Patellofemoral pain syndrome (PFPS) represents a significant concern in powerlifting, as squatting biomechanics can generate patellofemoral joint forces ranging from 0.5 body weight during walking to over 7 body weight during deep squats. Research demonstrates that all squat variations can potentially exacerbate PFPS symptoms, with peak stress occurring during knee flexion angles between 60° and 90°, where patella contact area increases but load distribution becomes suboptimal. The primary biomechanical risk factors include anterior knee translation beyond the toes during descent and muscle imbalances between quadriceps and hip stabilizers, which compromise optimal patellofemoral tracking patterns.pmc.ncbi.nlm.nih+1
Prevention strategies must address both movement quality and strength deficits through targeted interventions. Evidence supports implementing:
Controlled depth squatting above 90° knee flexion during acute PFPS phases, progressing to deeper ranges as symptoms resolve. highdesertsportsandspine
Hip and quadriceps strengthening protocols incorporating squats, lunges, and hip abduction exercises to improve knee alignment. pmc.ncbi.nlm.nih
Biomechanical assessment and correction focusing on femoral internal rotation control and dynamic valgus prevention during descent. exakthealth+1
Progressive loading strategies that emphasize proper kinematic patterns before advancing to competition-depth squats, particularly for athletes with PFPS history. highdesertsportsandspine
Clinical diagnosis can be confirmed through reproduction of retropatellar or peripatellar pain during squatting movements, making proper movement screening essential for identifying at-risk powerlifters before implementing competition-specific training protocols. jospt
https://www.exakthealth.com/en/blog/patellofemoral-pain-syndrome-exercises
https://highdesertsportsandspine.com/patellofemoral-knee-pain-prevention-and-treatment/
https://link.springer.com/article/10.1007/s40141-025-00502-9