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Does the position of your kneecap cause pain?

[read time ~4 minutes]

Good posture is important.

If you see a friend slumped forward at their computer, you might be concerned that they are setting themselves up for problems.

And if at the end of their day, they complain about pain in their neck or back, you’ll likely suggest things that will help them sit up straight while they’re at their desk.

So it might make sense that similar conclusions could be made about knees.

And in fact, many people are told that they have pain on the front of their knees because their kneecaps are out of alignment.

When knee X-rays are taken, a physician comments on the position of the kneecap. Sometimes, the kneecap is described as being tilted. Or it’s considered too high (patella alta), or too low (patella baja).

Stretching and strengthening, taping or braces may be recommended to better position the kneecap.

And back in the 80s and 90s, it was common for people to undergo a surgery that cut connective tissue near the kneecap. This was known as a lateral retinacular release.

I lost track of the number of physical therapy patients I saw who regretted having that surgery.

It’s no surprise that the surgery fell out of favor. Because rarely does changing the position of the kneecap alone solve the problem of knee pain.

Moreover, research published roughly 25 years ago indicated that the vast majority of people without knee pain had kneecaps that were not perfectly positioned.

Although the participants in the study did not have knee pain, “only 4.5% of 200 women's knees and 21% of 220 men's knees had no ‘positive’ physical findings. The findings of hypermobile patella [too much kneecap movement], patellar crepitus [friction and noise under the kneecap], and lateral patellar position on Merchant X-ray view were common.”

My colleague Doug Kelsey, PT, PhD, has written about this on his blog: “This belief, that your knee pain comes from a poorly positioned knee cap, is very firmly entrenched in the medical community even though the assessment process, how you figure out that the patella isn’t where it should be, is a completely unreliable one... If you plan a course of action based on unreliable information, you often end up with at least a poor result….

Dr. Kelsey goes on to say, “The problem of anterior knee pain (patellofemoral pain syndrome, chondromalacia) is not primarily the result of an abnormally positioned knee cap but the result of poorly conditioned tissues which is then exacerbated by patellar mechanics.

The root of the problem of kneecap pain is poor conditioning and weakness behind the kneecap.

To eliminate kneecap pain, you need to treat this weakness by conditioning and strengthening it. Here are two ways to begin doing so:

  1. Perform an exercise– known as a Quad Set-- to improve the quality of the fluid inside your knees. This involves tightening the muscles on the front of the thigh, which in turn thickens the fluid behind the knee cap to provide better cushion and lubrication. Completing ten Quad Sets, several times per day, and doing so over multiple weeks, is associated with less knee pain. (For more details, check out The Ultimate Guide to Quad Sets.)

  2. Gently move your knees. One way to do so that does not require any exercise equipment involves sitting in a rocking chair. By resting your feet on the floor while you rock in the chair, a gentle, lubricating motion occurs in the knees. Or many of my clients perform Sitting Sliders by using a furniture mover, a dust cloth, or something that decreases the friction under their feet to effortlessly create knee motion. (For more details, watch How to Use a Furniture Mover to Decrease Knee Pain or Stiffness.) Moving with the right amount of force strengthens the area behind the kneecap by making it more firm and resilient.

Regardless of your kneecap posture-- the position or alignment of your kneecaps-- you can take steps to reduce kneecap pain.

For more information on this topic, access the guide to Save Your Knees.


My colleague, Doug Kelsey, PT, PhD, and I have developed Better Knees for Life, a program for people with tolerable knee pain. Better Knees for Life offers step-by-step instructions that can be performed at home with very little equipment.

What people are saying about Better Knees for Life :

"...well thought out, easy to understand and implement."

"BKL (Better Knees for Life) is an outstanding program -- with graded exercise programs and guidelines for advancing, and outstanding support with the Zoom sessions."

"I've already recommended BKL to 2-3 friends because of the noticeable difference in reducing pain in my left knee."

Better Knees for Life helps you get stronger, feel better and maybe best of all, feel more in control of your life.

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