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Patellar Tracking Disorder: Exercises

Introduction

Key points

The thigh muscles (quadriceps) help keep the kneecap (patella) stable and in place. Weak quadriceps increase the risk of patellar tracking disorder.

Ligaments and tendons also help stabilize the patella. If these are too tight or too loose, you have a greater risk of patellar tracking disorder.

The goals of nonsurgical treatment of patellar tracking problems are to reduce symptoms, increase quadriceps strength and endurance, and return to normal function. Exercises for patellar tracking disorder are not complicated and can be done at home in about 20 minutes a day.

  • Most patellar tracking problems can be treated effectively without surgery. Nonsurgical treatment may include rest, regular stretching and strengthening exercises, taping or bracing the knee, using ice, and short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Quadriceps strengthening is the most commonly prescribed treatment for patellar tracking disorder. Exercises to increase flexibility and to strengthen the muscles around the hip can also help.1
  • Patience and dedication are essential. The slow progress and improvement can be frustrating. But most people can be spared a surgical procedure by closely following a conservative therapy program.

Be sure to stay on your exercise program. You may not notice much improvement in your symptoms right away, and recovery can take several months. Problems can come back if you don't keep your strength and flexibility.

 

At first, following an injury or a flare-up of symptoms of patellar tracking disorder, knee activity should be reduced. Rest your knee by avoiding activity that increases your symptoms. Exercises should begin as the symptoms resolve.

Steps you can take to help treat patellar tracking disorder include:

  • Reducing knee activity until pain and other symptoms resolve.
  • Strengthening exercises, especially for the quadriceps (muscles in the front of the thigh).
  • Flexibility exercises.
  • Taping the knee or using a brace.
  • Using ice and nonsteroidal anti-inflammatory drugs (NSAIDs). After 2 or 3 days of using ice, you can try heat to see if it helps.

Test Your Knowledge

Surgery is usually needed to treat patellar tracking disorder.

  • True
    This answer is incorrect.

    In most cases, nonsurgical treatment including rest and quadriceps-strengthening exercises done in combination with taping or bracing the knee and use of ice and nonsteroidal anti-inflammatory drugs (NSAIDs) will resolve a patellar tracking disorder.

  • False
    This answer is correct.

    In most cases, nonsurgical treatment including rest and quadriceps-strengthening exercises done in combination with taping or bracing the knee and use of ice and nonsteroidal anti-inflammatory drugs (NSAIDs) will resolve a patellar tracking disorder.

  •  

Continue to Why?

 

Nonsurgical treatment, especially strength and flexibility exercises, is usually all that is needed for patellar tracking disorder. But be sure to seek diagnosis as soon as you notice symptoms, so that you can begin the right treatment. In general, the longer you have a patellar tracking disorder, the longer treatment will take.

If a patellar tracking disorder is left untreated or treated without success, it can lead to chondrosis or osteoarthritis of the knee.

Test Your Knowledge

Ignoring the symptoms of a patellar tracking disorder can have severe long-term consequences.

  • True
    This answer is correct.

    If a patellar tracking disorder is left untreated, it can lead to chondrosis, a softening or loss of the cartilage that covers the back of the kneecap, which can cause pain during activities that require bending of the knee. It can also lead to osteoarthritis of the knee, a progressive breaking down of cartilage that is a major cause of disability in older adults.

  • False
    This answer is incorrect.

    If a patellar tracking disorder is left untreated, it can lead to chondrosis, a softening or loss of the cartilage that covers the back of the kneecap, which can cause pain during activities that require bending of the knee. It can also lead to osteoarthritis of the knee, a progressive breaking down of cartilage that is a major cause of disability in older adults.

  •  

Continue to How?

 

Correct diagnosis is of great importance in designing an exercise or rehabilitation program. The treatment you receive and the exercise program you use to rehabilitate your knee should be developed specifically for your condition. Some doctors will recommend using a brace or a taping technique to keep your kneecap in proper alignment, in addition to an exercise program. Be sure to closely follow the instructions from your doctor or physical therapist.

At first, following an injury or a flare-up of symptoms of patellar tracking disorder, knee activity should be reduced. Overuse and trauma are common causes of knee pain. And resting your knee will help relieve pain. Exercises should begin as the symptoms resolve.

