Patellofemoral pain syndrome, often referred to as “runner’s knee”, is one of the most common causes of knee pain. PFPS is a common injury seen in adolescent athletes, particularly females. It is caused by an imbalance of forces placed through the patella, or kneecap. The amount of stress placed on the patellofemoral joint varies during certain activities, ranging from about ⅓ to ½ of body weight during walking, 3 times body weight with stair climbing, 5 to 6 times body weight with running, and up to 7 times body weight with squatting. As you can imagine, there is a good amount of running and squatting involved in cheer and this places athletes at an increased risk of developing PFPS.
Risk Factors for Developing PFPS
Any of these factors alone could cause an athlete to develop PFPS, however if multiple of these factors are at play, that further increases the likelihood of the athlete developing PFPS. The good news is that many of these factors are preventable and/or fixable.
Symptoms of PFPS
Treatment of PFPS
Physical therapy is a key component in recovering from PFPS. A physical therapist will evaluate you to help determine what the cause or causes are and then develop an individualized program to address these factors. Some of the common treatment activities include:
Prevention of PFPS
While PFPS is usually easily resolved with physical therapy, there is a high chance that it can recur, or come back, unless changes to your training are made.
An overuse injury is a type of muscle or bone injury, such as tendinopathy (tendinitis) or a stress fracture, that is caused by repetitive trauma.
There are different causes of overuse injuries, but they tend to originate from 2 different sources:
Overuse injuries are more common in athletes as they get older as well as with athletes that specialize in one sport year round. This is part of the reason why it is important for athletes to participate in multiple sports, so different muscles can be used and develop equally with other muscles.
Ways to help prevent overuse injuries from occurring:
If you believe you or your athlete have sustained an overuse injury, it is important to manage and treat it early as it can persist and turn into chronic pain, which tends to take longer to recover from. More mild overuse injuries such as a tendinitis can usually be treated with just physical therapy, more serious injuries such as a stress fracture usually require treatment from a physician.
What is Stretching?
Stretching is defined as the lengthening of muscles in order to increase muscle flexibility and improve joint range of motion. Stretching activities are a very important part of any exercise or rehabilitation program.
There are a few different goals that can be accomplished from stretching. Before you begin stretching, ask yourself what you are looking to do.
2 Basic Types of Stretching
The million dollar question that comes up a lot is when to stretch. Should you stretch before or after exercise?
Research shows that static stretching before exercise or sport shows no incidence of reducing injury risk and static stretching prior to exercise can actually lower your physical performance. Static stretching helps to relax your muscles and this is not something that you want to do prior to engaging in physical activity.
So what should you do? Dynamic stretching helps to activate and warm up your muscles prior to activity. Research suggests that dynamic stretching prior to exercise can actually improve performance by increasing blood flow to muscles, speed of nerve impulses, and oxygen delivery while increasing flexibility and force of muscle contraction. Although dynamic stretching can help to improve your physical performance, research does not explicitly show that it will decrease risk for injury.
While static stretching before exercise may not be the best idea, static stretching does still have its benefits. Post-exercise muscles tend to get stiff and this is where static stretches can help. Performing static stretches immediately post workout can help to return the muscle to its pre-exercise length and help prevent further stiffness.
How Long Should You Hold a Stretch? How Often?
Holding a stretch for at least 30 seconds, once a day, has been shown to be effective in increasing muscle length and flexibility. Research shows that holding for longer than 30 seconds and increasing frequency for more than once per day does not have any significant increased benefits for improved flexibility.
It is also important to be consistent with your stretching and know that you will most likely not see any improvements overnight. On average, it takes approximately 4-6 weeks to seen an actual change in muscle length from stretching regularly. So keep it up and don’t get discouraged if you do not see results immediately.
When Not to Stretch?
Key Points to Remember
In order to understand the best ways to strengthen the core, we must first understand what muscles make up the core.
When you hear the word “core”, you probably think of “abs” or “six-pack”. However, the muscle that leads to the 6-pack look, the rectus abdominis, is just one of the many muscles that make up the core.
