Anterior knee pain is a common issue that limits clients from traditional training and performing their desired functional activities. In the next two columns, I am going to feature isometric exercises that are both safe and effective for improving strength. When isotonic loading creates knee pain, isometric exercise can serve as a good alternative until the client can progress to more traditional loading patterns.

Note: I prefer to use a stability ball for this exercise because it allows the client to make small incremental changes in range of motion with little effort and avoid the risk of sliding unexpectedly down the wall.

Execution: Place a stability ball in the small of the back and up against the wall. Stand in an up-right position with the feet approximately 2-3 feet away from the wall to ensure the knees do not travel beyond the toes during descent. Next, slowly squat down to 60 degrees. Hold for 30 sec-onds and then return to upright. Rest 30 seconds, and repeat this sequence for 2-3 sets.

The depth of the squat can be increased or decreased based on the client’s response in terms of discomfort and perceived exertion. Focus on maintaining an erect posture and not allowing the knees to cave in (dynamic valgus). Do not allow the client to place the hands on the thighs.

Progressions:

1. Increase the hold time (more time under tension)

2. Fold the arms across the chest

3. Add external resistance (weight vest, dumbbells, etc.)

Regression: Perform more repetitions with less total time under tension for each repetition.

Application: This exercise is a simple, yet effective way to increase quadriceps strength and improve knee function. In clients who struggle with patellofemoral pain, quadriceps weakness or cannot perform a free-standing squat with good form, this exercise offers a safe, pain-free alter-native. Using the ball allows for better posture, increased stability and very small incremental changes in range of motion based on the client’s form, fatigue and comfort level.