You look forward to tennis each week. It’s your outlet, your stress relief and now you are starting to experience knee pain. Tennis is a demanding sport, especially on your knees, as it involves quick bursts of acceleration, stopping, starting and changing direction. One of the more common complaints amongst tennis players is Patellofemoral Pain Syndrome (PFPS), which is often the diagnosis given for pain in the front of the knee. It is estimated that PFPS affects between 25-30% of individuals and some research suggests that PFPS may comprise up to nearly 25% of knee injuries. Common signs and symptoms of PFPS are pain in the front of the knee that is worse with bending, squatting, going up/down stairs and after exercise. Some research has suggested that PFPS may be more common in females and those with a strength deficit of the quadriceps relative to the hamstrings or an increased Q-Angle. Inhibition and improper activation patterns of the gluteus medius and gluteus maximus may also increase one’s risk of developing PFPS.

We often focus on treating the symptom (knee pain) and forget to step back and identify the root cause. Knowing the cause allows us to develop an effective rehabilitation program and also prevent this condition from developing in the future. It is commonly accepted that improper lower extremity mechanics are a major cause of knee pain. Poor mechanics are the result of an imbalance between the mobility, stability and proprioception (balance and neurological control) of the joints and flexibility and strength of the muscles and tissues that support them. Continuing to participate in activities with poor mechanics or deficiencies in any of these categories could increase one’s risk of experiencing knee pain. What we find is that many tennis participants experience pain, but the root cause of the pain may involve issues above or below the area of pain.

If knee pain is limiting your tennis game the good news is that many different solutions exist:

  • Preventative Care: If you know that you are prone to knee pain, seek out a functional movement test to understand your movement patterns. A good starting place is the Functional Movement Screen. You can then focus on increasing strength and flexibility in deficient areas. Reducing your chance of knee pain before it starts is extremely helpful in decreasing your risk for injury.
  • Preventative & Post Injury Knee Assessments: We now have access to various forms of technology that help us understand, with great accuracy, how someone moves. DorsaVi is a wireless wearable technology utilized by many professional and collegiate teams across the world to assess knee function, running gait, posture and core activation among a number of other types of movements. Knee specific DorsaVi assessments, like those offered by InHealth, will explore your knee function during dynamic movements like those involved in tennis and will help identify restrictions or limitations in your movement or signs of hip weakness (i.e. valgus collapse of the knee). Once these restrictions and limitations have been identified the team at InHealth will develop an individualized treatment plan to restore optimal movement and help enhance your game.
  • Soft Tissue Therapy: A combination of manual therapy techniques like Graston Technique and Active Release Technique (ART) are commonly utilized soft-tissue therapies that are effective in alleviating symptoms associated with various types of knee pain. These treatments may be used in conjunction with gait training, hip and knee strengthening, and various taping techniques to restore optimal movement and balance of the surrounding tissues. This combination of manual therapy and functional exercise is effective in both injury prevention and injury management scenarios.
  • Functional Rehabilitation: Working with a healthcare professional to develop a rehabilitation plan post injury is extremely important in restoring proper strength and flexibility post-injury.
  • Self Care: Self care is another important element of treatment. Foam rolls, Lacrosse balls and other self-myofascial release tools in conjunction with certain stretches are an excellent complement to soft tissue treatment and functional exercises for knee pain.

Do not let knee pain stop you from improving your tennis game. When you are ready to eliminate knee pain and improve your game contact the expert staff at InHealth to schedule an appointment.


Barton, C., Lack, S., Malliaras, P., & Morrissey, D. (2012). Gluteal muscle activity and patellofemoral pain syndrome: A systematic review. British Journal of Sports Medicine, 47, 207-214. doi:10.1136/bjsports-2012-090953

Fagan, V. & Delahunt, E. (2008). Patellofemoral pain syndrome: A review on the associated neuromuscular deficits and current treatment options. British Journal of Sports Medicine, 42(10), 789-795. doi:10.1136/bjsm.2008.046623

Lankhorst, N., Bierma-Zeinstra, S., & Middelkoop, M. (2013). Factors associated with patellofemoral pain syndrome. British Journal of Sports Medicine, 47(4), 1-16. doi:10.1136/bjsports-2011-090369

Noehren, B., Sholz, J., & Davis, I. (2011). The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. British Journal of Sports Medicine, 45(9), 691-696. doi:10.1136/bjsm.2009.069112

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