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.

Study Overview

• Status: Completed
• Conditions: Patellofemoral Pain
• Intervention / Treatment: Behavioral: Hip- and Ankle-Mobility-Based Rehabilitation Program

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 48
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shaanxi
    • Xi'an, Shaanxi, China, 710068
      • Xi'an Physical Education University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hip- and Ankle-Mobility-Based Rehabilitation; Participants receive a 6-week hip- and ankle-mobility-based rehabilitation program, performed 3 times per week for approximately 30 minutes per session, in addition to regular soccer training.	Behavioral: Hip- and Ankle-Mobility-Based Rehabilitation Program; 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.
No Intervention: Control; Participants continue regular soccer training during the same 6-week period and do not receive any additional structured hip or ankle mobility intervention.

What is the study measuring?

Primary Outcome Measures

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

Secondary Outcome Measures

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

Collaborators and Investigators

• Sponsor: Beijing Sport University

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2026
• Primary Completion (Actual): March 2, 2026
• Study Completion (Actual): March 4, 2026

Study Registration Dates

• First Submitted: April 14, 2026
• First Submitted That Met QC Criteria: April 14, 2026
• First Posted (Actual): April 21, 2026

Study Record Updates

• Last Update Posted (Actual): April 30, 2026
• Last Update Submitted That Met QC Criteria: April 26, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Soccer; Ankle mobility; Patellofemoral pain; Hip mobility
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Patellofemoral Pain Syndrome; Heterocyclic Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Alkaloids; Opiate Alkaloids; Isoquinolines; Benzylisoquinolines; Papaverine
• Other Study ID Numbers: XAIPE-PFP-2025-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No