Massage therapy · Kitchener–WaterlooPatellar Instability

Dislocations often happen with a non-contact injury, such as a pivot, twist or awkward fall, and a sharp blow to the kneecap can also knock it out of place (AAOS, n.d.).

After a dislocation, the tissues around the kneecap may have been stretched or torn, so they do not hold it in place as well. About 1 in 4 people have further problems with the kneecap moving out of place after a first dislocation (Blønd et al., 2025). However, non-surgical treatment of a first dislocation often gives good results with a relatively low chance of it happening again (AAOS, n.d.).

Warning signs: if your kneecap has moved out of place and has not gone back by itself, do not try to push it back yourself. Call 911 or go to the emergency room at your nearest hospital, where a doctor can put it back safely (AAOS, n.d.).

Surrounding the patella is the retinaculum, a sheath of tissue that helps hold the patella in place and allows the quadriceps muscle group to blend into the patella. One important part of this is the medial patellofemoral ligament (MPFL), on the inside of the knee, which stops the patella moving too far sideways (AAOS, n.d.).

The unstable patella tends to move laterally (to the outside of the knee).

1. Reduction

When the patella has come out of its groove, the first thing that needs to be done is to return it to its proper place, which is known as reduction. Sometimes this happens on its own. Other times, a doctor has to apply gentle force to push the kneecap back into place (AAOS, n.d.).

2. Physical Therapy

Physiotherapy is an essential part of recovery (Balcarek et al., 2025). I can help with the strengthening and hands-on side of your recovery, working alongside your physiotherapist if you have one.

3. Cycling and Bracing

Cycling is often recommended as part of a physical therapy programme (AAOS, n.d.). The goal is to increase flexibility and strength. A doctor may also prescribe a stabilising brace (AAOS, n.d.), although research has not shown a clear long-term benefit from bracing (Balcarek et al., 2025). The aim is to return to your normal activities within 1 to 3 months (AAOS, n.d.).

Surgery is usually considered if the kneecap keeps dislocating, for some very high-risk first dislocations, or if the kneecap is badly out of line as the knee moves (AAOS, n.d.).

Options outside my scope

• MPFL reconstruction: an operation to rebuild the ligament on the inside of the knee that stops the kneecap moving too far sideways, usually using a tendon graft. This is the preferred stabilising operation in current expert guidance (Balcarek et al., 2025).
• Other procedures: operations to correct poor bony alignment or reshape the groove that the kneecap runs in (AAOS, n.d.).

How I can help (see the My Approach tab)

• Thigh and hip strengthening to help keep the kneecap on track
• Hands-on work for tight, guarding muscles around the knee
• Taping and a gradual return to sport

If the kneecap keeps slipping out despite treatment, see your family doctor or nurse practitioner. If it comes out and doesn't go back, don't push it back yourself: call 911 or go to the emergency room.