Knee Pains when Squatting: Causes, Prevention & Treatment

The squat is one of the most fundamental and important exercises you can master. You’re likely squatting more than you realise. Think about it, we squat when we sit down and we squat when we return to a standing position. You may squat more than you even realise, you typically perform this exercise through your day such as standing up from your desk, getting up from the couch, sitting down to eat dinner and even getting out of bed! As you can see, we squat in many everyday activities – so it’s important you can perform squats correctly and most importantly, pain free. Not to mention the benefits are varied and wide, benefits include strengthening leg muscles and joints, promoting fat burn and weight loss, improving flexibility, just to name a few. It is relatively easy for most people to perform because it does not require any equipment and can make a great foundation for a workout routine. It is an exercise that is easy to implement but it is also an exercise that can be done incorrectly. Unfortunately, oftentimes squatting is avoided due to knee pain. This pain may be a result of incorrect technique, pre-existing injury, muscular imbalances, lack of flexibility & mobility, and a variety of other reasons. In this article you will learn the causes of knee pain when squatting, pain prevention, and treatment to keep your knees healthy and your squats on point. 

What Causes Knee Pains When Squatting?  

“My knee hurts when I bend it and straighten it” is not an uncommon statement we as Personal Trainers hear. So, what’s the reason? Let’s start with the causes of knee pain when squatting. 

The most obvious reasons of why knees hurt would be pre-existing injuries. Playing sports is one example of a common factor in knee injuries. Assuming that the injury has been diagnosed by a specialist, this would fortunately be the easiest to address, with a prescribed rehabilitation program to follow. From there it would be a matter of patience and diligently following the program to address the injury to overcome the pain.  

Before delving into the list of potential injuries that cause knee pain, let’s discuss one of the most common causes: Incorrect technique. Even with detailed instructions from the most experienced trainer, client technique can still fall short for several reasons. This can be due to weak glutes, tight hamstrings and quads, lack of mobility in the ankles, hips, thoracic spine, along with motor control issues (lack of co-ordination of all the muscles involved). These factors can limit knee bends and places unnecessary strain and additional load, putting pressure on the knees causing repetitive friction between the patella and femur, resulting in discomfort or pain. Especially if your knee feels tight when bending it and you persist with heavy loads. Unfortunately, if these factors are not addressed early and overloaded too soon, it can lead to potential injuries. Sometimes it may be difficult to differentiate between injury and tightness, however, there are some sure signs that indicate injury, for example, if you experience knee pain when bending and straightening it.  

So, what injuries can cause knee pain when squatting?  Here is a list of the most common:(a)

• Cartilage tear 

• Knee bursitis 

• Patellofemoral Pain Syndrome (aka Runners Knee) 

• Chondromalacia Patella 

• Patellar tendonitis 

• Iliotibial Band Syndrome 

• Knee Arthritis 

• Hamstring Injuries 

Although, most of the above will have their individual rehabilitation exercises to follow, the good news is that there are common recommendations that can offer pain relief, overcome further injury, and/or prevent injuries altogether. 

Muscular imbalance is another cause of knee pain. To perform correct squat technique, we require our spine to be neutral, heels flat on the floor and knees pointing in the direction of our toes.  Human movement is reciprocal in nature: Opposing muscle groups must coordinate for proper movement (b). When there is an imbalance, there is less coordination and cohesion in muscles moving effectively together. This can be a result lack of symmetry or an uneven distribution in strength. For instance, when it comes to squats, if we favour one leg over the other, it can lead to the shortening and tightening of the stronger leg and the lengthening and loosening of the weaker leg, inhibiting effective execution of proper squat technique. Over time with progressive overload, the stronger side will persist to overcompensate for the weaker side leading to the continuous shortening and tightening which can eventually lead to pain, or worse, injury. This pain can be experienced in the knee, hip or back. 

How to Prevent Knee Pains When Squatting?  

So how do we prevent knee pain when squatting? 

