Important ConceptsKneeSit Like A Man

Knee Cap Pain and Crunching

I feel compelled to write about knee cap pain again. Many of you have already read my earlier blog on this subject. It was my very first post!

Do Not Do Squats

Today I saw 6 women in my office with knee cap pain and crunching. All but one had been participating in supervised exercise routines which made squats, deep knee bends and lunges the backbone of the program.

Women have a physical predisposition to having pain around their knee caps. It has to do with the shape of our pelvis. We were put together  for having babies but not so much for running stairs and doing squats. And in the natural world we didn’t have to get in and out of chairs or go up and down stairs all day, or do squats deep knee bends and lunges with weights in our hands, three times a week. And remember…in the natural world we didn’t live much past 25 years.

When I see a woman with pain around her knee caps, 8 out of 10 times I can get some kind of history of excessive stair climbing or participation in an exercise class including lunges and squats! Trainers get very upset when I write about this and often send comments impugning my knowledge. Remember…I’m the expert. I’ve been doing this for 31 years. And I have this condition. I feel very strongly about this because I see a lot of women and truthfully, this is a big problem, especially since the exercise industry is invested in the squat, the lunge and the deep knee bend…especially for women! Trainers would be doing their female patients a service if they took this information into consideration, and sought out versatile strengthening programs which didn’t rely on squats and lunges.

But more importantly, just pay attention to clients while they’re doing these exercises. Watch for clients who are “cheating” or making grimaces while squatting. Turn off the music and listen for crunching knee caps. Most of the time the clients just quit, so trainers don’t hear about the problems. Women are embarrassed to complain because they feel they might be accused of just being lazy. Feel their knee caps while they’re doing the exercises. You’ll be able to feel, and sometimes even hear the grinding! That’s your sign that they shouldn’t be doing this exercise. That symptom often precedes the pain. Let clients know they should watch for pain and grinding around their knee caps while participating in a squatting program. Keep in mind that it doesn’t always occur while they’re doing the exercises. Sometimes it starts hurting that night, or even the next day. Sometimes it takes a month for the symptoms to show up!

Okay, so you might be getting tired of me telling you to change the way you’re doing things, but I’m going to tell you to change the way you’re doing things that hurt you. If you come to see me with a cut on the end of your finger, you’re not going to question me when I tell you not to tap your finger!

Modify Activities

Stairs: The first thing I’m going to tell you to do is to modify the activities that hurt you. If it’s climbing stairs, I’m going to tell you to diminish stair climbing or to somehow lessen the effect of stair climbing on your knees by using the handrail. Take elevators and escalators rather than the stairs. Keep a hair brush, deodorant and toothbrush in the downstairs bathroom so you don’t run up and down the stairs to finish your toilette. Yes, stair climbing is exercise, but if you’re having pain, trust me, the benefits don’t outweigh the risks.

Chairs: You can’t stop getting in and out of chairs, but you can use the arms of the chair to help push yourself out of the chair. Your knees will reap the benefits from getting in the habit of decreasing this stress by pushing yourself out of the chair. The toilet is a chair you get in and out of many times a day. And it’s a low chair. Convert your master bath toilet to a handicap or “comfort height” toilet. Use the sink or cabinet next to the toilet to help yourself up. Put in a stainless-steel bar for that purpose. Use the handicap toilet in public places. This is a serious, potentially life altering condition. Do what it takes to make it better!

Squats: I’m going to tell you to stop squats and frankly, my advice is to never do them again! Find another, less stressful way to strengthen your legs. Ride a stationary bike, swim or walk. Do straight leg raises and hip extensions against resistance. These exercises are adequate for strengthening the legs on an average person. Sure, you can do some lesser form of the squat if you must. But for me to recommend that would be like your primary care doc telling you some alternative ways to enjoy sugar. Better to tell you not to eat sugar in any form.

SIT LIKE A MAN (S.L.A.M.™) This is an important concept. Just sit like a man. Please read my extensive post on this. If you’re here, you likely have a problem with knee cap pain, and my S.L.A.M.™ program is critical to your ability to get well.

Strengthening the Muscles Which Control Your Knee Cap

I do want you to strengthen the muscle that helps control the movement of your knee cap. It’s a simple exercise: the straight leg raise (with a twist). I do it almost every day. This exercise strengthens the muscle which controls the position of your knee cap.

Lie down on your bed. Don’t get on the floor because then you’d have to do a squat to get up and down! If you’re exercising your left leg you will bend your right leg in order to take some of the stress off your back. Then turn your left foot to the eleven o’clock position. That way your whole leg will be turned slightly outward. Now raise the leg up off the bed about a foot and hold it there for a count. Then slowly bring it back down. When you’re exercising the right leg you will turn it to the 1:00 position.

Do these 10 times on each leg and do at least 30 of them EVERY DAY! You really can’t do too many of these. You can add ankle weights or heavy shoes to make this more difficult. You can do seated straight leg raises, which will also increase the degree of difficulty a little. You can also try this in a standing position with rubber tubing for resistance.


Sometimes I will recommend you temporarily wear a brace which helps align and support your knee cap. I may ask you to use this for a month or so while you start the exercises and activity modifications. Wear the brace during the day. Don’t wear it to bed.

Keep the brace even after your pain is better. You never know when you’ll need it again. Perhaps you’ll use it specifically for activities you know will irritate your knee cap, like hiking up hills or climbing up and down ladders. You can buy braces like these on-line or in stores.

 I started having patellar pain, along with crunching and grinding under my knee caps when I was in my early thirties. Having had the advantage of my training, I knew immediately what was happening. First, I stopped running stairs and doing squats for exercise. Then I started the straight leg raises, which I do about 5 days a week. Now, more than 30 years later, I have no knee cap pain. I still have a little crunching there, but no pain. I ride horses competitively, which means I spend hours in that bent knee position…with no pain.


IMPORTANT CONCEPT! This condition is kind of like having a disease such as hypertension. One you have it, you’ll always be susceptible to having it again. Your pain will likely come back if you stop treating the condition, just like your high blood pressure will come back if you stop taking the pill your doctor prescribed to lower it. Your exercises and activity modifications are like the anti-hypertensive medication. My recommendation is that you continue to do the exercises and modify as many of the activities which aggravate your knee…for the rest of your life, because the shape of your knee and the way it moves aren’t going to change!


  1. Lisa

    I have patella femoral knee pain and hip bursitis/hamstring tendonopathy. I find that the straight leg raise irritates this. Does doing it with a twist help or hinder the hip?


    1. Barbara

      I have used straight leg raises as my alternative to squats since I was 31! Now I’m 68. Never had an issue. I’ve used them for my patients for the same number of years. Like all treatments, whether it be pills, exercise or surgery, what’s good for the goose is not necessarily good for the gander! Now it’s possible you’re doing them in a way which could irritate rather than help. I always rotate my entire leg slightly outward. If I were doing them lying down, and exercising my right leg, it would be turned outward to the 1:00 position (if my feet were the hands of a clock). The left leg would rest in the 11:00 position. I keep my knee locked gently in a straight position. I am not doing them bent to straight.

      Of course I can’t tell you exactly what’s wrong with your knee, or why the exercise might not work for you! You’ll need to visit with your own doc for more personalized recommendations.

  2. Lisa

    Thanks for your reply!
    It doesn’t hurt my knee doing them. Just hurts my hip bursitis. I try to keep holds longer and repetitions down b/c of this.

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