Abstract
CASE HISTORY: A 47-year-old male nurse who participates in Jiu-Jitsu and weightlifting presented with bilateral knee pain during squatting, accompanied by chronic hip, gluteal, and lower back pain. Initial injury to his left hip occurred while running, followed by right gluteal pain radiating across the lower back and occasionally down the lateral thigh. Subsequently, he experienced a severe exacerbation of right hip pain following exercise, resulting in a limp. He later developed anteromedial knee pain, which was worsened by deep squatting, knee flexion, and stair climbing. PHYSICAL EXAM: Exam showed a positive right J sign, mild patellar maltracking, and medial joint-line tenderness. Bilateral Ober’s tests were positive, with mild right glute weakness and early hamstring recruitment during straight leg extension. No numbness or tingling. DIFFERENTIAL DIAGNOSES: Patellar tendinopathy, Knee osteoarthritis, Meniscal injury. TESTS & RESULTS: X-rays showed enthesophyte formation at the left quad tendon insertion and slight lateral patellar tracking, greater on the right. No joint abnormality, dislocation, or effusion found. FINAL DIAGNOSIS: Bilateral Patellofemoral Pain Syndrome (PFPS) DISCUSSION: Patellofemoral pain is a multifactorial condition characterized by anterior knee pain that is aggravated by jumping, squatting, stair climbing, and running. It is more common among active populations, with females 2.23 times more likely than males to develop it. Common impairments include hip and quadriceps weakness and hamstring tightness. Assessment of the hip and lower back is important, as proximal weakness may contribute to PFPS even when imaging findings are mild. OUTCOME OF THE CASE: Physical therapy focused on glute activation, hip and knee strengthening, core stability, and flexibility. Knee pain persisted for two months but significantly improved by the three-month mark, as did hip and low back pain. He progressed to complete one rapid squat, which he had previously been unable to perform. Gluteal activation cues reduced knee pain to 0/10 during the Pallof press. At the final visit, the Right J sign was mildly positive; crepitus persisted. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient increased squat depth and weights and resumed Jiu-Jitsu. Physical therapy continued every few weeks.
Recommended Citation
Mathew, Heba S.; Arbel, Vered; Verma, Ankur; and Amasay, Tal
(2026)
"Bilateral Patellofemoral Pain in a Recreational Weightlifter and Jiu-Jitsu Practitioner,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
Iss.
9, Article 12.
Available at:
https://digitalcommons.wku.edu/ijesab/vol15/iss9/12