Knee pain while squatting is often the response to compensatory movements that occur over time, such as mobility restrictions and strength imbalances.
Our body works in a chain-like manner, meaning if one muscle doesn’t do its function, others will take over its role. Of course, that muscle has a very different purpose, so it can get your body out of its optimal movement, causing knee pain while squatting.
The knee is in the middle of two joints: the hips and the feet. That’s why you can have knee pain from the wrong foot position, tight ankles, and weak hips!
The great news is that this blog will serve you to treat the root causes of your knee pain with a functional approach!
So, join us on a journey to reclaim optimal movement and discover practical solutions to squat pain-free.
NOTE:
This blog provides educational information and is not a substitute for professional medical advice!
If you experience pain, it is recommended to consult with your doctor and seek the help of a qualified professional to design a personalized plan for your needs.
Your safety is important, and professional guidance is crucial for proper evaluation and tailored recommendations.
Reasons and Treatment of Knee Pain While Squatting
As I mentioned, this blog focuses on functionality (movement) rather than the symptom. Let me explain!
Medical or clinical approach to knee pain is very different! If you turn up at your doctor’s office saying you have knee pain, they won’t do a movement assessment on you. They may refer you to an MRI/X-ray or give steroid injections to ease the symptoms without considering why you have knee pain!
Please don’t misunderstand me; this approach has its place and is necessary, especially after an accident or fall.
Also, steroid injection can reduce inflammation, allowing you to perform basic rehab exercises without severe pain! So sure, they can be handy.
If you are a regular gym goer who squats and follows an active lifestyle, the cause of your knee pain during squatting is likely related to functional movement issues.
This can be due to:
- Imbalances lead to incorrect squatting techniques.
- A sudden increase in weight and activity level.
- Weak muscles that are not performing their job effectively.
- Repetitive movements in day-to-day life or job that result in compensations during squatting, leading to knee pain.
You can easily identify these issues with a movement and postural assessment and treat them with the right exercises, which is why I am writing this blog!
To understand this better, I would like you to see how each part of our lower body is involved in squatting.
So, I’ve created a little chart for you:
| Body Part | Function While Squatting | |
| Hip Flexor | – Flexes to the hip during the lower phase of the squat. – Stabilizes the pelvis for proper alignment. – Keeps the torso upright so we don’t fall back, aiding in better balance and control. – Generates force and power during the upward phase of the squat. | |
| Femur (thigh bone) | The femur glides towards the bum in the ball and socket during squatting. It plays a huge role in maintaining proper alignment and tracking of the knees during squats, which should be towards your 2nd to 4th toes. It interacts with the patella (kneecap) and the tibia (shinbone) to ensure smooth and controlled movement, minimizing stress on the knee joint. | |
| Knee | The knee flexes (bends) and extends (straightens) as we squat. In the bottom position (knees flexed), the quads, hamstrings, and calves are highly activated. In a deep squat position, high forces are on the ligaments. | |
| Tibia | The tibia (shin bone) internally rotates but also slides laterally to move your knees over the toes. Limited tibial rotation can cause knee pain and make your squat less efficient! | |
| Ankle | The ankle performs dorsiflexion (toes getting closer to your knees) as you are lowering into a deep squat. Limited ankle mobility can lead to decreased peak knee flexion, which means you won’t be able to squat low or only by compensating with your lower back (butt wing). | |
| Foot | The foot position during squatting can hugely affect muscle activation. For example, a pronated foot may reduce the activation of the glutes and put excessive load on the knees! When it comes to squatting, foot pronation particularly has bad effects on stability, alignment, and muscle activation. | |
Now, let’s look at common reasons for knee pain during squatting!
Our approach to treating your knee pain will focus on addressing the root cause using simple, functional exercises!
1. Patellofemoral Pain Syndrome (Anterior Knee Pain)
Clinical Diagnosis: Patellofemoral pain syndrome
Symptoms: Pain at the front of the knee while squatting or even going up or down stairs. People can also get pain behind the knee (under the patella) when sitting for an extended time.
Root Cause of Patellofemoral Pain Syndrome (PFPS) – Functional Approach
Anterior knee pain can result from weak hips like gluteus medius and maximus weakness and mobility restrictions like hip internal and external rotation.
Quadriceps and hip flexor weakness can also cause front knee pain while squatting.
A National Library of Medicine study got women with patellofemoral pain syndrome to perform exercises.
The first group did hip strengthening exercises, the second did quadriceps, and the third only stretched. In contrast, the fourth group only rested and did no exercises!
The outcome says it all!
Only the quadriceps and hip exercise groups demonstrated improvements in muscle strength, decreased knee valgus (knees dropping inwards, internally rotating), and reduced knee pain.
This is very important when we are squatting. If you have weak hips, your knees may drop inwards, putting excessive load on the knees.
Also, when we lack hip internal rotation, our foot automatically turns out, putting us in a poor squatting position, which can cause knee pain.
