip abductor and external rotator strength: side plank with a top leg lift, banded lateral walks, single-leg Romanian deadlifts. A hip that cannot hold the thigh lets the kneecap grind off-centre.
• Slow, controlled step-downs from a box. Descending is where the joint is loaded hardest and where control is most often absent.
• Calf raises and knee-to-wall ankle mobility. A stiff ankle forces the knee forward and adds compression at the kneecap.
• Ramp jump volume and low-position volume across preseason instead of doubling it in the first week back. This problem is usually a load spike wearing a technique costume.