The rectus abdominis can flex the trunk, like you do when you perform crunches or sit-ups. This is why these exercises are so popular, because they can help you achieve that 6-pack abs look that so many people desire. However, there are other muscles in the body that help control your core that are just as important, if not more important than this one.
The external obliques help to form the outer wall of your core and run along the sides of your trunk. They also help to flex the trunk, but also assist with rotation.
The internal obliques run just underneath the external obliques, running in the opposite direction, and also assist with rotation of the trunk.
Another muscle of the core is what is called the transversus abdominis, or TA. This muscle wraps around you like a corset and helps to improve the stability of your core.
The spinal erectors run down your back right up against the spine. These muscles help you stand up straight and maintain upright posture.
The hip flexors are another component to the core. These muscles are crucial to jumping and tumbling.
Often times in cheerleaders, the spinal erectors and hip flexors will be overactive and lead to what is called an anterior pelvic tilt, typically noted by an arched back in standing. A little bit of tilt is ok. However, too much tilt can mean weaker muscles in the abdomen and/or glutes leading to increased stress on the back and hips. Good core exercises will help to keep these muscles in check while strengthening the other muscles of the core.
Other muscles, such as the hip extensors and abductors, as well as hamstrings, are not always included in the “core”, but when weak can lead to problems that affect the core. So it is very important to make sure that these muscles are strong as well.
So, now that we know a little bit more about what makes up the core, how do we strengthen it? Here is a list of some of the most effective core strengthening exercises as well as how to do them. If you are experiencing any pain, either prior to, during, or after doing any of these exercises, stop and consult a physical therapist.
2. Rolling Side Plank
3. Physioball Pike Rollouts
4. Hollow Body Holds
5. Bird Dog
6. Reverse Crunch
7. Flutter Kicks
8. Leg Lowering
10. Single Leg Bridges
Ankle sprains are one of the most common injuries in cheerleading, and sports in general. There are several things that athletes can do to help prevent ankle sprains from occurring. Here are my Top 5:
1. Build Up Ankle Strength. Having strong muscles that support your ankle will act as a “brace” to support the ankle and aid in preventing ankle sprains from occurring. A physical therapist can prescribe specific individualized exercises, some of which may include: lunges, single leg squats, resistance band exercises, or toe/heel raises.
2. Improve Your Balance. Improving your balance is another great way to prevent ankle sprains. To understand how good balance will help, it is important to understand how the body’s balance system works. There are 3 main components to how the body balances itself. The first is through vision. When you see your surroundings, you are able to anticipate the environment and react accordingly. The second is with the vestibular system, or the inner ear, telling you that your body is moving, spinning, or changing positions. Without the help of the eyes, your body relies on the senses to know where it is in space, this is called proprioception and is the third component. The nerves in your foot and ankle help you sense the surface of the ground when you are running, walking, jumping, etc. Ways to improve the proprioception of the ankle is to work on different balance activities, such as standing on one leg.
3. Strengthen Your Core. The strength of your hips and trunk are important in controlling how the parts below move and function, including the ankles. Imagine if you were running in one direction and changed abruptly. If you lacked strength in your core, your feet and ankles would likely continue going in the initial direction, potentially leading to an ankle sprain.
4. Increase Flexibility. It is important to keep a good balance between strength and flexibility. Having adequate mobility in the ankle will allow the ankle to have a little more “give” before an injury occurs. However, hypermobility (increased mobility) of the ankle is one of the leading risk factors of ankle sprains, so too much flexibility can be a bad thing. A physical therapist can help you determine if you have too much, too little, or just enough ankle flexibility.
5. Progressive Activity. If you have taken some time off, either between seasons, or during a holiday break in the middle of the season, it is a good idea to return back gradually. Getting your body back into the habit of the activities performed in the sport can help decrease the risk of ankle injury.
Disclaimer: The information contained on this website is compiled from a variety of professional sources as well as the author's own experiences. The information should NOT be used in place of a visit to your healthcare provider or used to disregard any advice provided by your healthcare provider.