The season is getting good but now your knee hurts

The soccer season started and you finally got your form back. Your passes are connecting, your stamina is even better than last season. Your awareness on the pitch is finally catching the coach attention, and now you are getting more playing time. As your responsibility grows on the pitch, so does this knee pain. You noticed it a while back but you thought it was the result of overtraining during the preseason. You find it strange because you did not receive any trauma nor did you notice instability on your knee. Now you can barely run without you knee popping or clicking. The pain is starting to affect your game and that is very unfortunate because you had the form of your life. “When will this pain go away?”

A better question to ask is: How did I acquire this knee pain? This scenario described above doesn’t only apply to pro soccer player, high school and college athletes and even your regular Sunday league guy run into this problem. Sometimes the pain is on the side of the knee, and sometimes it is right at the front. However your symptom presents itself, it usually follows a recent increased in activity. More time on the pitch, more training session, even increasing your pick up soccer game from one to two or three times a week can have a negative impact on you knee. With an activity such as soccer, the force on your knees can easily go up to 3-5 times your body weight, if your body is not prepared for such a sudden increase in playing time, your knees will be the first to suffer.

The increase playing time is not the sole reason for your knee pain. Sure if your body is not prepared for extra time, you might be thinking you can solve this problem by hitting the weight to strengthen your lower extremities. This would be a good deduction but do you even know which parts need strengthening? Knee pain can also derived from muscle strength imbalance. Most of us are quadriceps-dominant, meaning anytime we execute a big movement, our quadriceps do most of the work while other big muscles, such as the glutes, are less active. This over-reliance on your quad muscles over time can change the alignment on your patella and cause knee pain. What tends to also happen with quad-dominant players is a neglect of the hamstring muscles. The ratio of hamstring strength to quad strength plays a big role in your risk for injury. Players with knee pain is often found to have significant weaker hamstrings comparing to their quadriceps. The normal hamstring to quadriceps strength ratio is between 50 and 80 percent, anything lower can negatively impact the knee so do not neglect your hamstring when you do your strengthening.

Lack of flexibility is another culprit for your knee pain, and adequate attention should be placed on tissue extensibility as it can also change the alignment around your knee and cause pain. How tight are your hip flexors, hamstrings and calves? How much time do you spend a week in improving your extensibility?

If you are noticing knee pain right after an increase in playing time in your sport, you should check with a Physical Therapist to screen you for all those impairments mentioned above (weak glutes, weak hamstrings, tight hip flexors, tight hamstring and calves) as well as for potential flags of which you may not be aware. As a soccer player myself, I understand the frustration of having to rest right when you finally got your groove back, so I compiled a series of exercises to do to keep your knee healthy. I have had popping and pain on my left knee from soccer and these exercises help me get better. The hardest part is adding them regularly into your weekly routine. It is ideal to do them 2-3 times a week to maintain good knee health status but I understand there is life outside of rehabilitation. However the key to any great habit is to start. Once you do them once, you will feel the effect and will want to do them more so you can stay longer on the pitch.



  1. Anterior knee pain, a holistic treatment:
  2. Patella femoral pain syndrome, proximal, distal and local:

Written by Berg

Hey there! I'm Berg and I am a Physical Therapy student at MGH IHP. I developed a passion for life-long learning and self-improvement and enjoy helping other people do the same. I am also a soccer fanatic. In the future I want to contribute to its expansion and popularity in the US. My aim is to create a community where aspiring Physical Therapists push each other to become the best version of themselves. I do this by sharing my experiences, books I read and what I'm implementing. As I add more to my skill set, I will be sure to feed you with more content, just like in the picture. Join me in the quest for self-improvement.

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