Updated: Nov 23, 2021
Most soccer and field-sport athletes (certainly not exclusive to) have experienced knee pain in one capacity or another throughout their career. Some maybe experienced it after a traumatic event like after a tackle or a collision, stepped or landed "wrong" without direct contact of another player, or it may have happened over a stretch of time (typically in transition from offseason to in season or over the course of the season in its entirety).
Overuse injuries involving the knee are probably the #1 reason for an athlete to visit their Athletic Trainer or Physical Therapist (besides us being extremely awesome and entertaining to hang with). These types of injuries have a very simple reason for why they appear. They are typically painful and uncomfortable, but are usually considered a secondary injury or condition as a result of a primary cause or dysfunction.
The root dysfunction, in the case of overuse injuries, is almost always not at the knee itself. Where the symptom/s (pain, etc) appear, the culprit most of the time starts higher at the hip or below in the foot/ankle.
One of the most common overuse injuries of the knee, for example, is Patellar Tendonitis, Tendonosis, or Tendonopathy commonly diagnosed as a Patellafemoral Syndrome or PFS. Super common in runners and jumpers...(oh wait...isn't running and jumping a general requirement for almost all sports, with a few exceptions sprinkled in?) In my experience, this is typically the result of a biomechanical coordination dysfunction that is responsible -- in other words, a movement issue.
When we apply a repetitive load or stress to anatomical structures (body parts) over periods of time (moving throughout the period of a season in training, the weight room, and out at the pitch game day), overloaded tissues or structures break down faster than it can repair, thus resulting in pain, swelling, and weakness (each having their own reason for occurring and a discussion for another time...because wow is that rabbit hole deep).
Imagine having an office run by 3 people. If 2 of the 3 people don't do the work they're supposed to, the remainder of the slack for the lazy workers falls on the one person remaining to keep the office running to maintain the output. Over time, that leads to burnout, frustration, reduced work capacity (output quality and volume) and a decrease in efficiency until they reach their breaking point and the office has to shut down.
Recognition is KEY.
Seeking the right HELP is also just as important.
Proper management of these kinds of injuries goes much further than the typical "RICE" method everybody has drilled into normal practice and prescription.
When you experience signs and symptoms including:
Dull/Achey pain that typically starts either, first thing in the morning after getting out of bed, walking up and down stairs (down typically worse than up), running, jumping, just before an increase in activity, at beginning of training or playing, or at rest typically after training or playing.
Sometimes progressing to sharper pain while shooting, kicking, passing (usually long passing elicits more symptoms)
Accelerating or decelerating
Stiffness when flexing and extending the knee
Observable widening or thickening of the tendons (most common is the patellar tendon)
Visible and palpable (able to see/feel) swelling
Palpable Heat or warmth (at rest is more indicative)
Reduced Muscle Tone
The feeling of "giving away"
Development of Secondary Injury or dysfunction due to compensation above or below the knee (ie: low back, hip or ankle pain and stiffness to name a few)
The Answer To Your Main Question: "How do I fix it or make it go away?"
GET EVALUATED BY A PROFESSIONAL THAT KNOWS WHAT THEY'RE DOING.
Be sure to do your research about clinicians and how they are, who they treat, and what their core values and experiences are.
Sounds wild I know.
You want to see someone that is truly there to guide you into pain-free performance and get you back at or better than your best.
A practice or clinician should never make it about, and never should be about, the number of visits you show up (pay) for and if you start to get that vibe this could be a red flag for sure that the clinician or practice is not for you.
HOWEVER-- and this is a BIG HOWEVER. There are a few key things that you need to understand.
In any situation, you will need to invest time into getting better and achieving results as it doesn't happen in just a visit or two. If you do see relief that soon, treatment is either "masking" symptoms or its providing you the temporary relief to get through your training and rehab with your clinician (Physical Therapist, Athletic Trainer, or PTA). Key thing to remember is, just because the pain stops, doesn't mean you're done. That's just the beginning.
In either case, it's either too-good-to-be-true OR you still have to put in the time, effort, and energy investing in personal sustained relief. Otherwise, you end up back at square one in a few weeks to a few months.
That being said, its a two way street that requires cooperation on your part (the injured athlete). In training or treatment, it takes the body some time to adapt to training or rehab to get recognizable results. If you don't give treatment a chance, you'll find yourself back at the beginning.
You also want to see someone with a clear plan of action. They should be able to articulate that to you and also be able to explain to you that the healing process is almost NEVER linear. Sometimes it is, but those are rare.
For the clinicians in the room:
Understand that there are very few cases that require ABSOLUTE REST. Clinicians should see this as a potential red flag when reading scripts from Physicians about this kind of injury diagnosis when dealing with athletes.
The better choice here is almost always to understand precautions, movements, and environmental factors that exacerbate the injury and MODIFY exercise and training loads.
Why do we modify?
Because we need to also maintain a level of cardiovascular fitness. Athletes typically, once they don't feel pain or are discharged to return to play, don't take into account how quickly we can detrain as humans and leg extensions/curls and a few sets of weighted squats will not make up for the week 4-8 weeks (depending on severity and progression of injury) they are not running or training at an intensity that allows them to maintain an adequate level of fitness.
There are so many other ways to elicit these responses without aggravating an existing injury.
Another commonly botched component in athlete and overall patient recovery management is what I like to call the 3C's...
Simply put, there needs to be a direct conversation with an athlete that gives them specific instructions on what they can and can't do. By not being explicit with return to training and game play instructions and protocols, it can be the difference between someone who leaves your clinic in a few weeks and excels--
-- and the client that never seems to get better, that's still working with you for months and years down the line for the same issues or secondary and tertiary conditions associated with it.
The Final Boss.
The final part that I see completely mishandled and may be the most simple form of management for the prevention of overuse injuries is:
PROPER Nutrition and Sleep for specific athlete/lifestyle and demands.
If we aren't fueling to optimize our body's natural recovery processes and immune responses to NORMAL tissue breakdown after exercise/training, the ground work for inadequate tissue repair is already laid.
Taking the total athlete, patient-first, approach should be the only way to manage athletic injuries and is what is going to help get players back faster and better than before.
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Co-Owner and Co-Founder
Thryve Healing and Performance