September 2025

Patellofemoral Pain and Squat Mechanics

Patellofemoral joint pain (PFJP), or anterior knee pain, is often diagnosed when pain in and around the knee cap occurs while flexing the knee too much as in sitting down or rising from a seated position, going down stairs or hill, jumping (especially landing), and even just sitting too long (often called ‘the movie sign’). Potential causes are quadriceps or hip external rotators weakness; tight quads, hamstrings, or iliotibial band; overuse or trauma; dysfunctional quads; “malalignment of the lower extremity, and excessive rear-foot pronation.” We’ve discussed this as well as how to train with PFPJ here, and  here.

PFJP is due to repetitive and high PF stress that affects soft tissues around the joint such as the fat pad beneath the patella, synovial plicae, the capsule surrounding the whole knee, and the PF ligaments that keep it aligned. Also, since the subchondral (under the cartilage) bone has many pain receptors, high levels of bone stress can exacerbate PFJP. Over the long run, high levels of bone, cartilage and soft tissue stress can lead to cartilage degeneration leading to osteoarthritis of the PF joint. Understanding PF forces and stresses helps therapists and trainers make exercise modifications for those with PFJP.

A study comparing 2- and 1-leg body-weight squats on the floor or on the dome side of a Bosu ball (a half-dome of a large stability ball used for stability training) found that deeper knee bends (70-100 degrees) may not increase risk since joint stress is spread over a larger area of the patella. They also engage more quadriceps, hamstrings, and gluteals compared to lesser angles.

Furthermore, squats on the Bosu tend to engage more gluteals at the expense of the thigh muscles.

While 1-leg exercises are harder overall and require greater balance, the principles of squat depth still hold.                             

IJSPT Feb. 2025

Should Overweight/Obese Kids Do Ozempic-Like Drugs?

Semaglutide (SGT), liraglutide, and other -tides are becoming well-known among people with all kinds of of weight-related concerns, from being overweight to having diabetes, heart and kidney disease. But these Ozempic-like drugs have been tested mostly in adults. The questions, as we confront the rising tide of overweight/obesity in people under 19 (estimated at ~33% and ~20%, respectively) is, do these drugs work and are they safe to start at so young an age?

A quick review of www.pubmed.gov (a clearinghouse of scientific research journals worldwide) shows two things: one, not a lot of studies have been done on young people and, two, generally, at least short term, these drugs are safe.

A once/wk injection of SGT plus lifestyle intervention resulted in a greater reduction in BMI than lifestyle intervention alone,” according to an article in NEJM (Dec. 2022). Serious adverse events were reported in 11% of the study group and 9% of the lifestyle intervention group. Another recently confirmed the benefits of SGT as part of a “multidis-ciplinary weight management” program – 8.9% weight loss after one year with mostly mild GI side effects. (Arch Disease Childhood (2024 Sept.))

A 68 week-long study of SGT, noting success in reducing BMI and improving hyperglycemia and hyper-lipidemia, cautioned that long-term effects are unknown. (Curr Opinions Pediatr, May 2024)

The bottom line, at this point in time is, they do work as they do in adults but we simply don’t know what might happen as they get to adulthood.

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