Patellar Maltracking: Why Your Kneecap Isn’t Moving Properly

Patellar maltracking is one of the most common causes of front of the knee pain, especially in runners, gym-goers, cyclists, netball players, footballers, and people who notice pain with stairs, squats or lunges.

What is patellar maltracking?

In simple terms, this means that the kneecap does not glide smoothly as the knee bends and straightens. This occurs due to altered movement of the patella within the femoral trochlear groove.

When this tracking is altered, the kneecap may move slightly too far to one side, tilt, rotate, or load unevenly. This can increase pressure through the patellofemoral joint, irritating the joint surfaces, surrounding soft tissue, or tendon structures.

Patellar maltracking is commonly linked with patellofemoral pain syndrome. Pain around or behind the kneecap that worsens with squatting, stairs, running or jumping is a key feature of patellofemoral pain.

How do people get patellar maltracking?

Patellar maltracking usually builds up over time rather than starting from one single incident. It often occurs when the knee is repeatedly loaded while the hip, knee, ankle or foot are not controlling movement efficiently. Common contributing factors include:

• Sudden increase in running, gym, sport or stair-based activity

• Weakness or poor control of the quadriceps, particularly the VMO muscle

• Hip weakness, especially gluteal weakness, leading to the knee collapsing inward

• Poor single-leg control, often seen with squats, lunges, step-downs or running

• Tightness through the quadriceps, hip flexors, ITB region or calf complex

• Foot mechanics, footwear changes or poor shock absorption

• Previous knee injury, swelling, instability or reduced confidence loading the leg

• High training volume without enough recovery

In technical terms, we often assess for dynamic knee valgus, altered patellofemoral joint reaction forces, reduced hip external rotation control, quadriceps inhibition, and poor load tolerance through the anterior knee.

Common signs and symptoms

Patellar maltracking symptoms can vary, but people often describe:

• Pain at the front of the knee or around the kneecap

• Pain behind the kneecap with squats, stairs, running or jumping

• Clicking, grinding or creaking around the knee

• A feeling that the kneecap is not moving smoothly

• Pain after sitting for long periods, sometimes called “movie sign”

• Discomfort walking downhill or downstairs

• Mild swelling or irritation after activity

• A feeling of weakness, giving way, or lack of trust in the knee

Clicking alone is not always a problem. The bigger concern is clicking that is painful, worsening, associated with swelling, or causing loss of function.

Physiotherapy treatment for patellar maltracking

Physiotherapy treatment should not just focus on “pushing the kneecap back into place.” The goal is to identify why the patella is being overloaded and then improve the way the whole leg absorbs and controls force. Treatment may include:

1. Load management

Your physio will usually look at your current running, gym, sport or activity load and reduce the specific movements that are irritating the kneecap. This does not always mean complete rest. Often, the right approach is modifying painful activities while keeping you moving.

2. Strengthening

Exercise is usually the main part of treatment. This may include quadriceps strengthening, hip and glute strengthening, calf strengthening, and progressive single-leg control work. Current physiotherapy guidelines support exercise-based management for patellofemoral pain, often combining hip and knee strengthening.

3. Movement retraining

For runners and athletes, this may include looking at running technique, cadence, stride length, knee position, hip control and landing mechanics. For gym-based patients, we may assess squat, lunge, step-down and jumping technique.

4. Taping or bracing

Patellar taping can sometimes provide short-term pain relief and help the knee feel more supported while strength and control are being rebuilt. It is usually a temporary tool, not the whole solution.

5. Mobility and soft tissue work

Manual therapy, mobility exercises and soft tissue treatment may help reduce symptoms where stiffness or muscle tightness is contributing to altered mechanics. This is usually combined with exercise, not used on its own.

6. Return-to-running or return-to-sport plan

A good rehab plan should gradually rebuild tolerance to stairs, squats, running, jumping, sport or gym training. The aim is not just pain relief, but restoring confidence and capacity.

How Urban Physiotherapy Can Help You!

Consider seeing a physiotherapist if your kneecap pain is affecting stairs, squats, running, gym training or sport, or if symptoms keep returning every time you increase activity.

At Urban Physiotherapy North Sydney, our sports physiotherapists assess patellar tracking, lower-limb biomechanics, strength, mobility and training load to identify why your knee is being overloaded and build a clear plan to get you moving properly again.

Get in contact with us at (02) 8526 4000 or info@urbanphysiotherapy.com.au