Genepatella-malalignmentralised knee pain can be a disabling condition with significant activity limitations. The good thing about the knee, though, is that there are “normally” simple exercises and processes that can be put into place to decrease pain whilst increasing activity levels. Of course, every knee is different in terms of function, symptoms and effective rehabilitation.

A very common cause of knee pain is patella mal-tracking, simply meaning that the knee cap has moved position. The majority of the time the patella moves towards the outside of the leg, however, it can also move to various other positions including a slight twist.

Abnormal tracking of the knee cap is commonly associated with an imbalance in the quadriceps muscles. The outer muscle on the front of the thigh is called Vastus Lateralis (VL) and the inner muscle Vastus Medialis Oblique (VMO). When there is an imbalance between these two muscles it can create limitations with regards to strength, flexibility and functional movement patterns. VL becomes very tight and takes on all of the workload of the quadriceps and VMO suffers with a weakened and wasting effect.

Patella mal-tracking could lead to other knee injuries or conditions if it is not treated and corrected. Five common symptoms of patella mal-tracking can include one or more of the following:

  1. a grinding sensation,
  2. pain on ascending and/or descending stairs,
  3. pain on resisted knee extension,
  4. a weakness in VMO,
  5. possibly a slight bit of puffiness/swelling above or below the knee cap.

To combat this imbalance in the quadriceps, the VL on the outside needs to be rolled out and stretched. The VMO on the inside, should be isolated and strengthened by:

  1. squatting with a ball between the knees

Also turn the foot outwards causing external rotation at the hip and do:

  1. straight leg raises


  1. knee extensions


  1. body weight squats

I have had a lot of personal experience when using these simple exercises, particularly squatting whilst squeezing a ball between the knees and knee extensions with the foot turned out, showing an improvement in range of movement and a decrease in pain levels. There is also plenty of scientific evidence that reinforces this idea, if you would like to read any of the journals that support the points made here please see below.


Better Body Exercise Prescription