Your doctor or physical therapist should help you decide what exercises to do. He or she will probably have you start with one or two exercises and add others over time. Your physical therapist may use biofeedback during some exercises to help you learn to contract certain muscles, especially the inner muscle of your quadriceps.

The following exercises may be the first ones that your doctor or physical therapist recommends.

Quad sets

Picture of an isometric exercise for the quadriceps
slide 1 of 2
    
  1. Sit with your leg straight and supported on the floor or a firm bed. (If you feel discomfort in the front or back of your knee, place a small towel roll under your knee.)
  2. Tighten the muscles on top of your thigh by pressing the back of your knee flat down to the floor. (If you feel discomfort under your kneecap, place a small towel roll under your knee.)
  3. Hold for about 6 seconds, then rest up to 10 seconds.
  4. Do this for 8 to 12 repetitions several times a day.

Mini squat

Picture of isometric exercise for the inner part of the quadriceps muscle group
slide 2 of 2
    
  1. Stand with your feet about hip-width apart and 12 inches from a wall.
  2. Lean against the wall and slide down until your knees are bent about 20 to 30 degrees.
  3. Place a ball about the size of a soccer ball between your knees and squeeze your knees against the ball for about 6 seconds at a time.
  4. Rest a few seconds, then squeeze again.
  5. Repeat 8 to 12 times, at least 3 times a day.

When your doctor or physical therapist thinks your knee is ready for more intensive exercise, he or she may recommend some of the following:

Straight-leg raises to the front

Picture of straight-leg raise exercise for quadriceps (lying on the back)
slide 1 of 11
    

Note: For straight-leg raise exercises, your physical therapist may have you add light ankle weights as you become stronger.

  1. Lie on your back with your good knee bent so that your foot rests flat on the floor. Your injured leg should be straight. Make sure that your low back has a normal curve. You should be able to slip your flat hand in between the floor and the small of your back, with your palm touching the floor and your back touching the back of your hand.
  2. Tighten the thigh muscles in the injured leg by pressing the back of your knee flat down to the floor. Hold your knee straight.
  3. Tighten the quadriceps muscles of your straight leg and lift the leg 12 to 18 inches off the floor. Hold for about 6 seconds, then slowly lower the leg back down and rest a few seconds.
  4. Do 8 to 12 repetitions, 3 times a day.

Straight-leg raises to the inside

Picture of straight-leg raises to the inside (lying on the side)
slide 2 of 11
    
  1. Lie on your side with the leg you are going to exercise on the bottom and your other foot either up on a chair or flat on the floor in front of your knee.
  2. Tighten your thigh muscles, and then lift your leg straight up away from the floor.
  3. Hold for about 6 seconds, slowly lower the leg back down, and rest a few seconds.
  4. Do 8 to 12 repetitions, 3 times a day.

Straight-leg raises to the outside

Picture of straight-leg raises to the outside (lying on the side)
slide 3 of 11
    
  1. Lie on your side with the leg you are going to exercise on top.
  2. Tighten your thigh muscles, and then lift your leg straight up away from the floor.
  3. Keep your hip and your leg straight in line with the rest of your body, and keep your knee pointing forward. Do not drop your hip back.
  4. Hold for about 6 seconds, slowly lower the leg back down, and rest a few seconds.
  5. Do 8 to 12 repetitions, 3 times a day.

Straight-leg raises to the back

Picture of straight-leg raises to the back (lying on the belly)
slide 4 of 11
    
  1. Lie on your belly.
  2. Tighten your thigh muscles, and then lift your leg straight up away from the floor.
  3. Hold for about 6 seconds, slowly lower the leg back down, and rest a few seconds.
  4. Do 8 to 12 repetitions, 3 times a day.

Half squat

Picture of half-squat exercise
slide 5 of 11
    
  1. Using your thigh muscles, extend your leg slowly from 30 degrees to 0 degrees (straight leg) and slowly back again.
  2. Do 8 to 12 repetitions, 3 times a day.

Remember to limit the bend of your knee to a 30-degree angle at first. When your knee is bent past this point, your kneecap will have more contact with the thighbone, causing more pressure, pain, and possible cartilage damage.

