What is patella maltracking?

patella maltracking logoPatella maltracking is one of the main causes of knee problems, so it’s important to understand why it occurs. If you have general knee problems, this brief guide will help clarify exactly what patella maltracking is and how it might be responsible for your pain. We will explain what the patella is, why it tracks incorrectly and the problems this can cause, as well as briefly touch on what can be done to relieve pain.

What is the patella?

The patella is what most people know as the kneecap. It is the point highlighted in our KneeStrength.com logo (above), as it is the focal point of our exercises. The movements of areas of the whole body can have an impact on the way the patella tracks over the knee, so the movement of the kneecap can point to different problems. In the immediate area around the knee, we are most concerned with the impact of these quadricep muscles:

location of the patella and quadriceps from the front

Position of the patella from the front (left leg).


What is patella maltracking?

Patella maltracking is an imbalance problem. The muscles in the upper thigh, the vastus medialis (inside) and vastus lateralis (outside) pull on the patella tendon in different directions. If one side is tighter than the other, it will pull the patella out of balance. Demonstrated with this simple diagram, the patella should ideally run smoothly down the middle of the groove between the condyles (the two sides) of the femur, at the end of your thigh bone:

Correct patella tracking diagram.

In most cases of patella maltracking, the lateral (outer) quad is overactive and stronger than the medial (inner) quad, which is weak and underused. In these cases, the patella gets pulled out of the groove, to the side, and rubs against the femur, and this is what causes the pain you feel.

patella maltracking diagram

When the outer quad is especially tight, it can even pull the patella out of the joint and cause a dislocation. To tackle patella maltracking, therefore, you have to address the tightening of the muscle and the strength imbalance.

What causes the muscle tightness?

There are a number of reasons that the patella movement can become imbalanced, but muscle tightness is caused by an imbalance in strength or through muscles being overworked or used incorrectly. The muscle tightness stemming from improper muscle use comes from an evolutionary survival mechanism. When the muscle is overworked, there is a risk that it will tear and be damaged. In order to prevent this, the body sends impulses for the muscle to contract and avoid overstraining. This contraction forms a permanent knot in the muscle, which shortens the muscle. The shortened muscles then pulls tighter on the joint, causing it to feel stiff. The stiff feeling makes you want to avoid using the joint.

The corrective measures made by your body are well-intentioned, as they may prevent you from performing seriously harmful actions, but these warning signs leave lasting stiffness in the body. The muscle knots causing this stiffness can be removed manually. If you remove the knot, the muscle can be restored to its full length, preventing tightness and alleviating the pain. You can do this, simply, by massaging the knot. This breaks it down, switching off the nervous impulse and releasing the waste products caught in the knot. It also restores blood-flow to the muscle.

How to prevent future knots

Removing the knots treats the symptoms of patella maltracking and knee problems, but to prevent the problems from returning you have to address the strength imbalance. Performing correct body-movement exercises such as squats helps rebalance the muscles and increases strength where it is needed to maintain balanced knee movements. By training yourself to do these exercises in a controlled environment, you will start to move more correctly in everyday life, including in more strenuous situations (for instance when you lift something heavy or do outdoor sports). That trained balanced everyday movement is what will ultimately cure you of patella maltracking related problems for good.

For more information, please read other articles on this site and watch our instructional videos. The LiftAge video providing a brief introduction to correcting patella maltracking is a good place to start.

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35 Responses to What is patella maltracking?

  1. Pingback: How to use sissy squats to correct patella maltracking

  2. Pingback: Interview with a trainee: Andrew LeDuc - KneeStrength.com

  3. Pingback: How to use sissy squats to correct patella maltracking

  4. Pingback: How to use a foam roller to correct patella maltracking: outer quads

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  8. Stephanie says:

    I wanted to schedule a skype session to see if I’m squatting properly .

