Knee Pain When Squatting

Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board

Knee Pain When Squatting: Causes, Treatment & Prevention

Knee pain when squatting is a common, but avoidable, problem. 

There is a common misconception that squatting is bad for your knees, but that just isn’t true.

When done correctly, squatting is actually really good for you! Indeed, in many countries, squatting is a common resting position.

Our bodies are designed to be able to squat without knee pain. The key to pain-free squatting is a combination of good muscle strength, adequate flexibility, a healthy joint and good technique.

Squatting is rarely the primary cause of knee pain, but often exacerbates underlying knee problems. Here we will look at the most common causes of knee pain from squats, how to treat and prevent them and how to make sure you using the best technique when you squat. 

Top Causes of Knee Pain When Squatting

The most common causes of knee pain when squatting are:

1) Weak Glutes

In my experience, almost everyone I’ve seen complaining of knee pain when squatting has weak gluteal muscles. The glutes play a massive role in supporting the knee joint. If they are weak, the knee cannot track properly and gets overloaded, resulting in knee pain during and after squatting.

How Not To Squat: Knee pain when squatting is often due to poor technique. Find out how to squat properly

2) Poor Technique

Poor technique is one of the most common causes of knee pain when squatting.

If the hips, knees or ankles are in the wrong position when squatting, particularly with deep squats, then knee joint gets overloaded which leads to pain.

3) Cartilage Tear

The most common injury to cause knee pain when squatting is a meniscus tear where there is damage to the special cartilage that lines the knee joint.

Sharp knee pain when squatting is common with cartilage injuries and people often experience a catching or locking sensation in the knee when they squat down. The deeper the squat, the worse the pain typically.

4) Underlying Knee Conditions & Injuries

There are a number of conditions that can cause knee pain when squatting:

  • Runners Knee: aka PFPS (Patellofemoral Pain Syndrome). Here, there is a problem with how the kneecap moves resulting in irritation of the cartilage on the back of the kneecap, making it painful to squat. The symptoms of Runners Knee tend to come and go, are typically worse after prolonged rest or long periods of exercise and sufferers often experience clicking/grinding sensations when moving their knee

  • Chondromalacia Patella: Softening of the kneecap cartilage. Chondromalacia typically affects young, healthy individuals. Sufferers typically complain of a dull, achy pain at the front of their knee and a grinding sensation when they squat

  • Patellar Tendonitis: aka Jumpers Knee. Here, there is damage to the patellar tendon below the kneecap from repetitive forces through the tendon e.g. frequent jumping and kicking. Symptoms gradually get worse increasing in frequency, intensity and duration

  • Iliotibial Band Syndrome: aka ITBS. With ITBS, there is irritation of the thick band running down the outer thigh to the knee. Tightness in the band pulls on the kneecap resulting in knee pain when squatting. The pain tends to be on the outer side of the knee and may be accompanied by a popping/snapping sensation. ITBS most commonly affects runners

  • Arthritis: Wear and tear of the knee cartilage and bones associated with arthritis can make squatting very painful. With knee arthritis there is less cushioning and space between the knee bones and when you squat down, the cartilage gets squashed and the bones rub on each other which can cause a lot of pain. The inner side of the knee is most commonly affected

Treatment And Prevention

Most cases of knee pain from squatting can be treated at home using a combination of:

  • RICE - Rest Ice Compression Elevation
    Rest: the knee and avoid activities that cause knee pain, especially squats
    Ice: regularly apply a wrapped ice pack to the knee for 15 minutes to reduce pain and inflammation
    Compression: Reduce swelling and support the knee with tubigrip compression bandage
    Elevation: When resting, prop your leg up on pillows to help reduce swelling. Aim to get your knee higher than your heart
  • Medication: Over the counter pain relief and non-steroidal anti-inflammatories help to reduce pain and inflammation in the knee from squats

  • Strengthening Exercises: Strengthening the muscles around the knee, particularly the glutes, are one of the best ways to prevent knee pain when squatting. In most cases, after 4-8 weeks of daily strengthening exercises for the knee muscles and glutes, people find they can do full squats without any knee pain. Strengthening exercises are a must here, just steer clear of squats for a while!

  • Increase Flexibility: Stretching the quads, hamstrings and ankle joint helps to ensure normal biomechanical function at the knee - find out how in the knee stretches section. But always work on strength first as muscle tightness is often the bodies way of providing stability to a weak joint. You don’t want to take away that stability until you’ve replaced it!

NB If you have injured your knee, make sure you get checked out by your doctor before trying these to rule out anything serious.

How To Do The Perfect Squat

Without the right technique, knee pain when squatting can be a real problem, particularly if you are using weights or doing deep squats. But making a few small adjustments really can make all the difference. Anyone doing squats as part of their workout problem should be aware of their technique.

Standing Squats

So let’s look at how to perform the perfect squat:

How to do the perfect squat and avoid knee and back pain
  • Stand with your knees hip width apart. Hips, knees and toes should be pointing forwards. TOP TIP: To get the right distance, start with your feet together, turn your toes out to form a “V” and then follow the movement with your heels so they are in-line with your toes

  • Ensure your weight is spread evenly through your feet: TOP TIP - Imagine 3 points under your foot: one under the base of your big toe, one under the base of your little toe and one under the middle of your heel. Gently rock backwards and forwards a few times and come to rest with your weight spread evenly between those 3 points

  • Take a deep breath in and as you breathe out start to squat: Bend at the hips and knees and squat down, taking your bottom backwards as if you were going to sit in a chair

  • Check Your Knee Position: Keep your knees behind your toes and make sure you keep your knees apart - don’t let them drop inwards. TOP TIP: Look down and check your knee is in-line with your second toe - you should always be able to see your big toe as you squat

