How to use sissy squats to correct patella maltracking

sissy squat, kneesIf you suffer from patella maltracking, the chances are you find it difficult, and likely painful, to perform any activity that involves bending the knees. Sissy squats are all about bending your knees, and are a big step towards making that knee pain a thing of the past. They’re not a quick fix: they may take time to master, and progress may be slow, but if you were to do only one exercise to help your knees, the sissy squat could make the most difference in the long run. Why? Because they improve the balance between the muscles which pull the patella laterally and medially, specifically targeting the tracking of the patella.

What is a sissy squat?

It’s a strange name, but there’s nothing easy about sissy squats. They’re supposedly named after a king from Greek mythology, Sisyphus, better known as the man who was damned to roll a rock up a hill, repeatedly, for eternity. If you see sissy squats in their most developed form, as performed by body builders, the bottom limit might look like someone lifting a rock. But for the purposes of addressing knee pain, the sissy squat doesn’t require anywhere near that range of movement. In fact, when you start out it’s unlikely you’ll move more than a few inches.


How to stand for a sissy squat

The exercise is best performed with your heels elevated, ideally on a 2 inch wooden block, with your toes on the floor. This elevation prevents tightness in the calf muscles from complicating the movement. Wearing solid shoes with a firm heel (this will provide better balance than shoes with a soft sole), keep your feet parallel, slightly inside hip width, with your toes pointing forwards.

sissy squat feet

Correct position for feet during sissy squat.

Beginning the sissy squat

Standing up straight with your feet in position, lean back very slightly by unlocking the knees. At first, this might be all you can do. When I started out, that was enough for me – due to my incredibly weak inner quads (vastus medialus) and tight, overactive outer quads (vastus lateralis), this motion was incredibly painful.

However, just by standing in this position the body will rebalance: your body will gradually switch on the inner quad muscles and centre the knee cap, addressing the maltracking issue. Do the slightest movement, whatever you can manage, in the sissy squat position, and you’ve made an important step towards correcting your knee problems. When you’re comfortable in the starting position, you can start increasing the range of motion.


Performing the sissy squat

Increase the range of motion by bending the knees further – making the knees go forwards and the shoulders go backwards. Your shoulders, hips and knees must maintain a straight line throughout the exercise. Squeezing your glutes will help keep your hips in line. As you push your knees forwards, also push them out slightly, keeping your knees outside your big toe, and your neck in line with the rest of your back.

sissy squat form

Correct sissy squat form.

This is not a normal squat, the hips should not bend and the knees should travel in front of the foot. Don’t worry about how it looks – we’re here to solve your knee problems, not make you look pretty. And this movement will strengthen your knees, and allow them to tolerate more extreme movements.


Improving your range of motion

To test and improve your range of motion, do your sissy squats facing a wall. Push the knees to the wall, then return to standing position. If you haven’t reached your limit, move the block further from the wall. If you reach an intolerable point before the wall, move the block closer. Keep practising, and strive to move the block further from the wall each session, even if it’s just by a few millimetres.

Going too far too fast will not help you – for lasting solutions to your knee problems you must be patient. Whatever your limit, as long as you keep pushing yourself a little further each time, you will improve. You do not need to go far – nowhere near as low as the body builders in their rock-lifting pose. You simply need to progress.


One-legged sissy squats

To increase the challenge of the sissy squat, you can start doing the exercise on one foot. All the details are essentially the same as for the two-legged squat, but balance on one leg. This way you can provide your quads with even more stimulus to rebalance and improve your patella tracking.


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  14. I was wonder if you’ve experienced any grinding/crepitus, or noticeable malalignment, when you’ve palpated the knee through a ROM. If so did these things change or go away after this routine?

    • I used to experience audible and very painful grinding under the kneecap as I extended my leg through a range of motion. Partly due to a routine of building strength with sissy squats, this grinding and pain has now gone.