Knee Pain When Squatting: Solutions
A Brief Disclaimer
This is not meant as medical advice! If your knee pain when squatting is severe, continues to persist or doesn’t improve with time off, I highly recommend you visit your doctor! If left unchecked, you could be looking at a serious injury that could affect much more than just your squats. Play it safe and schedule a visit if you have any doubts about your condition.
What Causes Knee Pain from Squats?
Knee pain from squats is a common issue that I hear of and have dealt with myself. In fact, it is so prevalent that I felt compelled to dedicate an entire article to the discussion of it. One could conclude that if this is such a frequent problem, then perhaps squats aren’t good for the knees. I’ve also met people who believe they will never be able to squat again because their knees hurt so much from squatting. Both of these couldn’t be further from the truth. If done with proper form, you should not have knee pain when squatting, and even if you do have knee pain, chances are you can still recover to squat again pain-free.
On top of this, squatting can even be beneficial for our knees by building up the musculature that supports it, thus taking less stress off the passive structures of the knee. By implementing a few simple steps, we can go a long way toward alleviating any problems with knee pain during squats that you may have developed.
Knee Pain Solutions
1. Wear Knee Sleeves
If you don’t already own knee sleeves, I highly suggest you hurry up and buy some. Knee sleeves have been shown to decrease damage to the knee in individuals with an active lifestyle. They are a cheap, effective and hassle-free way to drastically reduce your knee pain when squatting without having to do any time-consuming stretches or alterations in form. When I first began lifting, everything went well at first.
Fast forward a year later though, and three times a week of squatting on the Starting Strength Program was beginning to tear up my knees. I had a difficult time staying still and sleeping at night because they hurt so much. After reading around, I decided to buy a pair of Rehband Knee Sleeves (price is per knee sleeve, not per pair) and I was back to normal for the first time in months. Because of this, I cannot recommend knee sleeves enough. They also can serve as a pair of elbow sleeves in a bind. For more information on the importance of knee sleeves when squatting, click here.
2. Foam Roll and Stretch Your Calves
When we squat, our knees travel forward, putting pressure on our ankles. If our calf muscles, specifically the anterior tibialis and gastrocnemius, are not flexible enough to accommodate this position, our ankles will buckle inward. While this may take pressure off the ankles, the pressure is now focused on the quadriceps and our knees which are in a vulnerable caved-in position. If your knees cave when you squat and you don’t currently have knee pain after squats, you are bound to sooner or later. Fortunately, there are solutions.
Before you rush off to foam roll and stretch your calves; however, you should determine if tight calf muscles are actually the culprit because weak hips can also cause knee cave. To determine whether it’s a calf issue or hip issue, we have several options. The easiest is probably to have somebody record your squats in such a way that your ankles, and any shifting that they may do, can be easily seen.
Unfortunately, if the hips are weak enough, knee valgus (the fancy term for inward knee cave) may be so bad that the ankles will roll inward too even though they aren’t at fault. If the recording isn’t definitive, there’s an easy test that almost always gives a clear answer. Simply put something an inch or so in thickness, such as a plate, under your heel when squatting and see if the knee cave disappears. If it does, your calves are the problem and need to be foam rolled and stretched.
Meanwhile, you can squat with something under your heels or invest in a pair of weightlifting shoes that come with a raised heel for this very purpose. Not only will a pair of weightlifting shoes reduce knee pain from squats, but will also make it easier to hit depth as well. There are some drawbacks though to using these shoes and for a minority of lifters, they may even make knee pain worse! For more information on the pros and cons of weightlifting shoes and powerlifting shoes in general, click here. Even if you opt to go with weightlifting shoes, you should still foam roll and stretch your calves.
I’ve already written an article on foam rollers, but for those who have yet to read it (which you should), I will quickly recap why I am such a fan of it. Foam rolling is the best way for an individual to get rid of trigger points, which are associated with pain, reduced range of motion and possibly even injury, on his or herself. Because foam rolling is a form of self-massage, it also feels fantastic. Luckily, many gyms carry foam rollers now, although nicer ones can be found online.
As I mentioned previously, the anterior tibialis and gastrocnemius are the two muscles that need to be stretched. In conjunction with foam rolling, stretching will help to return short, dysfunctional calf muscles to a normal and healthy length. Your squat form and knees will thank you for it. As of this writing, I do not have legal access to pictures of stretches for these two muscles, but I will provide links below to them and update with my own pictures as soon as possible.
3. Strengthen the Hips, Stretch the Groin
If your knees cave but it isn’t because of tight calves, then your hip abductors, hip external rotators and adductor flexibility must be brought up to par to take pressure off the knees. To strengthen the abductors and external rotators, I prefer lateral band walks and seated band hip abduction. If you don’t own any bands, they can be found here and I will provide some other options below as well. Renowned powerlifter Mark Bell also created a product called the hip circle which serves a similar purpose and many consider it to be more comfortable than a band. Stretching the adductor muscles of the groin will help reduce knee pain from squats as well. If you are a sumo deadlifter, these steps should also improve your pull and possibly allow you to bring your stance out further, significantly reducing the range of motion required. The shorter your range of motion, the more efficient the lift and the more weight you theoretically will be able to lift.
