Knee pain during squats is common among those with strength deficits, muscle asymmetries, balance impairments, and those with joint irritation. The good news is, almost all of these are able to be fixed and you will be able to squat again. We squat countless times per day and have been since the caveman era. It is NORMAL to be able to squat without pain. Here are the reasons why knee pain during squats is common.
Squats can be one of the most painful movements with knee osteoarthritis, general knee pain, or following a total joint replacement. But, squats are one of THE if not THE most important movement that we do during daily life.
Most of our ancestors depended on the deep squat! Our bodies are meant to squat but why are we starting to develop pain with this movement?
There are many reasons we have developed knee pain during squatting. I want to tell you some of the common reasons that I see when I am working with clients that have knee osteoarthritis or other types of knee pain.
Try this experiment
Stand up from where you are and try to do a squat, bend down and stand up how you usually would.
Think about how it feels:
- Do you have any pain?
- Do you have difficulty squatting lower?
- Does it feel awkward or just not right?
Now, stand in front of a chair. Squat down to sit down and then stand back up. Does it feel any different? Does it feel better?
For most of the people I do this with, the squat dramatically changes from when you have a chair behind you to when you are free squatting. If you watch the video below, look to see what bends FIRST- hips or knees.
The answer, the HIPS. When the knees bend first, they tend to take most of the load. This is one the of the most common problems I find when people have pain when squatting. Now try to squat again, think about bending the hips first NOT the knees.
Typically when people come to me with knee pain during squats, this is one of the first things I look at. This tends to be one of the most common problems that leads to joint pain, especially with increased knee bend.
This test can also be turned into an exercise and can be a great way to teach your body how to squat properly again. This can make a world of difference to knee osteoarthritis pain.
Let’s look at the 4 other potential reasons you are having knee pain with squats…
Reason #2: Pain has control
Especially when dealing with knee arthritis, I see quite a few people that have pain with squats because they are expecting it. Now I know this sounds crazy but it’s true.
If we are anticipating pain when we have to get in the car, bend down to sit on the toilet, or when we have to squat down to a chair- we will likely have pain.
Don’t get me wrong, the pain is real when you have it. But sometimes we can further convince our bodies that the squat is a potentially dangerous movement if we expect pain every time we do it. If we think “Man, this is going to be painful” then our mind thinks that’s actually what we want to happen!
Our words are very powerful. If you don’t believe me, I would highly recommend checking out the video below with Marisa Peer, a world renowned psychologist. She states: “First you make your beliefs, then your beliefs make you.”
If we start trying positive self talk, you may actually be shocked at the results. If each time you go to squat, you tell yourself some variation of “I can do this” you may start to notice you feel more confident in the movement.
Reason #3: You're stiff
“I just want to be able to squat like everyone else”, I hear this from clients all the time. When I bend down into a deep squat during a session, I hear “Man I wish I could do that”.
In order to regain squat depth like in the cave man picture above, you have to make sure your joints are free to move how they should. Joint stiffness can alter your ability to squat. With stiffness being one of the leading symptoms of osteoarthritis (learn what the other 3 common symptoms are here!) your joints can be holding you back from getting down into a deeper squat.
There are a few ways to release joint stiffness and regain mobility. The four main joints that limit squatting ability are typically knees, hips, ankles, and/or spine (upper and/or lower back). This is why it is so important to look at all of these when figuring out where you need to work on most. I’ve heard physical therapists are great at this 🙂
If you are looking to get started, here is one video to help you find out if your ankle is actually the problem!
Reason #4: Your hips could use some strength
In having knee pain with squats, the hips may have a part to play in this puzzle! During daily life, we tend to primarily work the muscles that help us walk forwards and stand up from a chair. Do you know what the prime muscles are that do those things? Your thigh muscles.
The backs of our legs and glutes tend to get neglected a little more than we would like, especially if walking is your primary form of exercise.
Variety in movement is crucial to keeping well-rounded, strong legs. When we play sports, do variable workout routines, or try different activities for exercise, we may get the variety that we need. In most cases, though, there is not enough variety.
One of the recent clients I met with was very active playing pickleball, walking, occasionally running, and riding his bike. He started to develop knee pain though, particularly when he was running. Upon assessment, knee pain was prevalent during squats too. Taking a look at his training, it was primarily all in one direction, forwards.
It can be difficult to achieve this variety, especially when dealing with pain because we may be unsure if the exercises we are picking are good for our joints and this was the trap he was falling into.
We added some lateral movements to work the outside hip muscles and some other exercises to help strengthen the back of his legs. Knee pain during squats slowly started to go away once we were able to regain strength. This created a well rounded knee joint, getting support from all sides!
Unsure of which exercises to start with? This exercise video shows just how simple it is to add in some of these varying directions and movements. All you need is one washcloth to complete it!
Reason #5: you may be off balance
Now what does balance have anything to do with my knee pain with squats? Actually, way more than you think! Part of decreasing knee pain involves being comfortable shifting your weight backwards.
You might be surprised with your balance! Even if you aren’t falling over the place your balance may not be as great as you think.
When you have appropriate balance, your muscles are all working together as a team. This team is successful when each muscle is doing its job. When we have pain, and/or a strength or mobility deficit, your team may start to experience some dysfunctions. These dysfunctions can then lead to increased joint pain because it alters how your joint accepts stress.
If your balance is better on one leg than the other or if you feel as though your balance is “off”, this could be contributing to your pain.
To test your balance I want you to try this test. This is more than just standing on one leg. We have to be able to stand on one leg and move our bodies without losing our balance.
This ultimate balance challenge can give highlight any potential balance deficits and asymmetries. Keep in mind, this is only one test. You can check out more balance exercises here!
If you notice balance impairments, one of the best thing you can do is add support to your squat! This can include squatting down to a box or a chair, squatting with a TRX band (this is my favorite brand of straps!), or hanging onto a kitchen counter. There are TONS of variations you can try.
There are a few different reasons that could be contributing to your knee pain during squats. Commonly, pain originates from a combination of things and it is unlikely pain is coming from one singular thing- especially if you have started to experience gradual pain without any injury.
The quickest way to find out why you are having knee pain during squats is to find a physical therapist or movement specialist that can help you answer this very question! The longer you try to ignore this pain, it will likely get worse!
If you are dealing with knee osteoarthritis and are looking for ways you can build stronger legs without having to worry about if you are doing the right exercises, hop on over and grab the Knee Osteoarthritis Exercise Guide!
One of the most common things I hear is that people avoid exercise because they are in pain and not sure if what they are doing will cause more damage. Resting is one of the worst things you can do, especially for knee osteoarthritis. It’s time to take action and get control over your knee pain with squats.
Disclaimer: This post is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Kuhn and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Move Well Age Well, LLC and Dr. Alyssa Kuhn, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this video or site.