If there are no underlying injuries, then the most important step will be to ensure we implement the correct technique. Performing squats correctly is paramount. There is a common misconception that there is only one way to squat. Given that human beings are born with different biomechanics and physical shape & sizes, it is incorrect to say that there is a one size fits all approach to squatting. What may work for one individual may potentially be challenging for another. For instance, a low barbell squat is ideal for people with ankle mobility issues, high bar squats are ideal for people with a long torso and short femur. Individuals with long femurs may want to consider having a wider stance. Perhaps the heels need to be slightly elevated with a wedge because of tight or weak hamstrings, or poor ankle dorsiflexion. Understanding your biomechanics will help you determine which approach is most suitable for you to remove or reduce knee pain when squatting. Once you have identified this, there are some golden rules you must consider when performing a squat: 

• Spine must always be neutral. Your spine must have natural curvature in every stage of a squat. This means avoid forward rounding of the spine, excessive pelvic tilting, jerking, twisting, or contorting during the squat.   

• Core must always be engaged. It is essential to uphold intraabdominal pressure to stabilise the core and minimize the compressive forces on the spine. 

• Perfect your foot placement. Regardless of whether your stance is neutral, narrow, or wide, it's crucial that your knees align with the direction of your toes. Avoid excessive inward or outward pushing or pulling of the knees. 

• Ensure your feet are consistently grounded. Always exert pressure through the middle or rear of your foot, avoiding pushing through your toes or letting your heels lift off the surface. 

• Execute deliberate contractions and controlled movements. Whether you're performing rapid repetitions or slow ones, ensure that your movements are controlled. Avoid bouncing off in the lower position, as it can subject the knee to increased forces. 

• Prioritise warming up before lifting heavy loads. It's essential to engage in a pre-load warm-up to activate the muscles in use, enhance flexibility and mobility. This preps your joints and connective tissues, promoting muscle elasticity, thereby reducing the risk of injuries, and enhancing overall performance. 

What To Do If You Are Experiencing Knee Pains While Squatting?  

Here are 10 tips you can implement in your training routine if you are experiencing knee pain: 

1. Stop and Rest: If you're feeling pain during a squat, stop the exercise immediately. Continuing to push through pain may exacerbate the issue.  

2. Assess Your Form: If your knee hurts when bending and squatting, be sure to check your squatting technique. Ensure that your knees are in line with your toes, your feet are properly positioned, and your overall form is correct. Poor form can contribute to knee pain. 

3. Reduce Weight: If you're using heavy weights, consider reducing the load to a more manageable level. Overloading the squat can contribute to knee strain. Ensuring you’re avoiding the potential for a knee injury is paramount.  

4. Modify Your Stance: Experiment with different squat stances, such as narrowing or widening your feet, to find a position that feels more comfortable for your knees. Ensure the front of the knee feels comfortable as you progress through the squat motion.  

5. Warm-Up Adequately: Ensure that you warm up properly before squatting. Warm muscles and joints are more flexible and less prone to injury. This can be done with light cardio and/or resistance bands. 

6. Strengthen Supporting Muscles: Work on strengthening the muscles around the knee, including the quadriceps, hamstrings, and hips. Muscle imbalances can contribute to knee pain. 

7. Ice and Rest: Apply an ice pack to the affected area to reduce inflammation and assist with pain relief. Give your knees time to rest and recover before attempting squats again. 

8. Consider Professional Guidance: If the pain persists, consult with a qualified professional. They can assess your situation, provide guidance on proper exercises, and recommend a rehabilitation plan if needed. 

9. Avoid Overtraining: Give your body adequate time to recover between squat sessions. Overtraining can contribute to muscle fatigue and increase the risk of injury. 

10. Listen to Your Body: Pay attention to your body's signals. If the pain persists or worsens, it's crucial to seek professional advice to rule out more serious issues. 

(a) Knee Pain When Squatting: Causes, Treatment & Prevention (knee-pain-explained.com)
(b) Muscle Imbalance: Causes, Treatment, and Prevention (healthline.com)