Peterson Step Up (Petersen Step): How to Do It for Knee Pain

Video: Peterson step up demo with coaching cues and common mistakes.

Knee pain is a very common issue that affects most weightlifters, athletes, and the unenlightened who choose not to exercise. While there are many potential causes to knee pain, such as a tight iliotibial band, weak glutes, and quad dominance to name a few, I have found that there is a great solution that works for many.

Since most people compensate for these imbalances by deactivation of their vastusmedialis obliquus (VMO for short), paying attention to the VMO can get you back into pique form with minimal time lost.

Strengthening your VMO helps to counteract many muscular imbalances because many of these issues manifest themselves as tension and strain on the patella and patellar tendon. Strengthening the VMO helps to correct patellar tracking issues and reduces pain. Incorporating the Peterson Step-up into your routine will help to significantly decrease knee pain, no matter the ways to lower ACL tear risk.

What Is the Peterson (Petersen) Step Up?

The Peterson step up, properly spelled Petersen step up, was created in 1985 by Canadian physiotherapist Carl Petersen while he was the travelling physiotherapist and fitness coach for Alpine Canada Alpin. He designed it to fix knee and hip stability problems that World Cup skiers were dealing with after knee injuries. Today it’s a go-to knee exercise for hockey, soccer, basketball and volleyball athletes.

Muscles Worked

• Vastus medialis oblique (VMO): the teardrop-shaped quad muscle on the inside of your knee. It’s the main target and helps keep your kneecap tracking in its groove.
• Gluteus medius: stabilizes your hip and stops your knee from caving inward.
• Rest of the quadriceps: controls knee extension as you straighten the working leg.

The Peterson Step-up is a simple exercise that can be done at home or in the gym.

All you need is a low platform, and in most cases, your stairs will do just fine. When you perform Peterson Step-ups properly, you will feel the VMO handling the load. The tension will be on the medial portion (inside) of your knee.

Video: Petersen step up, toes elevated, for more emphasis on the working leg.

1. Start by placing the exercising leg on the step, with the resting leg on the floor.
2. The heel of the resting leg will be slightly ahead of the toe of your working leg.
3. The working leg (on the step) will be slightly bent, heel raised, with your weight on the ball of your foot.
4. Slowly push through the ball of your exercising leg and let your heel touch the step.
5. Your resting leg will remain ahead of the toe on the exercising leg.

Coaching Cues

• Keep the heel-to-toe relationship: the heel of your resting leg stays lined up with the toe of your working leg.
• Turn the toe of your working foot out about 5 degrees on the step.
• Press the ball of your working foot hard into the step and stand up straight until the working leg locks out.
• Move slowly. Feel the inside of your knee working the whole time.

Common Mistakes

• Pushing off the floor with the resting leg. It should only tap lightly.
• Letting the working foot point straight ahead instead of turning it out slightly.
• Losing the heel-to-toe position, which takes the tension off the VMO.

Repeat the prescribed sets and reps for each leg, and in just a few weeks’ time you will feel less knee pain and your legs will be much stronger.

The VMO is recruited in many different types of exercises, including the overhead squat and its variations. VMO strengthening will help you in all aspects of your weight lifting routines and athletic endeavors.

Sets, Reps and How Often

Start with 2 to 3 sets of 10 to 15 slow reps per leg, using body weight only. As your control improves, build up to sets of 20 to 25. Do them 2 to 4 times a week, either as part of your warm-up before squats, jumps or practice, or as a stand-alone knee strengthening block. If your form breaks down, end the set.

Peterson Step Up Variations and Progressions

Work through these progressions in order. Only move on when the current version feels smooth and pain-free:

1. Assisted, heel flat: hold a wall or rail for balance and let your heel come down flat on the step (video below).
2. Unassisted: the standard Peterson step up shown in the videos above.
3. Toes elevated: lift the toes of your floor foot so the working leg does even more of the work.
4. Loaded: hold light dumbbells in one or both hands.
5. Higher step: raise the step height a little at a time, as long as your form stays clean.

Video: Petersen step up, heel flat, the beginner version you can do on a stair at home.

Peterson Step Up FAQ

Is it the Peterson step up or the Petersen step up?

They’re the same exercise. It’s named after Canadian physiotherapist Carl Petersen, so “Petersen” is the original spelling, but most athletes and coaches search for it as the Peterson step up.

Does the Peterson step up help knee pain?

It can help. The exercise builds strength and control in the VMO and gluteus medius, which supports better kneecap tracking and less stress on the patellar tendon. If your pain is sharp, gets worse during the exercise or follows a recent injury, stop and get assessed by a physiotherapist or doctor first.

How high should the step be for a Peterson step up?

Start low, roughly 3 to 6 inches (about 8 to 15 cm). A stair at home or a weight plate works well. Only raise the step once you can keep the heel-to-toe position and a smooth, controlled rep.

How is the Peterson step up different from a regular step up?

A regular step up uses a higher box and mostly trains the glutes and quads to drive the hips up. The Peterson step up uses a low step, a raised heel and a knee that travels forward over the toes, which puts the focus on the VMO and knee control.

How often should athletes do Peterson step ups?

Two to four times a week works well for most athletes. Use them in your warm-up before lifting or practice, or as part of an injury prevention or knee rehab block.

We all know how much knee pain sucks, so don’t waste any more time.

Our injury prevention and rehab programs include exercises like the Petersen (Peterson) Step Up that will help reduce knee pain and to increase VMO strength.

For a full plan beyond one exercise, see our athlete strength and conditioning program.

Hockey athletes often use this in dryland blocks — see hockey dryland training.