Best 5 exercises for Squatter’s Knee

Squatter’s knee or patella tendinopathy is a very common sporting injury. There are multiple reasons as to why this injury may occur. These can relate to overuse injuries, knee cap instability, bone defects, and biomechanical issues in the lower limb. Some physios speak about patella tracking, although the science is dubious if patella maltracking actually occurs. Activities such as squatting, kneeling or bending the knee can aggravate symptoms. It mainly affects women about twice as often as men. This may be attributed to women’s hip width in comparison to the knee joint, known as the Q angle.

The patella or kneecap is a small bone that sits in front of the knee and is held in place by ligaments and tendons. The kneecap acts as a fulcrum for the knee joint, during movement the kneecap slides over a groove at the end of the thigh bone called the trochlear. The underside of the patella is smooth causing less friction during movements. The shape of the knee cap and groove is different in everyone and this can cause some symptoms of squatter’s knee.

Some symptoms include:

Most commonly there is pain below the knee cap, on the tendon called the patella tendon. However, you could get pain around or behind the kneecap as well, and the pain increases with running, jumping or squatting activities.

You may also feel a grinding or clicking when moving the knee and swelling or tenderness around the knee.

As discussed many contributing factors can lead to squatter’s knee, some factors include:

• Patella mal-tracking

This is when the knee cap does not follow the groove due to imbalances in forces (usually an over-dominant lateral quadricep muscle, and a weak inner quadricep muscle). These forces can arise from the muscles surrounding the knee. Muscles like the quadriceps, hamstring and iliotibial band have direct influence on the knees movement. Therefore if they are not flexible or weak it can contribute to mal-tracking. This is a dubious concept and many physios don’t subscribe to this. The general consensus is that the patella normally does track slightly laterally (outwards) on contraction of the quadricep.

• Anatomy

The shape of the knee cap and groove is important in patellofemoral pain. If there are abnormalities in these it can cause pain around the knee. The alignment of the knee in relation to the hip is different in men and women. Women naturally have wider hips which places can affect how force is distributed in the knee (Q-angle).

• Patella instability

The patella finds stability from the ligaments, tendons and muscles around the knee, If one of these structures are injured it can cause poor tracking and pain.

• Biomechanics

The way in which we move is important, particularly during sporting activities. Therefore poor technique during running, squatting can be a risk factor in developing squatters knee.

• Previous injury

If you have had in injury previously it can increase your risk, trauma and previous knee surgery are also risk factors.

The good news is that Surrey Physio treats many squatter knees. We’ve looked after dozens of British Weightlifting Champions and some of the best powerlifters in the World, and these athletes are the biggest squatters in the World. It’s a very common problem in the weightlifting communities.

We offer careful assessment of the knee joint and perform detailed examinations to identify attributes that could alter your mechanics. In the meantime try some simple self-care tips:

  • Rest: take a break from activities that aggravate your knee pain.
  • Ice: apply ice to your knee for ten mins at a time, this can help with pain and/or inflammation.
  • Compression: wearing a compression sleeve or bandage around the knee can help support the joint if your knee is unstable.
  • Elevation: elevating the leg can also help with swelling and pain.
  • Underlying causes such as training load, volume and in some cases footwear may also contribute.
  • Exercises: we have collated the best five exercises for squatter’s knee for you to try. At Surrey Physio this is a common injury we treat. We provide a well structured rehabilitation program personalised to you and your goals.

Try these top 5 exercises for squatter’s knee

• How to improve mobility of your knee cap

Sit with your knee straight, and your leg relaxed. Grasp your knee cap (patella) with your fingers and thumb, and wiggle your knee cap from side to side and up and down. You can also hold the patella to one side, and to the other side. It may be stiff to start, but once mobile the patella should move freely. This is a great exercise for anyone with a stiff patella, and can help reduce inflammation under the kneecap.

Try 3 reps x 30 secs

• Hamstring Stretch

Standing up, place your foot on a chair. Keep your leg straight. You should feel a stretch behind your knee and into the back of your thigh. Pull your toes towards you. To make the stretch stronger, push your leg downwards into the chair, or rest your foot on something higher. This exercise will stretch your hamstring muscle group.

Try 3 reps x 30 secs

• Hip flexor psoas and rectus femoris stretch

Stand up with good posture, and bend your knee so your foot goes towards your butt. Extend your hip behind you, to create a stretch to the front and top of your thigh. You may need to hold on to a table for support. This exercise will help to stretch your hip flexor (psoas and rectus femoris muscles), and quadricep muscle group.

Try 3 reps x 30 secs

• Half squat

Open your legs slightly wider than shoulder width, and bend your knees to the 1/2 squat position. Make sure you keep the middle of your knee-cap in line with the middle toes of your foot.

4 sets of 10 reps

• Gluteus medius strengthening 1

Lie on your side, and lift your leg upwards. You can hold this position, or move your leg up and down. This exercise predominantly strengthens your outer hip and gluteal (buttock) muscles, but also mobilises a stiff hip joint.

Try 2 sets of 15 reps with 10 sec holds

If you are experiencing knee pain, it is important to visit Surrey Physio. Often this is the quickest way to recovery as we have highly trained physiotherapists and osteopaths that can help diagnose the cause of your pain. With the right care, most people with squatter’s knee make a full recovery and return to their normal activities. Book an appointment with one of our friendly physiotherapist or osteopaths.

(Therapists: if you are reading this page, these videos are provided by Rehab My Patient – the best exercise prescription software for therapists to prescribe exercises Free trial available on their website. Patients: If you are a patient needing advice or a course of treatment, call Surrey Physio to book a telephone/video consultation with one of our expert physios or osteopaths, or book in face-to-face for an appointment. You can call us on 0208 685 6930 or book online by clicking the link at the top of the page).