When the patella or knee cap is not tracking or gliding correctly in the groove made for it, pain can result. The undersurface of the patella/kneecap can become irritated and overtime can become roughened (known as chondromalacia patella) if the tracking is off. Often time the culprit causing poor tracking is poor firing or strength of the quadriceps muscles (the large muscle on the front of the thigh). When the quadriceps fires with normal strength it should pull the patella upward toward the head (superiorly) and inward toward the inner thigh (medially). After injury or surgery to the knee or thigh, the quadriceps muscle can become inhibited, which makes generating a strong contraction difficult. We often see people with patella femoral dysfunction/pain several years after a surgery or injury to the knee who never had the tracking of the knee cap addressed fully. It is important to restore normal flexibility of the soft tissues around the knee to allow good tracking as well as normal firing and strength of the quadriceps. For bicyclists who go through repetitive motions at the knee, having your bicycle properly fit to you is critical in avoiding patella femoral dysfunction. Our physical therapists are trained in proper bicycle fit, as well as in strengthening and soft tissue and patella mobilization techniques to restore normal mechanics at the patella femoral joint.