Treatment
If you are dealing with anterior knee pain while squatting, these are the things you should do:
Clear hip internal and external mobility restrictions
By clearing these mobility restrictions, the femur will be able to rotate adequately in the ball and socket while squatting, allowing for proper muscle activation and reducing the load on the knees.
Exercises to clear hip internal rotation:
Hip Airplanes
Perform 5-10 reps each way, and hold each end range for 3-5 seconds!
Banded Hip Joint Mobilization
Perform 1 minute of mobilization on each side!
Exercises to clear hip external rotation:
Kettlebell weight shifts
Complete 4-10 shifts on each side with a 3-5 second hold.
Hip CARs
Complete 1-2 sets of 5-10 CARs on each side
Strengthen the Gluteus Medius and Maximus
The glutes generate power while squatting but also stabilize the hips; adequate hip stability is necessary for other muscles, such as the IT band, Tensor Fascia Latae (secondary hip stabilizer), to overtake the job. The adductors will become tight, and excessive and uneven forces will transfer through the knees, resulting in pain!
Strengthen the glutes by doing the following:
Glute Bridges
Perform 2-3 sets of 10-15 reps with a 5-second pause on top!
Banded Clam Shells
Do 2-3 sets of 10 slow reps on each side with 5 seconds pause on top!
Lateral Mini Band Walks
Complete 2-3 sets of 10 sidewalks each way!
Strengthen the quadriceps muscles
Strong quads can help you absorb the load when squatting or impact when jumping and taking stress off the knee joint! Weak quads will damage cartilage, ligament, or tendon and pain while squatting!
Exercises to strengthen the quads:
Banded sissy (Spanish squats)
Perform 1-2 sets of 4-8 squats with 3-5 seconds hold.
Wall sits
Hold for 30 seconds to a minute or build up gradually to 1 minute.
Improve hip hinge coordination and overall stability
Once you clear mobility restrictions, getting safe, strong, and stable within that newly gained range of motion is essential. Therefore, you should perform exercises that improve hip hinge coordination (the glutes firing up at the correct time) and stay stable and balanced while squatting.
This will give you an absolute root solution to your knee pain!
Touchdown Squats
Do 2-3 sets of 6-10 reps on each side. Focus on the hip hinge and how your knees are traveling forward!
The balancing cone reaches
Do 2-3 rounds on each leg!
Strengthen the hip flexors
Without strong hip flexors, your torso will lean far forward, the feet wobble around, and the knee will be caught in the middle of this issue, causing pain while squatting.
Banded marching
Perform 2-3 sets of 10 reps on each leg.
Dead Bugs
Do 2-3 sets of 15 reps
2. Iliotibial Band Syndrome
Clinical Diagnosis: Iliotibial Band Syndrome
Symptoms: This type of knee pain is present on the knee’s lateral (outer part) as a rubbing sensation. You may also experience pain radiating to the hip. These symptoms would worsen with exercise, especially that involved bending and strengthening of the knees repetitively, like squats!
Root Cause of IT band Syndrome (Functional Approach)
People with IT band syndrome present with gluteus medius weakness that fails to stabilize the pelvis. As a result, the hip abductors become tight and weak! Also, excessive foot pronation and sudden increases in activity can lead to IT band syndrome.
These will present pain on the lateral side of the knee.
A study showed that the hip abductors play a significant role in controlling the rotation of the limb and maintaining pelvic stability while walking and squatting!
Therefore, these muscles must fire adequately to help stabilize the pelvis and control femoral adduction. Failing to do so can result in knee and lower back pain!
Treatment
Strengthen the Gluteus Medius
By increasing hip stability, you can prevent or treat knee pain!
In addition to the exercises I mentioned above for glute strength, you can perform a more specific squatting exercise, which is the squat itself but with a band around your knees.
You need to keep constant resistance on the band and push your knees out until your feet remain stable and flat on the ground without pronating (pushing inward).
Banded squats
2-3 sets of 10-15 slow reps. Control on the way down, and pause on the bottom for 3-5 seconds!
Improve Ankle Mobility
Your foot can collapse inward in a deep squat due to poor ankle mobility. As we mentioned above, this can contribute to knee pain over time. Therefore, your ankle mobility and conscious foot position are critical when aiming for a pain-free squat!
Exercises to clear ankle mobility:
Knee to Wall
Improve Tibial Rotation
Your tibia internally rotates while you squat. Limitation to tibial rotation can lead to uneven forces on the knee, leading to pain and injuries.
To check tibial rotation limitation, complete this test:
Tibial rotation test
To improve tibial rotation, complete this exercise:
Tibial internal rotation banded mobilization
Do 30 seconds to a minute focusing on your limited side!
Have Kinesiology Taping and Sports Massage
Taping and massage to relax tight adductors may also be beneficial to reduce knee pain while squatting!
