The TRUTH About Patellar Tracking Disorder

5 Exercises to Keep Your Knees Healthy and Pain-Free

By Coach E

Were you told you’ve got patellar tracking disorder? It’s high time you were let in on the truth.

Read on to find out what’s really going on with this condition, and 5 exercises to help keep your knees healthy.

Persistent Knee Pain

If you’ve been told you have patellar tracking disorder or a kneecap out of alignment, possibly with patellofemoral pain syndrome, you’ve probably devoted hours to trying to alleviate the pain.

A quick Google search will tell you that to fix patellar tracking issues, you should perform exercises that target the vastus medialis oblique (VMO) – your medial quadriceps muscles.

So, you spend hours on these exercises, devoting your precious time at the gym on moves aimed at strengthening that vastus medialis olique and improving your kneecap tracking, hoping that eventually, your knee pain will go away …right?

But nothing happens.

No matter how much time and effort you put into training your VMO, your knee pain remains.

It still hurts when you get up after being at your desk for a few hours, it still hurts when you take the stairs, you still feel the occasional, unsettling “catch” in the knee…

So what the heck gives?!

I’m gonna let you in on the truth about this condition. Let’s start with understanding the diagnosis.

What is Patellar Tracking Disorder?

Patellar tracking disorder is the name given to the condition where the patella (kneecap) isn’t moving “correctly” [1].

patellar tracking disorder - human knee

This misalignment occurs when there is movement at the knee joint – i.e., when your leg is in the process of bending or straightening.

Patellar tracking disorder usually involves a patella that shifts too far laterally – to the outside of the leg.

patellar tracking disorder - leg anatomy

Image by

The condition is typically attributed to too shallow of a groove in the femur, where your patella normally sits.

Other commonly cited causes include damaged cartilage under the patella and issues with tense or loose musculature surrounding the knee [2].

The main symptom associated with patellar tracking disorder is pain at the front of the knee, especially when going up or down stairs, squatting, sitting for long periods of time then standing [3].

Popping or grinding noises, plus sensations like feeling your knee “catch” or buckle are all commonly tied to improper patellar tracking.

The TRUTH About Patellar Tracking Disorder

Okay so we’ve just covered the conventional wisdom about patellar tracking disorder – the general patellofemoral pain that’s caused by your kneecap shifting to one side.

But, the thing is…

It’s a bunch of BS!

The TRUTH is… there’s no ideal alignment for the kneecap. And there’s plenty of research to back this up.

Take for example a 2006 study where researchers from Queen’s University here in my home province of Ontario used MRIs to examine the kinematics of participants’ knees in 3D [4].

They studied 60 people in 3 different groups:

  1. 20 subjects with patellofemoral pain syndrome and diagnosed tracking issues
  2. 20 subjects with PFPS without evidence of tracking issues
  3. 20 subjects without any knee pain at all

They looked the subjects’ knees during 5 separate angles of flexion.

And what did they find?

A big huge pile of NADA.

They found no differences in patellar motion patterns between the groups, and instead found a lot of variety in the way the patellas moved.

At one of the 5 knee flexion positions, they did find that those with PFPS had patellas that were placed an average of 2.25 millimeters more laterally than those without knee pain.

But again, this was only at one specific position in a range of those tested, and the researchers concluded that you could not separate the PFPS patients from the non-patients by looking at the patellar movements they observed.

Another study, published in 2001, again used MRI, but this time to examine 40 knees with no painful symptoms [5].

They examined patellar motion during weight-bearing activities and again found a lot of variation, including lateral movement of the patella at certain points of flexion.

This team of researchers concluded that some lateral movement of the patella shouldn’t be a be-all-end-all sign of abnormal tracking, and that in fact, this shifting of the patella often occurs during normal movement in people completely free from knee pain.

So, What’s Causing Your Knee Pain Then?

If patellar tracking disorder isn’t the secret key behind PFPS, what is?

Unfortunately, there’s no secret, simple answer.

The TRUTH is that issues at the knee are often caused by problems up or down the kinetic chain i.e. at your ankle or your hip.

This image is a great way to visualize this concept.

patellar tracking disorder - kinetic chain

Image by

Outside of direct trauma, pain in one area of your body is often the result of dysfunction at another area.

