Massage therapy · Kitchener–WaterlooPatellar Tracking Dysfunction
Knee
What It Is
Patellar tracking dysfunction happens when the kneecap (patella) slides slightly out of place as the leg straightens or bends. The kneecap may shift too far toward the outside of the leg or, in some people, toward the inside of the leg (AAOS, n.d.a). It is one form of patellofemoral pain (pain around and behind the kneecap) and is sometimes called "patella mal-tracking" (St George's University Hospitals NHS Foundation Trust, 2026).
Knee joints are complex hinges joining the shin bone (tibia) with the thighbone (femur). The kneecap is held in place at the front of the joint by tendons along the top and bottom, by ligaments along the sides, and by a sheath of tissue around the kneecap called the retinaculum. A layer of cartilage lines the underside of the kneecap, which helps it glide along a groove at the end of the thighbone, called the trochlear groove (AAOS, n.d.a).
The kneecap can tilt or shift off track if the groove is too flat (AAOS, n.d.b) or if the cartilage becomes damaged. Weakness or tightness in the thigh and hip muscles can also contribute to the kneecap moving off track (AAOS, n.d.a; St George's University Hospitals NHS Foundation Trust, 2026).
Patellar Tracking Dysfunction Anatomy
Not a diagnosis — for more information, contact me or another trusted healthcare provider.
Treatment
Self-Care & Treatment
How to Treat Patellar Tracking Dysfunction
Tips
- Avoid activities that overload and overuse the knee, and increase your training gradually.
- Warm up before activity, and stretch the thigh muscles (quadriceps and hamstrings) both as part of your warm-up and afterwards (AAOS, n.d.a).
- Swimming and cycling are two great low-impact activities to keep the knee moving and healthy (AAOS, n.d.a).
- Maintain a healthy weight to help reduce the amount of stress placed on the knee joint (AAOS, n.d.a).
- Learn the right technique for your sport, and always wear the proper equipment and shoes for whatever sport you are participating in (AAOS, n.d.a).
- Keep up muscle-conditioning exercises and stretches to help the knee regain strength and flexibility.
- Be patient: symptoms can take between three and six months to improve (St George's University Hospitals NHS Foundation Trust, 2026).
- I can design an exercise programme that suits you (see the My Approach tab).
Treatment
My Approach
Pain around and behind the kneecap is rarely just a knee problem. Your hip, thigh, calf and foot all affect how the kneecap tracks, so I look at the whole leg. My aim is to settle the pain, then build strength in your thigh and hip so your knee copes with your activities again. Exercise is the main treatment; hands-on work and taping help you do it more comfortably.
I start by assessing how your knee and kneecap move, the strength and flexibility of your thigh, hip and calf, and how your leg lines up when you squat, step down and walk.
Hands-On Treatment
- Massage to ease tight muscles around the knee and hip, including the thigh, hamstrings and calf
- Buttock and hip work only with your informed consent and a written consent form
- Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
- Taping the kneecap for short-term relief if it helps you, and I'll show you how to tape it yourself
Strength and Movement
- Starting pain-free with thigh tightening, bridges and side-lying hip strengthening
- Building to wall squats, sit-to-stands, step-ups and slow step-downs, with the knee over the middle of the foot, then gym-based work if you lift
- Stretches for the thigh muscles, hamstrings and calves
- Some discomfort during or after exercise is fine, but if pain is worse for more than 24 hours afterwards, we do less next time
Day to Day
What to Expect
Typical Course
What I Focus On
Sources
References
- American Academy of Orthopaedic Surgeons (AAOS) (n.d.a) Patellofemoral pain syndrome. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/ (Accessed: 7 October 2026).
- American Academy of Orthopaedic Surgeons (AAOS) (n.d.b) Unstable kneecap (patellar instability). OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/unstable-kneecap/ (Accessed: 7 October 2026).
- St George's University Hospitals NHS Foundation Trust (2026) Patello-femoral pain (PFP). Available at: https://www.stgeorges.nhs.uk/wp-content/uploads/2023/11/CSW_PFP_03.pdf (Accessed: 7 October 2026).
- Crossley, K.M., van Middelkoop, M., Callaghan, M.J. et al. (2016) '2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions)', British Journal of Sports Medicine, 50(14), pp. 844–852. doi: 10.1136/bjsports-2016-096268