Taping
Self-massage/Foam Rolling
Foam roll for 1 minute on each side!
3. Knee Osteoarthritis
Clinical Diagnosis: Knee Osteoarthritis
Symptoms: Knee OA is a degenerative disorder when the cartilage wears out, and the bones rub together.
You may be unable to locate the exact place of your knee pain, or it may present on the front or the side of the knee. It’s pretty unpredictable. The pain is normally worse in the morning after waking up; it’s often swollen or makes a cracking noise!
While squatting, your knee can feel unstable and wobbly! It also reduces the range of motion, making squatting difficult and painful!
Root Cause of Knee OA (Functional approach)
This type of knee pain is a bit different from the others. We have control over the muscles but can’t build cartilage. Some cases may need surgical treatment, while you can also manage your pain with exercise.
Quadriceps weakness has been shown to be a major reason for developing knee OA. It also reduces neuromuscular control (unconscious muscle response), leading to joint instability and loss of proprioception.
This is a very important detail when it comes to treatment!
As long as you are able to modify your squats so you can perform them pain-free and with good technique, you are safe to squat with knee OA.
Treatment
Use elastic knee bands
This can help increase proprioception within the joint, which is especially useful when we squat!
Strengthen the quads with low-impact exercises, focusing on eccentric control
Strengthening the quadriceps muscle will reduce the stress on the knee joint, helping to manage knee pain caused by OA.
Also, to mention, you should assess your quad-to-hamstring strength ratio! If your hamstring is weak and quads strong, it can lead to other injuries like ACLs!
Therefore, you should always focus on strengthening all the surrounding muscles of the knee in general!
Exercises to perform:
Leg extension
Perform as many as you can without pain, or 2-3 sets of 10 reps. Control the lowering phase for 3-5 seconds.
Improve proprioception by performing balancing and single-leg exercises
We call this Sensory Motor Training that emphasizes postural control!
Wobble ball balance
Balance for 30 seconds to a minute
Stability ball kicks
Control the ball for 30 seconds to a minute
Single leg deadlifts
Do 2-3 sets of 8 reps on each leg
As you can see, these are a few examples of knee pain while squatting. While I mentioned the name of the ‘clinical diagnosis, you should pay attention to improving the following causes that can lead to knee pain while squatting:
- Activate and strengthen the Gluteus Max and Gluteus Medius.
- Clear hip mobility restrictions.
- Strengthen the quadriceps muscles.
- Asses quad to hamstring strength ratio.
- Improve your balance and proprioception.
- Gain stability of the hips after you clear hip mobility.
- Improve ankle mobility.
- Improve tibial rotation.
- Strengthen the hip flexors
- Perform regular soft tissue release or foam rolling.
These are the root fixes for those experiencing knee pain while squatting!
FAQs
Why do my knees hurt when squatting?
There are several reasons your knee can hurt while squatting, including weak hip muscles, limited hip joint movement, and ankle mobility. It’s important to assess your movement, gait, balance, and strength to identify the cause of your knee pain!
Do squats strengthen knees?
Yes! Squats strengthen the quads, calves, hamstring, glutes, and core that provide stability for the knee and hips, making the knees stronger to perform everyday movements.
How do I know if my knee pain is serious?
If you have stayed consistent with your rehabilitation plan and exercises, but your knee pain has worsened or remained, you should see a specialist to close out any serious damage to your knees.
These serious knee injuries include:
- A torn anterior cruciate ligament (ACL)
- Meniscus injuries
- Articular cartilage injuries
- Patella injuries
If you feel your knee is giving away with weight bearing, your knees locking in, painful while cracking or popping, swelling up, filled up with liquid, or you are unable to walk or straighten the knees, these are all signs of serious injuries!
Is it OK to squat with knee pain?
It is OK to squat as long as you can modify the exercise so it’s not painful while squatting or after.
How do I fix my knee pain when squatting?
Firstly, look at your squatting technique:
- Are your feet and knees dropping in?
- Are you maintaining a neutral spine?
- Which position do you experience knee pain in and where?
Once you answer these questions, modify your stance, foot position, the type of squat you do, and the load.
Did it make a difference? If it did, it’s great; if it didn’t, dig deeper.
Have a look at whether you have any hip limitations or weaknesses. Do you have tibial rotation limitations and ankle mobility restrictions?
If you do, these need to be fixed to squat pain-free.
You can complete exercises like:
- Gluteridge
- Knee to wall
- Side plank clam shells
- Pausing squats
These fixes can contribute to a pain-free squat!
How can I make my knees stronger?
By strengthening your quadriceps, hamstrings, and glutes, you can significantly improve the strength of your knees. That’s because these muscles improve the stability of the knee joint, reducing the load on it while squatting.
Additionally, exercises like eccentric squats, leg presses, glute bridges, leg extensions, and hamstring curls will contribute to stronger knees!