  9. Daniel says:

    Hey, can I schedule a skype session too so I can tell you what I feel and maybe you can help me out. Thanks

  10. john palm says:

    my problem also started with the sit-down leg press 6mos ago the pain started in the knee now is fairly constant behind the knee and cramping in the lower leg the GP doc said it maybe arithritus the pain level goes from 0 to 7 from day to day Im 65 yrs old with no previous problems

    • Hi. The back of knee pain you describe is a different injury to the one described in this article which refers to pain underneath the kneecap.
      Pain in the back of the knee can arise from a number of different causes as it is a very complicated area of the body containing a number of tissues which can be irritated easily. It is virtually impossible to resolve such an injury without treatment in person. I recommend you visit a physiotherapist to get an assessment as they will have a lot more specialist knowledge than your GP.

  11. Pingback: Improve your knees with this powerful lower leg stretch

  12. Megan says:

    Hi – I have been told by doctors and orthapedic surgeons that I have what they have always called “bi-lateral patellis” which is described exactly as it is in this article. The pain is primarily above my knee on the outer side – is this the same condition? It pretty much hurts constantly which limits my mobility and I am on a wide variety of medications to combat the problem. I have been to physical therapy and chiropractic with little results to show for huge bills.

    • Hi Megan,
      Bilateral describes something that effects both limbs. Do you have the problem in both knees? Patellofemoral pain is very common and so there is a good chance if this article sounds familiar to you then the information on this website could be very useful to you. Please drop us a message through the contact section if you want to discuss your situation in more detail. Patella maltracking can be self-treated effectively with the right knowledge and with no need for medications.
      Kind Regards,

  13. Ty says:

    Hi I am experiencing knee pain in lots of different places but mainly laterally above the knee. I play semi professional beach volleyball. MRI shows a bone bruise to the outer condyle of my femur. Can maltracking cause a bone bruise?

    • It is difficult to say whether the forces between a tight maltracking patella and the outer condyle of the femur could be high enough to cause a bone bruise. It is perhaps more likely that repetitive high compression forces between the femur and the tibia would be the more likely cause of such a bone bruise. However, if you also feel pain under the kneecap when you try to extend the leg, patella maltracking could be part of your problems.

      • Ty says:

        Thanks for the response. Any advise on treatment of the bone bruise?

        • Traditional medical advice for bone bruises caused by one-off traumas is rest, ice and anti-inflammatory medicine. But if this has developed slowly over time, you will need to think about more than that and try to identify what activities and movements could have contributed to it. It could be that you perform faulty patterns of movement. Correcting those is a massive but very rewarding project. The best place to start is with a foam roller and squat training.

  14. Gem Watson says:

    Hi, I had knee surgery (arthroscopy) last week to repair a meniscal tear (knee would randomly lock, no pain but it would lock for several hours) Post surgery this problem seems to have been resolved.

    I was able to walk normally post op, no swelling, no pain, all great until the weekend when the front lower knee cap started to catch (excruciating pain) it has continued to catch and when it happens it makes my knee collapse with terrible grinding pain.

    This is in a completely different area and I am extremely concerned as I feel my mobility has gone from 100% (with the occasional locking) to 25% and I’m so scared of walking even a few paces without it catching and making me yelp in pain.

    Any advice or indication of a likely cause would be very much appreciated, many thanks 🙂

    • Hi. If it’s only been one week since your surgery you really need to get back in contact with the surgeon and explain what is happening. Is there any follow-up appointment booked? This needs to be followed up. It could be that the operation has dislodged some debris further down into your knee and it is catching under your kneecap.
      I hope you get this resolved. Let us know if you have any questions after seeing the surgeon again.

  15. Gem Watson says:

    Thank you, I think you are right! I woke this morning and yelped as I swung out of bed, the crunch/grind was horrid. Then for the rest of the day and for the 1st time in two days I feel safe enough to bend my leg and weight bear. I’ve been walking normally all day 😀

    However, It’s in the back of my mind that whatever it was is still lurking in there?

    I’ve been doing the Sissy Squats! 🙂

    Thanks again!

  16. fatty says:

    hi #kneestrength#
    i am having a knee problem , i guess i have an extra cord in my knee, and that needs to be cut. my patella is rubbing against the femur and giving grating sounds. doctor says i have to be operated on it. the patella cord has to be cut and has to come back to place. is this something correct to do a surgery? im not saying its wrong, i just need to confirm with sm1 else about this .

    • It may be best to ask your doctor if he thinks the surgery is absolutely necessary. Use of surgery is best kept as a last resort only once all other treatments have been tried first. For instance, applying the exercises covered on this website may help you avoid the need for surgery.

