I hear this a lot from people that come to my clinic for help with their knee pain during or after they squat. I first would like to start by saying that squats are one of the best exercises an individual can do. The health benefits are tremendous and far exceed just leg strength. I will save those details for another post. Also, squatting is not bad for your knees and is a common misconception. In fact, not squatting is more likely the cause of generalized knee pain.
With the importance of squats emphasized, what do you do if you have knee pain with squatting? Pain with squats can arise from many different sources however I will discuss three of the most common ones I see with people I treat at my clinic, RISE Rehabilitation and Fitness.
This is the most common issue I come across. The hip, specifically the gluteal muscles, don’t support the knee sufficiently to allow for a proper squat. The knee is a ‘hinge joint’ and just wants to bend and straighten essentially. When the hips can’t keep the knee steady in place, the knees can cave-in. Doing this repeatedly will cause knee pain and, with enough load, may cause tissue damage.
It looks a bit like the image below:
THE FIX! A great way to fix this is to strengthen the gluteal muscles. That includes the series of exercises below.
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Hip Thrusters 💪👌 _ Perfect for finishing off the glutes at the end of a leg workout😅 _ 🧐Glutes tend to be a hard muscle for people to generally feel/work/engage. If that is you, give these a try. _ ⁉️How: back of shoulders up on a bench or box, heels down, glutes in the air, bar resting (with cushion) in front of hips, squeeze the glutes together and lift 👆💪 _ Troubleshooting 1️⃣: if you feel this more in your hamstrings (back of the thigh) keep the weight on your heels and focus on squeezing your glutes together. _ Troubleshooting 2️⃣: if you feel “pinching” in your low back — 🛑 stop 🛑 – Fix this by tightening your core and make sure the movement is coming from your glutes and *not* the low back _ Glutes are powerful muscles and can handle high work loads so either: ✅Go lower weight with higher rep ranges (12-15reps) or heavier weight in a lower rep range (5-8 reps)✅ _ #RiseRehabFit #Fitness #Workout #Training #strength #beastmode #PT #DPT #SPT #physicaltherapy #wellness #health #exercise #exerciseismedicine #womenwholift #stability #legday #glutes
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Side-lying heel slides against the wall can help with pelvic #stability which is vital for just about any human #movement. #hip #strength and #stabilization is the key (or foundation) for #athletics and to improve #performance. #RiseRehabFit #Strong #Healthy #HealthyLiving #Glutes *Use the wall to mediate the movement and ensure the leg is in line (or slightly behind the torso). The “burn” should be felt in the back pocket 💪
Limited Ankle Mobility
You might not even realize this but the ankle is critical to a proper squat. Many people pay close attention to the hip as well as strengthening the muscles of the thigh to improve the squat. While these are all important, if the ankle does not have sufficient mobility, no amount of strength will allow proper form and range of motion to have a complete squat.
THE FIX! A skilled manual therapist can help do various mobilization techniques to the ankle. At RISE Rehabilitation and Fitness, I work with individuals to target specific tissue or joint restrictions with my hands-on, manual therapy techniques. That essentially works on improving the mobility of the ankle joint.
I would say if you have knee pain with squatting, your form is likely not optimal. Granted there can be exceptions to that but we can review a couple key points.
- As we mentioned above, we never want your knees to collapse inward toward each other. You always want a stable base for your legs with your knee/thigh tracking in-line with your toes, or even slightly lateral/outside of your toes — never inward.
- We also want you to squat as if sitting back in a chair. Too often people do not bend at their waist to sit back and rather go forward with their knees. This creates tremendous stress on the patellar ligament in the front of the knee (see image below on right). This could be the cause of your pain for those that have excruciating, sharp pain, in the front of the knee. Often, this is diagnosed as patellofemoral pain.
Above you see the knees travel well-beyond the toes and the heels are elevated. Some individuals (say, with long thigh bones) can have their knees safely pass the toes, however, the heels should always stay firmly on the ground. This much pressure through the front of the knee can be dangerous and could contribute to your knee pain (aka, patellofemoral pain).
THE FIX! I find a great way to improve technique with the squat is to do box squats. To execute a box squat you want to be about 8–12 inches away from a box, bench, or chair that is tall enough to allow you to sit on it while keeping your feet firmly planted on the floor (no heel elevation).
If the above does not work, it is advisable to seek out the help of a physical therapist. Physical therapists at RISE Rehabilitation and Fitness are board-certified orthopedic specialists that focus on manual therapy techniques as well as other approaches to help you improve your function. Book an appointment or just speak with a therapist through RiseRehabFit.com.
The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.