  • Keep your heels down: Ensure your weight stays evenly spread through your foot to avoid excess force through the kneecap

  • Check your upper body position: Keep looking forwards with your head upright, spine in neutral, chest lifted and shoulders drawn back gently. Some people find it helps to lift both arms forwards as they squat down to help them balance

  • Don’t squat down too far: You shouldn’t feel any pain when you squat – if you do, reduce the depth of the squat. Never let your bottom drop lower than your knees

  • Use A Mirror: Doing squats in front of the mirror helps to ensure you maintain good position and form throughout the movement

  • Hold the squat for 2-3 seconds: If comfortable - remember, there shouldn’t be any pain in your knees

  • To come back up: inhale, tighten your abdominal muscles, clench your buttocks together, push down through your heels and slowly rise to the starting position

  • Gradually Increase Your Repetitions: Start with one set of 10 repetitions. Once you are happy with that, try increasing to 2 sets of 10 reps, and finally build up to 3 sets of 10 reps

Wall Squats

If you are recovering from a knee injury, have arthritis or find you are still getting knee pain when squatting, try these wall squats instead. The wall provides some support which helps to reduce the forces going through the knees, and makes it easier to balance and stay in good alignment.

To perform wall squats correctly:

How to do wall squats correctly
  • Stand With Your Back Against a Wall: Your heels should be around 18 inches from the wall, feet hip width apart as described above

  • Take A Breath In and As You Exhale, Gently Slide Down The Wall: keep your back and buttocks in contact with the wall

  • Make Sure Your Knees Don’t Drop Inwards: remember to keep them in-line with your second toe – have a quick peek down to make sure you can still see your big toe

  • Lower Down As Far As Feels Comfortable: Don’t let your buttocks drop lower than your knees and if you can, try and hold the squat position for a couple of seconds

  • To Come Back Up: breathe in, draw in your abdominal muscles, push down through your heels, clench you buttock muscles and slowly slide back up the wall

  • Start With One Set of 10 repetitions: once you are happy with that, try increasing to 2 sets of 10 reps, and finally build up to 3 sets of 10 reps

Recovery

Most people suffering from knee pain when squatting find that their symptoms settle down in a few weeks using the treatments we have talked about here. If however your symptoms persist you, talk to your doctor. Other things that can help if you get knee pain from squatting include:

  • Changing Your Activities: opt for low impact exercise such as swimming or cycling, and avoid activities that aggravate your knee

  • Warm Up & Cool Down: Whenever exercising or playing sports

  • Ensure Healthy Weight: Losing weight helps to reduce the forces through the knees, but is only indicated if you are overweight

  • Regular Strengthening & Stretching Exercises: These help to prevent muscle imbalance. Visit the knee strengthening and knee stretches sections to find the right exercises for you

  • Orthotics: If you have flat feet or valgus knees, then shoe inserts from a podiatrist can help to correct lower limb alignment

  • Physical Therapy: A PT can assess the cause of your knee pain when squatting and work on a rehab programme with you

If your pain from squats continues to get worse or is accompanied by knee locking or giving way, you may need to have arthroscopic (keyhole) knee surgery.

Common Questions About Squats

What Are The Benefits Of Squatting? There are a whole host of benefits of squatting: 

  • Improves Muscle Strength & Function: in the calves, hamstrings, quadriceps, abdominals and back muscles
  • Improves Balance: particularly helpful as you get older
  • Help Prevent Injuries: by improving strength, flexibility, balance and joint health
  • Improves Bone Strength: Weight-bearing exercises help improve bone density
  • Improves Health & Fitness: Performing fast sets of squats, especially if using weights, can help to improve fitness levels, burn calories and reduce body weight
  • Improves Posture: Another benefit of squatting is that it increases core stability which in turns helps to improve overall body posture
  • Makes Daily Activities Easier: such as getting in and out of a chair or bed

Why Do My Knees Crack When Squatting? There are a number of possible reasons why knees crack when squatting. If the cracking noise is accompanied by knee pain, it is most likely due to a cartilage injury or arthritis.

Often knees crack when squatting without there being any pain, which is usually due to gas bubbles in the joint popping. Visit the knee pain and popping section to find out more.

What Causes Knee Pain After Squatting? If you get knee pain after squatting down rather than during squatting, chances are you are overworking your knee. There is most likely a problem with muscle strength and endurance and as the muscles fatigue, they are unable to provide adequate support to the knee, resulting in pain.

Knee pain after squatting could also be the result of a minor injury inside the knee such as a small cartilage tear. Performing squats may be irritating the joint slightly causing a slow build of inflammation that continues to build once after you’ve finished squatting, resulting in delayed onset knee pain.

Summary

If you are suffering from knee pain when squatting, don’t lose heart. Chances are, things will improve with a combination of exercises and changing your technique.

Don’t be afraid to squat – our bodies are designed to do it, and in fact, being able to squat is really important when it comes to lifting heavy objects so that there is minimal strain on your lower back.

Listen to your body – if you are getting knee pain when squatting, don’t try and push through it. No pain no gain does not apply here. Takes things a bit easier, let the pain settle down then work on a home exercise programme to strengthen the leg muscle and you should find yourself back to pain-free squatting before you know it.

  1. Knee Pain Guide
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  3. Symptoms
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  5. Knee Pain Squatting

Page Last Updated: 09/09/19
Next Review Due: 09/09/21



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References

1. The Lowdown On Squats. Harvard Health Publishing. March 2019

2. Reasons For Knee Pain With Full Squats. Livestrong. April 2019

3. How To Squats Correctly. Arthritis Foundation


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