Knee Pain During Squats? Here’s What Could Be the Problem

Squatting is a basic human movement, along with hinging at the hips, pushing, pulling and rotating through the torso. While you may hear warnings that squatting — especially deep squatting — is bad for your knees, that's just not true.

In fact deep squatting is completely safe and actually beneficial for the joints in your knees, ankles and hips. 

With proper biomechanics and the absence of preexisting knee conditions, you should be able to squat deeply, with or without additional weight, and not feel pain in your knees. Some issues that could cause pain include hip muscle weakness, diminished joint mobility, poor form or an unrelated condition.

What You Should Know About Squats and Knee Pain

Considering that the full squat is a resting position in many Eastern cultures, it's safe to say that squatting is safe for the human body. But Westerners aren't used to sitting this way and typically lack the mobility required to easily assume the position.

Health professionals may discourage squatting below parallel because they believe it increases the risk of weakness in the knee joints and puts undue pressure on the knee. However, according to research published in the Journal of Strength and Conditioning Research in June 2014, that's unfounded. 

As long as you have adequate hip stability and lower body mobility, and you know how to perform a squat correctly and safely, there's no risk of knee damage.

In fact, squats may actually benefit knee pain in certain situations. For example, a study published in BioMed Research International in October 2019 discovered that low squats reduced knee inflammation and encouraged pain-free functioning for knee osteoarthritis patients.

Pain Point #1: Weak Hip Muscles

A very common reason for knee pain during squats is weak hip muscles — specifically the gluteal muscles.

The glutes aid knee stabilization. If the glutes are weak, the knees won't track straight over the toes as they should when you squat. The force of the stronger quadriceps and inner thigh muscles will often cause the knees to cave in. When this occurs repetitively, especially with added weight, it can cause tissue damage and pain. 

Try these two exercises to help build glute strength:

Hip Thruster

• Sit on the floor in front of a weight bench, chair or couch, positioned lengthwise with your knees bent and your feet flat on the floor.
• Press your shoulders into the bench and raise your hips up to full extension. Keep your knees at a 90-degree angle.
• Lower down, then repeat.

Start with just your bodyweight. You can slowly add resistance by placing a barbell or a dumbbell across your hips.

Outer Thigh Extensions

• Using the abductor machine at the gym or with a resistance band looped around your legs just above your knees, sit on an exercise bench (or chair).
• Open your knees against the resistance.
• Return to starting, actively resisting against the machine or band.

Pain Point #2: Limited Ankle Mobility

You'll know if you have ankle mobility issues because it will keep you from getting as deep in a squat as you'd like to. 

When your ankles aren't doing their job, the knees take over. Over time, this compensation can lead to increased wear and tear on the knee joints.

The usual suspect is limited ankle dorsiflexion, which is the movement when you pull your toes up toward you. It's required in nearly every lower body movement, including walking, running, lunges and squatting.

Here are two exercises to try that will increase ankle mobility and flexibility:

Knee-to-Wall Ankle Mobilization

• Stand facing a wall with your toes about 4 inches from the wall. Place your palms on the wall and step one foot back as if you're going to do a calf stretch.
• Bend into your front knee as you shift the weight forward, attempting to touch the wall with your knee. Your back heel can lift but your front heel should stay on the floor.
• Do 10 reps, then switch sides.

Banded Ankle Mobility

• Anchor a resistance band to something sturdy (like a table leg) and loop the other end around your ankle.
• Walk away from the anchor point until the band is taught.
• Kneel on the knee of the unbanded leg.
• Press forward, allowing the knee of the banded leg to extend beyond the banded ankle until you feel tension in your ankle.
• Hold three seconds, then release.
• Do 10 reps on each side.

Pain Point #3: Poor Technique

You can really mess up your knees — and the rest of your body — if you use incorrect squat form, especially if you're doing them with a lot of additional weight. Bad form can put too much pressure on your knees, and cause acute knee injury or overuse injuries over time.

With correct form, your heels stay on the ground the entire time, and your knees track straight over the middle toe, not gaping outward or buckling in.

To fix the issue, go back to basics. Dump the weight and practice bodyweight squats with proper technique, the finer points of which include:

• Stand tall in an athletic stance — feet hip-width apart and your toes pointed slightly out.
• Keep your weight in your midfoot.
• Bend your knees and shift your hips back slightly as you lower down without overarching in your lower back.
• Lower as far down as you can without letting your knees pass beyond your toes or your knees bow inward.
• At the bottom, check to make sure you're maintaining a neutral spine and an upward posture with the chest out, shoulders back and the gaze forward.
• Straighten your knees and press your hips forward as you return to standing, squeezing your glutes at the top.

Pain Point #4: You Have an Unrelated Knee Condition

It's entirely possible that your knee pain isn't at all connected to squats but is merely aggravated by them, causing sharp knee pain when squatting. 

Common conditions that can cause pain include:

• Patellar tendinitis: an overuse injury that causes irritation and inflammation of the tendons of the knee
• Osteoarthritis: a degenerative arthritis that occurs when cartilage in the knee decreases with wear-and-tear and age
• Knee bursitis: inflammation in the small sacs of fluid — called bursae — that cushion your knee joint

If you think an unrelated condition may be the culprit, back off from squatting and see a physical therapist to get to the root of the problem. And don't fret, in most cases and with the correct treatment protocol, you'll be able to do squats again with no problem.

❤️PIXIBU

This article was written by health and fitness expert and PIXIBU founder Jody Braverman, PN1, NASM-CPT, NASM-FNS, RYT 200.

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