My Mysterious Knee Pain – Treating and Preventing Patellar Tracking Dysfunction

Common Symptoms – is my kneecap mal-tracking?

  • Do you have knee pain despite having no incident where you specifically injured it?
  • Has your knee pain been persistent for a number of weeks without getting better?
  • Have you recently increase in activities/exercises that put a lot of weight/stress through your legs OR are you recovering from another unrelated leg injury resulting in significantly less exercise for your legs?
  • Are you feeling pain primarily in the inside of your knee? Is this pain worse when walking down stairs, and sitting with your knee bent for long periods?

General Information – why does this injury occur?

Your kneecap, first and foremost, is a bone which we call your Patella. When straightening and bending your knee, your patella glides over the front of your knee. Your patella is pulled through this movement by your Quadriceps (thigh) muscles. As well as pulling your patella upwards, your quadriceps muscles also pull your knee cap inwards (i.e. towards your mid-line). There is a smooth track of bone in your Femur (thigh bone) in which your patella glides quite comfortably. When your patella deviates from this track (pulled to the left or right), these symptoms are caused.

The pull of your patella  towards your mid-line is primarily the responsibility of your Vastus Medialis Obliquus (VMO) muscle, one of your four quadriceps muscles. If this muscle is weak, your patella will instead slide outwards (away from your mid-line) and grind against parts of your femur (thigh bone). It’s likely that this it what’s causing your pain.

If you have fallen arches in your foot (also known as Excessive Ankle Pronation), then this could be causing your tibia (shin bone) to be rotated/tilted ever so slightly. This can cause your patella to be tilted/rotated ever so slightly, which in turn causes your patella to grind against the sides of it’s track in your femur (hip bone).

Typical Treatment – how will you cure my patellar mal-tracking injury?

  • Rest: Resting from activities where your knee is working for extended periods of time is important to prevent further trauma to the injured tissues. Avoiding activities like descending stairs and sitting with knees bent should be avoided even if they are no longer painful, as they are still damaging your knee.
  • Manual Therapy: Hands on physiotherapy is important to stretch the tight structures pulling your patella out of alignment. I will perform glides on your patella, pushing and stretching it towards your mid-line. Manual stretching of the Ilio-tibial Band (fibrous tissue stretching from your hip into your knee cap) is also essential if this structure is tight.
  • Strengthening: As mentioned, if one of your quadriceps muscles (Vastus Medialis Obliquus) is identified in the assessment as being weak, then strengthening and conditioning of this muscle is crucial. For sportsmen and women quadriceps will have to be strengthened to a high level and continuous leg strengthening will be required going forward to prevent reoccurring injury. If the below exercises are pain-free, you can start performing them straight away.
  • Stretching: It’s common with almost all knee injuries to see some tightness in the hamstring muscle group (back of the thigh). Therefore stretching of these muscles is almost always prescribed. Additionally, home stretching of your Ilio-tibial band is also important to maintain the gains achieved with manual therapy.
  • Taping: Lastly, taping can help to manage this pain in the knee in the short term, especially if spending lots of time walking/running is unavoidable in your daily life. I can show you how to tape this injury effectively so you can manage this aspect of the treatment yourself on a day to day basis.

SLS Squat

Make an Appointment

Remember, if you’ve got a knee problem, or any other injury, why not get it assessed by a professional, before it gets worse. Call me on 0861546175 or send me an email on You can see me in my Blackglen Clinic, Sandyford or we can organise a Home Appointment. I have weekend and evening appointments available as well, just give me a call for more information.

Thanks for reading!

Seán Flynn, Senior Physiotherapist


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