The Spanish Squat: A Knee Rehabilitation Exercise Worth Knowing About
If you've been dealing with knee pain that flares when you squat, run, or jump and every traditional exercise seems to make it worse the Spanish squat might be exactly what your rehabilitation programme is missing.
At MotionPlus Osteo in Hamilton, we regularly prescribe the Spanish squat as part of structured knee rehabilitation plans, particularly for patients presenting with patellar tendinopathy (jumper's knee), patellofemoral pain, and post-injury quad weakness. It's one of those exercises that looks deceptively simple but is grounded in solid biomechanical principles and a growing body of clinical evidence.
Here's what you need to know.
What Is the Spanish Squat?
The Spanish squat — sometimes called the Basas squat after Spanish physiotherapist Ángel Basas, who popularised its clinical application — is a bilateral isometric squat variation performed with a rigid strap or resistance band anchored just below the knee joint.
By fixing the lower leg against the strap, you're able to sit back into a deep squat position with a vertical shin and an upright torso. This is the key mechanical difference from a standard squat: because the tibia is restrained, the knee doesn't travel forward over the foot in the same way, which dramatically reduces compressive load at the patellofemoral joint while still demanding significant quadriceps activation.
The position typically targets around 70–90 degrees of knee flexion, held isometrically. At this angle, the patellar tendon is placed under substantial mechanical strain — which, as we'll explain, is exactly the therapeutic stimulus we're after.
The Anatomy Behind the Exercise
To understand why the Spanish squat works, you need to understand the relationship between the quadriceps, the patellar tendon, and the knee joint.
The quadriceps femoris is a group of four muscles — rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius — that converge into the quadriceps tendon, which attaches to the top of the patella. The patellar tendon then extends from the bottom of the patella to the tibial tuberosity, the bony bump just below your kneecap.
During a standard squat, as the shin moves forward and the knee tracks over the foot, the patella is compressed against the femur. For someone with patellofemoral pain or patellar tendinopathy, this compressive force is often the primary pain driver.
The Spanish squat sidesteps this problem. The restrained shin position keeps the tibia more vertical, reducing patellofemoral compression while maintaining high quadriceps demand. The result is a way to load the quad-patellar tendon system without aggravating the anterior knee.
What the Research Says
The evidence behind the Spanish squat sits within the broader field of isometric exercise for tendinopathy — an area that has developed considerably over the last decade.
Isometric contractions held at moderate to high intensity have been shown to produce an analgesic effect — a reduction in tendon pain that can last for up to 45 minutes post-exercise (Rio et al., 2015). The proposed mechanism involves cortical inhibition: the sustained muscle contraction appears to dial down the central nervous system's pain response, creating a window of reduced pain that allows for more productive rehabilitation and training. Importantly, this effect makes the Spanish squat useful not just as a standalone rehab exercise but as a warm-up tool before activity for in-season athletes managing symptoms.
Clinical guidelines published in the Journal of Orthopaedic & Sports Physical Therapy specifically list the Spanish squat as a Stage 1 rehabilitation exercise for patellar tendinopathy, performed at 70–90 degrees of knee flexion (Cook et al., 2015). The recommended dosage in the literature — 5 sets of 45-second holds, performed 2–3 times per day — reflects both the analgesic and mechanotherapy objectives of the exercise.
A case series published in the International Journal of Sports Physical Therapy examined patellar tendon strain during the Basas Spanish squat using ultrasound imaging and found that the exercise generates meaningful mechanical strain through the patellar tendon, consistent with the principles of mechanotherapy — the idea that appropriately dosed tendon loading drives cellular and structural adaptation within the tendon itself (Basas et al., 2023).
A pragmatic study of 25 elite and sub-elite athletes using a portable isometric squat over four weeks found meaningful reductions in patellar tendon pain scores and improved function across a range of sports — with the authors noting the particular value of this approach for in-season management, where training cannot simply be stopped (Rio et al., 2019).
Who Can Benefit from the Spanish Squat?
