Effects of Hip and Ankle Mobility Rehabilitation in Male Collegiate Athletes With Patellofemoral Pain

Effects of a Hip- and Ankle-Mobility-Based Rehabilitation Program on Pain, Neuromuscular Coordination, and Physical Performance in Soccer Players With Patellofemoral Pain: A Randomized Controlled Trial

This study evaluates whether a 6-week hip- and ankle-mobility-based rehabilitation program can improve pain, knee-related function, neuromuscular coordination, and physical performance in male soccer players with patellofemoral pain. Patellofemoral pain is a common condition in soccer players and may affect training tolerance, movement control, and sports performance. In this randomized controlled trial, participants are assigned to either an intervention group receiving hip- and ankle-mobility-based rehabilitation in addition to regular soccer training or a control group continuing regular soccer training alone. The rehabilitation program is performed 3 times per week for 6 weeks. Main outcomes include pain intensity and knee-related function. Additional outcomes include hip and ankle range of motion, vastus medialis-vastus lateralis onset timing, Y-Balance Test performance, and countermovement jump height. This study aims to determine whether improving proximal and distal joint mobility can contribute to better clinical and functional recovery in soccer players with patellofemoral pain.

Patellofemoral pain is one of the most common overuse-related knee problems in soccer players and is often associated with pain during running, squatting, stair ambulation, jumping, landing, and other load-bearing activities. In addition to pain, patellofemoral pain may impair movement control, neuromuscular function, and lower-limb performance. Increasing evidence suggests that patellofemoral pain should not be viewed only as a local knee disorder, but also in relation to proximal and distal dysfunction within the lower-limb kinetic chain. Restricted hip mobility may alter pelvic and femoral motion during functional tasks, whereas limited ankle dorsiflexion may affect shock absorption, tibial progression, and movement strategy during squatting, landing, deceleration, and change-of-direction tasks. Therefore, improving hip and ankle mobility may represent a clinically relevant rehabilitation strategy for soccer players with patellofemoral pain.

This study uses a randomized, assessor-blinded, parallel-group design to examine the effects of a hip- and ankle-mobility-based rehabilitation program in male soccer players with patellofemoral pain. A total of 48 participants are allocated in a 1:1 ratio to either an intervention group or a control group. The intervention group performs a 6-week rehabilitation program focused on hip internal and external rotation mobility, ankle dorsiflexion mobility, and integrated lower-limb movement exercises, 3 times per week for approximately 30 minutes per session, while continuing regular soccer training. The control group continues regular soccer training without additional structured hip or ankle mobility intervention.

The primary outcomes are pain intensity assessed by visual analog scale and knee-related function assessed by Kujala score. Secondary outcomes include hip internal rotation range of motion, hip external rotation range of motion, weight-bearing ankle dorsiflexion, vastus medialis-vastus lateralis onset timing during a standardized bilateral squat task, Y-Balance Test composite score, and countermovement jump height. Assessments are performed at baseline and after the 6-week intervention. The purpose of the study is to determine whether a mobility-oriented rehabilitation approach can improve both clinical outcomes and functional performance-related measures in soccer players with patellofemoral pain.

Inclusion Criteria:

• Male soccer players aged 18 to 25 years At least 3 years of systematic soccer training experience Currently participating in organized soccer training at least 3 times per week Peripatellar or retropatellar pain consistent with patellofemoral pain Pain provoked during at least one load-bearing knee-flexion activity, including squatting, stair ambulation, running, jumping, or prolonged sitting Patellofemoral pain reproducible during squatting Symptom duration of at least 4 weeks Able to complete all testing and intervention procedures

Exclusion Criteria:

• History of knee surgery or major lower-limb surgery Acute lower-limb injury within the previous 6 months Other diagnoses that could explain anterior knee pain, including ligament injury, meniscal injury, patellar instability, osteoarthritis, or other tibiofemoral pathology Neurological or systemic disease affecting exercise performance Current participation in other structured lower-limb rehabilitation interventions