When you're bending and straightening your knee, your kneecap is supposed to move smoothly along a groove in the lower part of your thighbone, also known as the distal femur. If the bones in your legs aren't aligned correctly, however, the movement of your kneecap -- or patella -- is affected, which can be painful. Sometimes malalignment has to be surgically treated, but you might be able to avoid an operation by strengthening the muscles in your legs.
Exercises for Quadriceps
Your quadriceps are the muscles that keep your patella in line, so weak thigh muscles can increase your chances of developing patellar femoral malalignment. Lunges and leg presses will build your quads to help keep your kneecaps on the right track. Squats can be useful for building strong thigh muscles, too, but it's best not to overload your knees with a lot of weight if you're experiencing pain from patellar femoral malalignment. Use light weight and increase your reps, up to 12 to 15, to build quad strength by performing squats and hack squats.
Isometric exercises that use the immobile resistance of the floor or a wall are effective for building muscle to support your knee, stabilizing your kneecap and keeping it in place. One isometric quad exercise is performed by placing a rolled-up towel under one knee as you sit or lie with your legs extended. Press down on the towel with the back of your knee, tightening the quadriceps as you do so. Hold this tensed position for a count of 10, then relax for five to 10 seconds and repeat for eight to 12 reps, completing a total of three sets. Another useful quad-strengthening isometric exercise is the wall squat. One version of this exercise recommended by Idaho physical therapy assistant Rebecca Peterson starts with standing about a foot away from a wall with your back to it, then leaning back so that the wall is supporting you. Slide your back down the wall as you bend your knees into a 30 degree angle, coming into a shallow squat. Put a soccer ball between your knees and squeeze it, holding the squeeze for 10 seconds, then releasing for five to 10 seconds before repeating. Perform three sets of eight to 12 reps.
Addressing Glute Weakness
Weak glutes can add to patella problems, so strengthening your backside can help keep your kneecap aligned. Squats using minimal weight will give your glutes a workout, as will step-ups. Perform another useful glute exercise by lying face-down on the floor, your arms bent with your hands beneath your chest. Lift one leg up as far as you can, tightening your glutes as you lift. Hold at the top of the exercise for a count of 10, then relax back to the starting position in a controlled descent. Immediately lift the other leg and hold for a count of 10, the return to the starting position and continue alternating lifting your legs for eight to 12 reps on each leg. Perform three sets of this exercise, resting for about 30 seconds between sets.
Importance of Stretches
Stretches are important for any exercise regimen, but they're especially crucial when you're performing exercises to improve patellar femoral malalignment. That's because tense muscles and tendons can contribute to the improper alignment of your patella, so improving flexibility is essential. Beneficial stretches include hamstring stretches, abductor and adductor stretches, quad stretches and stretches for your calves, along with iliotibial band stretches and hip rotator stretches.