Patellar Maltracking – Busting Myths on How Our Kneecap Actually Moves

The Myth of Patella Maltracking

Patellofemoral pain is a very common problem with research indicating that 1 in 5 people will deal with patellofemoral pain at some point in their life. Females in particular are twice as likely to deal with patellofemoral pain as males are. This issue is so common in fact that it has been dubbed Patellofemoral Pain Syndrome (PFPS). While the nomenclature “syndrome” may make it sound like a complex disorder it is simply a way to group together anyone who has pain at their kneecap. 

So PFPS = pain in the front of your knee/ at your kneecap. Why does it occur? The short answer is we don’t know exactly why some people have patellofemoral pain and others don’t. And what do scientists and doctors do when they don’t fully understand something? 

They try to figure out a way to explain it quickly and easily. Hence, the myth of patella maltracking was born.

The idea behind patella maltracking makes sense. Your kneecap hurts when you squat or go downstairs, doing these activities (like any other activity that involves bending and straightening your knee) requires your kneecap to move back and forth within its groove. Knowing that some people have pain and others don’t, doctors and PTs started looking at the relationship between the kneecap and the groove and seeing if the way it slides is what is causing knee pain in those who have it.

There are many different theories on how this relationship can cause pain some point to the groove (or trochlea): accusing it of being too shallow for the kneecap to move in, or too narrow for it to comfortably sit in. Others point to the patella claiming it sits too high or too low in the groove.  But by far the common explanation goes like this – your kneecap is sitting laterally (on the outside of the groove) because it is being pulled that way by tight structures on the outside of your knee, and at the same time the medial structures on the inner part of your knee are weak, creating an imbalance that leads to kneecap pain.

Most commonly people are told they need to :

1. Stretch their IT band
2. Strengthen their VMO (the medial portion of the quad)

This Makes Sense….Why is it Wrong? 

Research doesn’t support the theory that patella maltracking plays a major role in patellofemoral pain. In one study – researchers used a type of high-tech moving MRI system to track subtle movements of the patella during loaded knee flexion activities (think stairs and squatting) and found that there was nearly no significant pattern to the way the patella moves in those with pain compared to those without pain, as well as those who had been diagnosed with maltracking and those who had not. They noted that in one position there was a “marginally significant” lateral position for those who have pain plus a diagnosis of malalignment compared to those without symptoms but despite this determined that :

“It is clear from the data that an individual with patellofemoral pain syndrome cannot be distinguished from a control subject by examining patterns of spin, tilt, or lateral translation of the patella, even when clinical evidence of mechanical abnormality."

Another study investigated a whole host of these supposed risk factors related to patella maltracking and found that none of them were significantly correlated with PFPS. All of the factors they noted were psychological, further supporting the growing body of knowledge that pain is a complex experience that goes far beyond simple biomechanics.

It has also been shown that 63% of people without PFPS had a laterally displaced patella. On top of this, studies have shown that doctors & PTs really can’t agree on what is truly patella maltracking. A systematic review composed of 9 different studies showed that reliability when assessing patellar position is “variable” amongst clinicians. This means that if 2 different MDs assess your kneecap they are unlikely to agree on whether its position is problematic or not.

So this means that: having a patella that doesn’t sit right in the groove does not mean it is causing your pain and it also means that being told by a healthcare professional that your patella doesn’t sit right in the groove doesn’t necessarily mean it's true. 

On top of this, the 2 most commonly prescribed treatments for patella maltracking have been unequivocally shown not to work: 

• Your IT band doesn’t stretch (more on that in the podcast below)
• You can’t isolate your VMO (check out the VMO blog above)

So Why Does my Kneecap Hurt & What Can I Do About it?

Pain is complex and there are a variety of physical and social emotional factors that play a role in the pain experience. So any time we are dealing with pain it is worth considering factors like sleep, stress, and other lifestyle factors.

Closing Thoughts:

So the research is clear: you can agonize over millimeters of kneecap movement and spend hours stretching your IT band and trying to isolate your VMO like it says on your PT script, or you can progressively overload and build the strength of your knee and hip muscles.