Knee Pain—To Squat Or Not?

Squat

Everyone from high school athletes to their grandparents can benefit from the regular practice of proper squats. It’s a foundational movement to activities of daily life (ADL) as well as most comprehensive exercise programs. But the discomfort that often comes with squats makes many wary of these exercises—especially those with knee issues. That’s natural; anyone with an injury will, and should, shy away from testing it too quickly. But with proper form and gradual pushing, it could be just the thing you need to strengthen the area.*

The important distinction is muscle discomfort versus joint pain. Challenging exercises are likely to produce a little muscular discomfort, but you shouldn’t experience joint pain. It’s true that improper or unsafe squat form may cause more harm than good, so let’s make sure you understand how to squat safely—especially if you have knee concerns—and what benefits you can expect. Don’t count out squats just yet!

Benefits of Squat Exercises

  • Increase leg and core strength, endurance, and power
  • Improve balance
  • Strengthen posture
  • Increase bone density
  • Improve your derrière’s aesthetic!

General Safety Guidelines

  1. Know your body! Learn the difference between productive discomfort and injury-inducing pain.
  2. Understand your diagnosis (examples below). A knee that sometimes feels “tweaky” may train differently than one with a torn ligament.
  3. Take baby steps. Introduce squat exercises two days per week max, allowing at least 1-2 rest days in between. Select an intensity or weight load that allows you to correctly perform 10-12 repetitions in a row (which would make 1 set).
  4. Learn how to progress your training one variable at a time. Warning: Adjusting all of the following during one workout could be dangerous.
  • Increase the number of reps in a set. Once you can complete 20 reps in a row with proper form, increase the resistance (or weight load) by 10-20%.
  • Increase the number of sets. Once you can complete 3 or more sets of a certain exercise, increase the resistance.
  • Decrease the rest intervals between sets. Start with 1-2 minutes rest between sets, then decrease gradually. Once you need no more than 30 seconds rest, increase the resistance or number of sets.
  • Increase the frequency of “squat day.” Once you can squat every other day without feeling sore the next day, increase the resistance, increase the number of sets, or decrease the rest intervals.

How to Squat

  • Stand with your feet slightly wider than hip-width apart.
  • Turn your toes out slightly.
  • Keeping your core tight and chest lifted, and bend your knees as if sitting on something behind you.
  • At the lowest point of your squat (ideally with thighs parallel to the floor), your torso should be parallel to your shins.
  • Press through your heals to stand up.

Modifying Squats Around Common Knee Injuries

  1. Jumper’s Knee (aka. Patellar Tendinopathy)
    • Widen your stance 6-12 inches.
  2. Runner’s Knee (aka. IT-Band Syndrome)
    • Loop a tension tube or thick rubber band just under your knees and press out against it while you squat.
    • Focus on isometrically “spreading the floor apart” with your feet while you squat.
  3. Abnormal Tracking (aka. Patellofemoral Syndrome)
    • Any of the above three modifications.
    • Stabilize your body more by using the smith machine as shown in Figures A and B below).
  4. ACL Injury (aka. Anterior Cruciate Ligament Injury)
    • Decrease sheer force by keeping the knee over or behind the ankle, as show in Figures A, B, and C below.

For all of the above, it may also be helpful to turn the toes out a bit more (to 10 and 2 o’clock, for instance) and push through the heels to shift the work away from the knees to the hips.

  Figure A: Smith Machine Squat  |  Figure B: Assisted Squat  |  Figure C: Ball Squat

 Smith Squat Assisted Squat Ball Squat

Not sure if you’re squatting correctly?

Pain is the most obvious indication. As I mentioned above, joint pain should not accompany these exercises. If you’re having issues, or just unsure, grab a buddy to record or analyze your movement from the front, side, and rear to check your form. And of course, you can ask your gym’s personal trainer for help. They can also help with modifications specifically tailored to your body; or ask me in the comments section below.

Happy squatting!

*If your personal trainer, orthopedist, physical therapist, chiropractor, or other sports therapy physician has prescribed a routine different from this article, take heed and do that one!  

Resources: Clark and Lucett, 2011 – “Corrective Strategies for Knee Impairments.” NASM Essentials of Corrective Exercise Training. Ed. Michael Clark and Scott Lucett. 1st ed. Mesa: Lippincott, Williams, and Wilkins, a Wolters Kluwer Business, 2011. 269-279. Print.

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Laura Burstein co-owns Anytime Fitness Poolesville and is the Regional Director of Operations for them and Kensington, MD. She dove into the Kinesiology field after 3 years of weight lifting and cheerleading to learn how to work around injuries and genetic musculoskeletal limitations. Over the last 15 years, she has earned certifications through NCSF CPT, NASM CPT, NASM CES, Zumba, and Trigger Point Therapy and has been focusing that knowledge on Anytime Fitness members since 2010—earning her the h2i of the Year for 2013! She takes special pride in helping her training team and members overcome lower back and joint pain through core strengthening, functional training, and exercise modification. As a personal challenge, Laura started competing in the Figure division of Body Building shows in 2014.