In clinical practice, we find the Spanish squat most useful for:
Patellar tendinopathy (Jumper's Knee): This is the condition the exercise was originally designed for. The combination of high quadriceps demand and low patellofemoral compression makes it ideal for loading a reactive or degenerative patellar tendon without provoking a symptom flare. For athletes in the middle of a season — rugby players, basketball players, netballers — who can't afford to pull back from training entirely, the Spanish squat offers a practical way to manage load while maintaining quad strength.
Patellofemoral Pain Syndrome: For patients with anterior knee pain that worsens going down stairs, squatting, or after prolonged sitting, reducing patellofemoral joint stress while still training the quads is a clinical priority. The Spanish squat allows progressive loading within a more comfortable range.
Post-injury or Post-surgical Quadriceps Inhibition: Following knee trauma or surgery, quadriceps inhibition — where the muscle essentially switches off as a protective response — is a significant barrier to recovery. Isometric exercises, including the Spanish squat, can help re-establish neural drive to the quadriceps in the early stages of rehabilitation when dynamic loading isn't yet appropriate.
General Knee Resilience and Injury Prevention: You don't have to be in pain to benefit from this exercise. For gym athletes, tradies, and anyone who loads their knees heavily at work or in sport, building quad tendon capacity through a range of loading strategies — including isometrics — is sound preventative practice.
How We Use It at MotionPlus Osteo in Hamilton
The Spanish squat is a tool, not a programme in itself. At our Te Rapa clinic, we use it as part of a structured rehabilitation progression that addresses the full picture: why the tendon became overloaded in the first place, what other contributing factors — hip strength, foot mechanics, training load — need to be addressed, and how to progress from isometric loading through to the dynamic, energy-storage demands of sport or work.
A knee rehabilitation plan at MotionPlus Osteo typically includes:
Isometric loading with the Spanish squat in the early stage, to manage pain and restore quadriceps output
Heavy slow resistance exercise — leg press, knee extension, squat variations — as load tolerance improves
Energy storage loading — hopping, bounding, sport-specific plyometrics — in the later stages of return to sport
Load management advice to reduce the risk of recurrence, particularly for athletes managing in-season
As an ACC registered provider in Hamilton, no GP referral is required to book an appointment. If your knee pain followed a fall, collision, or sudden increase in training load, we can assess whether an ACC claim is applicable directly at the clinic.
A Note on Getting the Technique Right
The Spanish squat looks straightforward but there are a few form cues that matter:
The strap or band should sit just below the knee joint line, not mid-calf
The trunk should remain upright — forward lean reduces quad demand and defeats the purpose
Aim for 70–90 degrees of knee flexion — roughly a right angle at the knee
Push back into the strap with your shins to keep tension through the whole hold
Breathe steadily — this is an isometric hold, not a breath-hold exercise
If you're experiencing sharp pain during the hold rather than manageable quad fatigue and dull tendon discomfort, that's a signal to get a clinical assessment before progressing.
References
Basas, C., Ito, N., Grävare Silbernagel, K., Reyes-Gil, F., & Basas, Á. (2023). The Basas Spanish squat: Superimposition of electrical stimulation to optimize patellar tendon strain: A case series. International Journal of Sports Physical Therapy, 18(6), 1299–1307. https://doi.org/10.26603/001c.89267
Cook, J. L., Rio, E., Purdam, C. R., & Docking, S. I. (2015). Patellar tendinopathy: Clinical diagnosis, load management, and advice for challenging case presentations. Journal of Orthopaedic & Sports Physical Therapy, 46(6), 694–707. https://doi.org/10.2519/jospt.2015.5987
Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283. https://doi.org/10.1136/bjsports-2014-094386
Rio, E., Purdam, C., Girdwood, M., & Cook, J. (2019). Isometric exercise to reduce pain in patellar tendinopathy in-season: Is it effective "on the road"? Clinical Journal of Sport Medicine, 29(3), 188–192. https://doi.org/10.1097/JSM.0000000000000549
Vang, C., & Niznik, A. (2020). The effectiveness of isometric contractions compared with isotonic contractions in reducing pain for in-season athletes with patellar tendinopathy. Journal of Sport Rehabilitation, 30(3), 512–515. https://doi.org/10.1123/jsr.2020-0171