Poor hip or ankle control, or mobility problems at these joints are usually the source of knee pain.

For example, let’s say you’ve got a weak gluteus medius.

Well, a weak glute medius doesn’t just make it look like you’ve got a small butt.

Weakness in this muscle may result in poor single leg balance, causing valgus stress or alignment at the knee (knock knees).

patellar-tracking-disorder-knock-kneesOr let’s say you’ve got super tight hip flexors.

In this case, these tight muscles are going to limit your hip extension, holding you in a position of anterior pelvic tilt and/or excessive lumbar extension.

What happens then is internal hip rotation, which rotates the entire lower leg internally and can result in medial and/or anterior knee pain.

In one study, 19 females with patellofemoral pain were compared to 19 females without [6].

The researchers found that the women with knee pain had a greater average internal hip rotation AND weaker hip muscles.

I’m not surprised, and after reading this, you shouldn’t be, either.

A Comprehensive Approach to Knee Pain

So how do you fix knee pain?

To rehabilitate your knee, you must treat the system as a whole – not just the individual symptoms.

That means you can just focus on the pain at the front of your knee, because while that is a symptom of a problem, it isn’t what’s causing the problem. Focusing your energy here won’t get you very far.

Instead, you need to:

1) Develop proper strength, control and mobility

Work on strengthening your entire lower body – from feet to hips, and even low back (have I mentioned it’s all connected?).

As you’re strengthening, work on your control in these movements – are you able to move slowly and under control throughout the entire range of motion, without using momentum or compensatory movements?

And, you definitely need to devote time to improving mobility.

I get it, everyone is busy, and you want to focus on getting strong, maybe working on that six pack or building those pecs when you’ve got time to work out.

But the truth is, mobility is key to taking your body to new places and reaching those goals.

Mobility is kind of like motor oil for your body.

Sure, you can keep driving your car for a while, even if you neglect to change the oil for way too long.

But eventually, it will catch up with you and the engine will grind to a halt…

patellar tracking disorder - engine stop

Don’t let this happen to your body.

Improving mobility will not only help heal any pain you’re currently dealing with – it will help prevent future injuries and setbacks. Meaning you will probably end up with more time in the gym in the long run if you devote some time to mobility now. This is a sound investment strategy if I’ve ever heard one.

2) Train the fundamental movement patterns

You also need to devote time to training the fundamental movement patterns – i.e., the squat, hip hinge, lunge and hip lift.

These moves are at the heart of most movements we perform with our lower body. If your form is off on any of these key moves, it’s kind of a no-brainer that you’ve got knee pain.

Devote time to training these moves until your form is spotless. And in the meantime, you’ll be building strength and working on your range of control.

5 Exercises to Fix Patellar Tracking Disorder

Exercise #1: Patellar Mobilization

Exercise to fix patellar tracking disorder - patellar mobilization technique 1

Exercise to fix patellar tracking disorder - patellar mobilization technique 2

Exercise #2: Metatarsal Pressure

exercise to fix patellar tracking disorder - metatarsal pressure

Exercise #3: Functional Ankle Mobility Drill

exercise to fix patellar tracking disorder - functional ankle mobility drill

Exercise #4: Monster Walk with Band

Exercise to Fix Patellar Tracking Disorder - Monster Walk with Band

Exercise #5: Walking Adductor Lunge

Exercise to fix patellar tracking disorder - Walking Adductor Lunge

Moving Forward & Building Healthier Knees

If you’re dealing with PFPS or if you just want to shore up the health of your knees, you definitely need to check out my article on 5 Patellofemoral Pain Syndrome Exercises.

Now that we’ve cleared up the patellar tracking myth, this article goes a bit deeper into what the term PFPS really means, plus gives you 5 killer moves that will help you fight it.

These moves are designed to do exactly what I prescribed above – help you build strength, control and mobility while training fundamental movement patterns AND treating the system, not the symptoms.

Quit devoting hours to targeted VMO exercises that aren’t doing anything to fix the problem.

Instead, hop over to the article and start working on these moves.

You should see a decrease in knee pain, plus gains in mobility, control and strength up and down the kinetic chain. Go for it!

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.