  17. Ryan says:

    I have had surgery to repair torn patella ligaments after dislocating my patella. Before which I had dislocated 20+ times. It has been 8 years since my surgery, but I am looking for a brace that I can use skiing.. Do you have any recommendations? While still playing sports in High School I wore a number of different braces, most of which were huge and bulky. I think I am looking for something that is hinged and constructed mainly to keep my knee cap from popping out again.

    Let me know if you have any suggestions..


    • There are articles on this website aimed at helping people gain better control of the tracking of the patella. With a very cautious approach, these could help to hold the patella in better alignment and reduce risk of further dislocations.
      As for braces I’m afraid that is not an area where I have any expertise. The methods on this website only look at medium to long term training based resolutions for injuries so I’m sorry I can’t be of any help here.

  18. Nirali says:

    Hi..I have “mild patellar tilt” (medial) in my both knees since last three years. Due to this I have “fallen arches” in both feet. I was told by my PT to do traditional “vmo strengthening” exercises along with “lateral retinacular stretches”. 

    Though I am able to walk (just simply walk) pain free ….. while standing for more than 10 minutes or so … there is lot of stress in both knees and feet (feet slightly turns inwards ….causing fallen arches). Stair climbing seems stressful too….(kneeling and running – don’t do at all…. As those activities promote pain in knees).

    While searching for an answer on the internet….’came across ur website and found it enormously hopeful.

    Can I choose sissy squats as remedy to my faulty knee biomechanics (i.e. medial patellar tilt)?

    Many thanks!!

  19. Chris says:

    I have had patella maltracking for about 2.5/3 years now. I have struggled to fix the problem. I was just wondering if this is likely to be causing any long term permanent damage to my knee? When I fully rest my knee does not feel too bad but the pain keeps returning when I use my knee lots.
    Kind regards

  20. William says:

    Hi knee strength,

    Great article! I have been getting knee pains for about 2 years now. I get my pain around my knee and in the back of my knee. I do a lot of running and exercise and am currently doing strenght exersises (eg. Squats with weights and other ranging exercises) to prevent further injuries. I also had an MRI done and it showed my knee cap was ‘maltracking’. In terms of fully resolving this problem what would you suggest?

    • Hi, there are a large number of articles on the website about patella maltracking so be sure to look around the site. You can use the website’s search function and also download the website’s guide to dealing with patella maltracking, which compiles and orders many of the relevant articles.
      Let us know if you have any further questions.

  21. Jess says:

    Hi! I just want to know if what I keep experiencing is indeed patellar maltracking. It feels like my patella gets displaced (but returns rught back) whenever I suddenly turn around or twist. This happens very rarely (like an interval of months or years), but it just happened to me again a few minutes ago. It would always feel very painful but I always try to extend my knee as soon as possible (which is so hard because the pain is too much to handle) because I think it kind of helps relieve the pain. Our professor in human anatomy said that this Patellar Maltracking usually happens to women, especially pregnant women (I’m not pregnant though. But I’m a 19y/o girl)…so this is nothing serious, right? I mean, should I start worrying about it? I walk everyday so I thought my quads get enough exercise to keep my knee stable.

    • You might be best off getting a physical therapist to take a look at the relative tightness of each of your quadriceps as you might have tight lateral quads and weak medial quads, say. The shape of the condyles of your femur might be such that they are more susceptible to these displacements. Learning about how to move better through squat training and foam rolling will help you lessen any inbalances in your quad muscles and reduce the risk of further displacements.

  22. Meena says:

    I just came upon your videos on Youtube on patellar tracking issues. I am an avid walker (walk 6-7 miles a few times a week) but recently ran a few times and started having knee pain, especially found that my knees hurt very badly when I get up from a sitting on a chair even for a few mins. However, if I stretch out my knee (painfully), then get up I am fine, Is this is patellar tracking malfunction? My orthopedician told me it is patellar tilt and asked me to do PT. Also, I have temporarily stopped going on long walks because my left knee does not feel very good after the walk.

    • Hi there, given the sounds of your symptoms, I think you could definitely benefit from the exercises and articles on this website to improve the way you move and hence the way your kneecaps move.

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