Shallow knee bend on one leg

Picture of shallow knee-bend on one leg.
slide 6 of 11
    
  1. Stand on a step, on the leg you want to exercise. Let your other leg hang down off the step.
  2. Keeping your head up and your back straight, lean slightly forward. Hold on to a banister if you feel unsteady.
  3. Slowly bend your knee so the foot hanging down moves down toward the floor, then slowly straighten your knee again. Your heel should stay on the step, and your knee should not go any farther forward than your toe.
  4. Do 8 to 12 repetitions.

Remember to limit the bend of your knee to a 30-degree angle at first. When your knee is bent past this point, your kneecap will have more contact with the thighbone, causing more pressure, pain, and possible cartilage damage.

Standing quadriceps stretch

Picture of standing quadriceps stretch exercise
slide 7 of 11
    
  1. If you are steady on your feet, stand holding a chair, counter, or wall. You can also lie on your stomach or your side to do this exercise.
  2. Bend the knee of the leg you want to stretch, and grab the front of your foot with the hand on the same side. For example, if you are stretching your right leg, use your right hand.
  3. Keeping your knees next to each other, pull your foot toward your buttock until you feel a gentle stretch across the front of your hip and down the front of your thigh. Your knee should be pointed directly to the ground, and not out to the side.
  4. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.

Hamstring stretch in doorway

Picture of hamstring stretch in doorway
slide 8 of 11
    
  1. Lie on the floor near a doorway, with your buttocks close to the wall.
  2. Let the leg you are not stretching extend through the doorway.
  3. Put the leg you want to stretch up on the wall, and straighten your knee to feel a gentle stretch at the back of your leg.
  4. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.

Hip rotator stretch

Picture of hip rotator stretch
slide 9 of 11
    
  1. Lie on your back with both knees bent and your feet on the floor.
  2. Put the ankle of the leg you are going to stretch on your opposite thigh near your knee.
  3. Push gently on the knee of the leg you are stretching until you feel a gentle stretch around your hip.
  4. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.

Iliotibial band and buttock stretch

Picture of iliotibial band and buttock stretch
slide 10 of 11
    
  1. Sit on the floor with your legs out in front of you.
  2. Bend the knee of the leg you want to stretch, and put that foot on the floor on the outside of the opposite leg. (Your legs will be crossed.)
  3. Twist your shoulders toward your bent leg, and put your opposite elbow on that knee.
  4. Push your arm against your knee to feel a gentle stretch at the back of your buttock and around your hip.
  5. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.

Calf stretch

Picture of calf stretch (standing with hands on wall)
slide 11 of 11
    
  1. Stand facing a wall with your hands on the wall at about eye level.
  2. Put the leg you want to stretch about a step behind your other leg.
  3. Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.
  4. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.

Test Your Knowledge

The first phase of strengthening your quadriceps should involve using weight-lifting equipment and bending your knee through a 30-degree angle.

  • True
    This answer is incorrect.

    After you have adequately rested your knee and symptoms resolve, the first phase of strengthening your quadriceps focuses on isometric exercise.

  • False
    This answer is correct.

    After you have adequately rested your knee and symptoms resolve, the first phase of strengthening your quadriceps focuses on isometric exercise.

  •  

Stretching your hip can help ease a patellar tracking disorder.

  • True
    This answer is correct.

    If you have tightness in structures such as your quadriceps, iliotibial band, or hamstrings, you can develop a patellar tracking disorder. All these muscles act on both your hip and your knee, so stretching around your hip can help loosen them and help ease patellar tracking disorder.

  • False
    This answer is incorrect.

    If you have tightness in structures such as your quadriceps, iliotibial band, or hamstrings, you can develop a patellar tracking disorder. All these muscles act on both your hip and your knee, so stretching around your hip can help loosen them and help ease patellar tracking disorder.

  •  

Continue to Where?

 

For more information about exercises to treat patellar tracking disorder, talk to:

  • Your doctor.
  • A physical therapist.
  • An occupational therapist for job-related activities.

Return to topic:

References

Citations

  1. Mercier LR (2008). The knee. In Practical Orthopedics, 6th ed, pp. 215–251. Philadelphia: Mosby Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Patrick J. McMahon, MD - Orthopedic Surgery
Last Revised January 9, 2012

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