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Knee Pain When Squatting: A Deeper Dive

Knee pain during squats is a widespread concern and something we often come across here at Performance United. To fully comprehend and address it, we need to delve into its anatomy, biomechanics, and evidence-based solutions.

Knee Anatomy

Understanding the intricate workings of the knee can clarify why it’s prone to injury:

Menisci: These cushion the joint and distribute load across the knee. Damage here can reduce shock absorption, leading to pain.

Ligaments: They stabilize the knee. Weak or injured ligaments can result in instability during squats.

Tendons: These connect muscles to bones. Inflammation here can be a source of pain, particularly the patellar tendon.

Hinge Joint: The knee is a hinge joint, it bends and flexes, it is often victim to issues at the foot and hip, due to its location being influenced by these areas. It is also subject to large amounts of load during lower body movements.

Knee Pain When Squatting

Causes of Knee Pain When Squatting

Unpacking common causes:

Patellofemoral Pain Syndrome (PFPS): It’s due to increased stress between the patella and femur, often from muscular imbalances or improper squat form.

Meniscus Tears: Age or acute injury can lead to tears, disrupting the knee’s normal function.

Tendonitis: Repetitive strain can inflame tendons. For squatters, the patellar tendon is often affected.

Symptoms

Recognizing the signs:

– Pain around or behind the kneecap, often exacerbated by prolonged sitting or descending stairs.

– Swelling post-exercise.

– Discomfort during the movement

– Popping or grinding, which can indicate cartilage wear or meniscal issues.

Prevention Strategies

Doing your best to avoid the worst. It is important to note, true prevention may never be possible, but we can always do out best to create the right environment for knee health under load.

Warm Up: Particularly with tendon issues, warming up is crucial. You want the muscles and joints to be warm, this means there is blood flowing in the area and they are prepared to work. Jumping the gun and getting into things too soon, can leave your tendons particularly unhappy, as they do not respond well without heat.

Strengthening: Get strong safely, use exercises that target muscles around your knee that do not aggravate it. If you find something feels off, do not push through, try to move in the ranges that feel good and progress it slowly, increasing the range of motion, load, or volume over time.

Footwear: Shoes influence your biomechanics. We generally recommend proper weight-lifting shoes when squatting, shoes that are not too far off the floor, or squat barefoot. Whichever you pick, will be down to personal preference and your squat style.

Technique: Find the form that works for you. There is no ‘correct’ form, as everyone will squat differently to how they are built. But finding what works best for you can make a difference. When addressing knee pain when squatting, one of the first things we do is address the squat technique before anything else, we often find, slight modifications can go a long way, without the need for extensive rehabilitation exercises or excessive time off the movement.

When addressing knee pain when squatting, one of the first things we do is address squat technique before anything else, we often find, slight modifications can go a long way, with out the need for extensive rehabilitation exercises or excessive time off the movement.

Rehabilitation Strategies

Evidence-backed solutions:

Manage training volume: Avoid making large jumps in your training volume, increase slowly each week. We recommend not doing more than 10% jumps each week to be on the safe side.

Knee Pain When Squatting

Reduce load but do not avoid it altogether: Overloading can exacerbate pain. By temporarily reducing weight, you give inflamed or damaged tissues a chance to recover. In addition to this, reducing load can give you the opportunity to both heal and improve your technique. We try to avoid taking time off the movement altogether, as this usually does not resolve the issue completely, often causing it to re-appear as soon as we get back under the bar.

We try to avoid taking time off the movement altogether, as this usually does not resolve the issue completely, often causing it to re-appear as soon as we get back under the bar.

Get help: If the symptoms are persisting or worsening, get help. Have someone evaluate your injury, and determine its severity and pathology. Have them assess your squat, training program and provide feedback. If you are not educated in understanding human movement or the types of injuries that can occur, getting the help of someone who is will not only help resolve the problem but educate you in managing this in the future.

Biomechanics

The science behind the squat:

Knee Pain When Squatting

Depth: Deep squats, contrary to some beliefs, are not inherently harmful. A study in the *Journal of Orthopaedic & Sports Physical Therapy* (2013) suggested that deep squats can decrease knee stress, likely due to increased engagement of the hip musculature, which can share the load.

Stance: Everyone’s anatomy is unique. Some people may have hip structures that favor a wider stance, while others might be more comfortable narrower. An individualized stance ensures that the knee moves in alignment with its natural mechanics.

Knees over toes: We usually try to advocate having the knee move forward or over the toes, as opposed to outwards which many coaches outline. We do this to ensure the kinetic chain is at its most efficient, without any energy leaks. When you experience an energy leak, you will usually require other joints or muscle groups to pick up the slack, in some cases, overloading these areas (like the knee) can cause some issues over time.

Foot placement: You want to ensure you maintain equal load distribution in your foot. We like to use the tripod foot . This ensures the individual has their foot in such a way so that it enhances the overall stability of the movement.

Knee Pain When Squatting

Practical Tips

Incorporating evidence-based insights:

Seek expert feedback: Clinical professionals can offer biomechanical insights and tailored advice. They’ll identify subtle nuances in your form, helping you manage your injury long term.

Try different foot and knee positions: You will need to find the right direction for your legs to move that suits your body type. There is no perfect answer to this, everyone will squat differently. Try to find the one that is most comfortable and pain free, then build it up slowly.

Heel Elevation: Heel elevation can alter your squat. You will find some people squat better flat footed, while others, with a slight heel elevation. For most people, heel elevation allows the lifter to get more range in their ankle, squatting more upright, with more forward knee travel. However, this may not suit everyone, in some cases, individuals may be more comfortable with a flatter foot on the ground.

Film Yourself: Seeing your form can highlight biomechanical issues. Research has consistently shown that visual feedback can be a powerful tool for modifying movement patterns.

Warm Up: I went over this before, but a dynamic warm-up increases blood flow and prepares the muscles and joints for the stress of squatting.

Closing thoughts

When we arm ourselves with knowledge and evidence-backed strategies, we stand a better chance of squatting pain-free. Always remember that each body is unique, so personalizing your approach is key. Listen to your body and adjust accordingly. If you need help with your knee pain when squatting, contact us now and we will guide you through your journey , educate you, and have you squatting again pain free.

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