4. Carry the Bar Lower on the Back
If you currently high bar squat, and you are suffering from knee pain during squats, moving the bar two to three inches further down your back could provide relief. When squatting low bar, the torso has to lean forward to prevent the bar from slipping down the back. To keep the bar from drifting too far forward from our mid-foot, we must sit back more in a low bar squat than what you would see from a high bar squat. This results in less forward knee travel and a more vertical shin when at the bottom of the squat, which puts less stress on the knees. In addition, lifters can squat five to ten percent more with their low bar squat because of improved leverages, so its worth making the change if you plan to or are competing in powerlifting. For a video comparison between high bar and low bar squats, click this link or watch the video below.
5. Widen Your Stance
Another straightforward way to eliminate knee pain when squatting is to adopt a wider stance. Much like lowering where the bar is carried on the back, a wider stance will force the lifter to sit back more which reduces forward knee travel. A wider stance will also strengthen the glutes and hamstrings, to further take off strain from the knees. For more information on wide stance squatting and box squats, check out non-other than Louie Simmons, one of the most famous powerlifting coaches in the world, in the video below.
6. Sit Back More
Regardless of whether you change your squat stance or bar position, thinking about “sitting back” is going to be a good idea if you are dealing with knee pain from squats. Many people who have knee pain when squatting tend to initiate the squat by breaking at the knees first. While this is optimal for high bar, close stance squatters, if you are having severe knee pain during squats, you should be tinkering with a low bar and wide stance. Instead of initiating the squat by breaking at the knees, think about breaking at the knees and hips at the same time and focus upon sitting back slightly with an upright torso during the descent. Be wary of sitting back too much though, as this drastically alters the mechanics of the squat toward something resembling a good-morning squat hybrid.
7. Incorporate Box Squats
I am not an avid fan of box squats because of their limited carry-over to the competition style raw squat; however, in this case, box squats can prove to be extremely valuable. If all the other tips above proved ineffective or your knee pain from squatting is so bad that you can no longer perform a raw squat at any time, it’s time to try out the box squat. By sitting back as far as we can onto a box that is behind us, we can drastically cut down on knee pain from squats. Just keep in mind that this is not a long-term solution. Unlike the traditional squat, the box squat is a posterior chain dominant movement, with a larger emphasis on glute and hamstring activation at the cost of quadricep activation. A competition style squat as seen in powerlifting; however, is a quadricep dominant exercise. Because of such, the carry-over between the two will be far from ideal. Use the box squat to get some sort of squatting in while you heal up and focus upon improving strength and technique for the squat that really matters. For insight into box squat technique, click here or check out the following video.
8. Strengthen the Vastus Medialis Oblique (VMO)
The vastus medialis is a quadricep muscle that functions to extend the leg and stabilize the patella, more commonly known as the knee cap. The vastus medialis oblique is a part of the vastus medialis that resembles a teardrop on the inside of the leg near the knee.
When weak, damaged or fatigued, the vastus medialis oblique (VMO) is unable to stabilize the patella, causing improper tracking of the knee during movements such as squats. It is theorized that a VMO that is not functioning as intended can cause injuries such as patellofemoral pain syndrome, chondromalacia, tendinitis and even anterior cruciate ligament (ACL) tears.
If your knees are caving on your squats or you have knee pain from squats, add movements that strengthen the VMO into your workouts. A great exercise for the VMO are Terminal Knee Extensions (TKEs) . The easiest way to do this is with an exercise band, as seen in the video provided. I do have a note about the video, however. When performing terminal knee extensions, your heel should remain on the ground. The details that Phil from NoLimitAthlete shares on VMO issues is correct and insightful (which is why I included it), but his execution of the exercise is not. Leg Extensions, but with a reduced range of motion focused on the final degrees of leg extension (the top end) can work as well if you don’t have access to a band.
Knee pain when squatting is very common and can be a daunting thing to overcome. Rather than bash your head against the wall and risk injury, try to assess the situation and see what’s causing your knee pain during squats. Start by purchasing a pair of knee sleeves if you haven’t (you won’t regret it!) and test to see whether tight calves or weak hips might be the root of your problem. Once you figure out which one it is, get working on it and add in some VMO work, foam rolling and NSAIDs for good measure.
To get through your workouts with minimal knee pain, take a week or two off and then try playing with your stance and bar position. If you’re really hurting, give box squats a shot. If your knees still hurt when box squatting, you have a bigger problem on your hands, and you should take even more time off and check with your physician to see if it’s anything serious. It’s always better to play it safe in these instances as a moderate injury can become a severe injury that could hinder your squatting forever if you aren’t cautious.