Knee Pain In The Female Athlete


Knee injuries are becoming more common in female athletes. Interest in women’s athletics at the amateur and professional level has changed the face of sports. Greater participation has heightened appreciation of health and medical issues specific to the female athlete. Studies comparing male to female susceptibility to injury of the knee have shown women to have considerably higher rate of injury.

Statistics gathered over a three year period in the early 90s in the U.S.A  showed that women suffered knee injuries more often than men, nearly 4 times as often in basketball, 3 times as often in gymnastics, and nearly 2 and a half times as often in football.

This is a concern for all female athletes.

Knee pain in women – anatomy

The reason may seem complicated at first but its really quite simple when you get your head round it.

Women athletes have a wider pelvis than their male counterparts as this facilitates natural child birth. However this extra width has a negative effect when its comes to lower limb biomechanics. Have a look at the diagram on the right. The angle that is created between the thigh bone and the shin bone is called the Q angle. The greater the Q angle the more unhelpful biomechanical forces  operate around the knee. There is therefore more stress placed on the knee itself and the associated structures such as ligaments and tendons.

The two major components that affect the Q angle are

(i) increased pelvic width (as increases the angle that the thigh bone joins the knee)

(ii) Position of the foot during the contact phase (when the foot is on the ground) as this alters the angle that the shin bone enters the knee.




Remember that virtually all patellofemoral problems occur at the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point.

Golden rule- Don’t ignore the problem, it won’t go away


The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however is control lower limb biomechanics by altering foot position during the contact phase of gait. This can be achieved by wearing a good shoe (see our shoe guide) with orthotics  (foot beds), knee strengthening and knee support.

1. Check your footwear

Are your running shoes worn and in need of replacing? If so change them. The chances of patellofemoral injury is greatly increased both with the higher impact forces and loss of stability caused by a worn shoe. For more advice on running trainers our running shoe advice page is worth reading. Read more->

Below are a selection of trainers that are ideal for athletes.

Trainers for a neutral or under pronating foot type

Trainers for over pronators

2. rectify Poor biomechanics with orthotics

The way your foot strikes the ground and the forces that are placed on it can have a direct effect on biomechanics causing patellofemoral injury and can also delaying healing times. Check our biomechanics page for detailed information. Read more->

3. Knee strengthening


The single best exercise to improve the strength of the muscles around the knee is eccentric loading. This is usually done none weight bearing, however the use of a wobbleboard is an excellent way to strengthen muscles around the knee, foot and ankle in a controlled gentle manner. Whilst our clinicians have found it a brilliant way to strengthen muscles around the knee, traditionally a wobbleboard was used to help balance (proprioception). Proprioception is the nerve connection from the brain to the foot. This is often damaged/ disrupted after injury and can increase the chances of injury from recurring. It can also significantly delay recovery.

Use of a wobbleboard therefore has a dual benefit in the treatment of patellofemoral injury.

4. Knee support

Consider purchasing a knee brace . This device provides extra stability to the knee when playing sports. The material also causes localised vasodilation (opening of the blood vessels) increasing circulation to the area. This is vital as all ligaments have a notoriously poor blood supply. Increasing circulation to the ligaments can reduce the chance of injury. Extra stability will also reduce the chances of irritation and damage to the knee.

Patellofemoral injury prevention checklist summary

  • Rectify Biomechanics if necessary
  • Check Running shoes
  • Knee strengthening
  • Knee support

Returning to Activity

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your patellofemoral injury, which could lead to permanent damage. Everyone recovers from patellofemoral syndrome at a different rate. Returning to your activity is determined by how soon your meniscus recovers, not by how many days or weeks it has been since your meniscus injury occurred

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

You have full range of motion in the injured leg compared to the uninjured leg.

You have full strength of the injured leg compared to the uninjured leg.

You can jog straight ahead without patellofemoral pain.

You can sprint straight ahead without patellofemoral pain.

You can do 45-degree cuts, first at half-speed, then at full-speed.

You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.

You can do 90-degree cuts, first at half-speed, then at full-speed.

You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.

You can jump on both legs without pain and you can jump on the injured leg without pain.