Effects of Hip and Ankle Mobility Rehabilitation in Male Collegiate Athletes 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.

• Hip- and Ankle-Mobility-Based Rehabilitation Program (Behavioral): A 6-week rehabilitation program performed 3 times per week for approximately 30 minutes per session. The program includes standardized warm-up, hip mobility training, ankle mobility training, and integrated movement exercises designed to improve hip internal and external rotation mobility, ankle dorsiflexion, and lower-limb movement control in soccer players with patellofemoral pain.

Primary outcomes

• Pain intensity assessed by Visual Analog Scale (VAS) [Baseline and 6 weeks]: Average anterior knee pain related to patellofemoral pain assessed using a 10-cm visual analog scale. Higher scores indicate greater pain intensity.
• Knee-related function assessed by Kujala score [Baseline and 6 weeks]: Knee-related function assessed using the Kujala Anterior Knee Pain Scale. Higher scores indicate better knee-related function.

Secondary outcomes

• Hip internal rotation range of motion [Baseline and 6 weeks]: Hip internal rotation range of motion measured in degrees using a standard goniometer.
• Hip external rotation range of motion [Baseline and 6 weeks]: Hip external rotation range of motion measured in degrees using a standard goniometer.
• Weight-bearing ankle dorsiflexion assessed by weight-bearing lunge test [Baseline and 6 weeks]: Weight-bearing ankle dorsiflexion measured as the maximum toe-to-wall distance in centimeters during the weight-bearing lunge test.
• Vastus medialis-vastus lateralis onset timing [Baseline and 6 weeks]: Relative onset timing difference between vastus medialis and vastus lateralis measured during a standardized bilateral squat task using surface electromyography.
• Y-Balance Test composite score [Baseline and 6 weeks]: Dynamic balance performance assessed using the Y-Balance Test composite score.
• Countermovement jump height [Baseline and 6 weeks]: Lower-limb performance assessed by countermovement jump height measured using a force platform.

Sex: Male, ages: 18 Years to 25 Years

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

• Results publication: Xu H, Feng Z, Dou Y, Wang G. Effects of a 6-Week Hip and Ankle Mobility-Based Rehabilitation Program on Clinical, Neuromuscular, and Functional Outcomes in Male Collegiate Athletes with Patellofemoral Pain: A Randomized Controlled Trial. Life (Basel). 2026 Jun 17;16(6):1013. doi: 10.3390/life16061013. PMID 42355539