The definitive guide to knee pain during squats.

You are sitting there nervous, calculating your next move. You have been here before so you already know how this story ends. 

You eyeball your surroundings. Now seems like the most opportune time to make your move. 

You start to stand up from your seat and there it is. 

Your nemesis. 

Knee pain. 

It almost causes you to have to sit back down but you power through and make it up to a standing position. 

As you stand, there is part of you that feels like you just climbed Mt. Everest. Triumphant. Victorious.

The other part of you wonders how the hell you have so much pain when standing up.

Or, in an alternate reality, you are heading to the gym, because that used to be a thing, and it is leg day.

Squats are on the menu.

But, there is guarded optimism. The last few times you squatted you had some knee pain. Maybe it was just a fluke.

Yeah. Just a fluke. All of the other times you had knee pain.

You get warmed up and get into your sets and your old friend makes an appearance.

Your knee pain grinds your workout to a screeching halt. 

You were only around half of your maximum weight. What is going on?!

Knee pain during squats is pretty common. Many people also state that squats hurt their knees. 

Could this be true? Are squats bad for your knees?

Probably not. In most cases, there are plenty of things you are doing wrong that are contributing to your knee pain. 

So the good news is that squats are not inherently bad. 

And for the record, squats and sitting and standing are basically the same movements, so when I refer to one, it kinda implies the other. 

Let’s dive deeper and break down why you might be having knee pain when you squat. 

Intro

Before we go too far, if you are having knee pain through the entire squat (top to bottom and bottom to top), jump down to the next section, which is about deloading.

If your knees still hurt during the deload, the rest of these ideas are not going to be overly helpful at this juncture.

You need someone to evaluate your knees a bit more and make sure the knees are ok. It is possible that they are ok but your technique is so bad that it needs a major overhaul. 

It is also worth noting that these strategies work best for chronic pain. You know, the kind that seems to start for no reason and build over time.

If you recently hurt your knee, and you know why you hurt it, these strategies are not for you. At least, not yet. 

Deloading your squat

If you have knee pain during a squat, the first thing I would encourage you to try is deloading the movement. 

Deloading uses something, usually a band or pulleys, to assist the motion. Basically, it makes the squat easier. 

Why does this matter?

Deloading helps to both assess the motion and works to retrain the movement. If you find any of the issues that follow, they can start to be corrected while deloading the movement. 

Deloading also gives you more information about your knees.

In general, if your knee pain goes away during deloading, your knees are probably not the primary issue. 

If the pain decreases or goes away during the deload, the issue is usually more muscular or movement-based. 

As I mentioned earlier, if the pain persists during the deload, I would encourage you to get evaluated by a qualified clinician. 

Check out the video to see how deloading can help.

Bottom of the abyss

Sometimes when you squat, you only experience pain in the bottom part of the motion. Welcome to the bottom of the abyss. 

What in the world does that mean?

Knee pain when you hit the bottom of the squat could be from a few different causes. 

Most often it is the result of a poor transition. You probably lose tension as you move from the bottom positions and start coming back up. 

A poor transition also shows up as weight shifting onto your toes when you hit the bottom and start your movement back up. 

Basically, you end up bouncing out of the bottom, which is less-than-desirable.

To remedy this, control your descent. Do not just drop.

Really focus on keeping tension at the bottom. To do this, pause just for a second at the bottom to ensure you are in the right position and are able to maintain your tension. 

This will probably require you to drop your weight so that you can focus on your technique. This will be a temporary sacrifice. 

Check out the video to see how to improve your transition.

Are you really 50/50?

What happens if you have knee pain in only one knee?

Your transition is still something to look at but often there is a weight shift present. This could be caused by an old injury, weakness, and/or tightness. 

A lot of people shift to one side when they squat and they have no idea they are doing it. Most people assume they have 50% of their weight on each leg but for most, this is not the case.

Weight shifting is tricky to fix because you probably have no idea you are doing it. You will have to employ a bunch of strategies at once. 

You will probably have to cut your weight. You will probably have to do fewer reps. You will have to pay attention to when in the movement you shift.

You will probably have to deload the movement to help control the shift. 

Sometimes the weight shift will happen only when the load is heavy. It is easy to allow this to happen because the weight was heavy.

That is flawed logic. If your technique falls apart at a certain weight, THE WEIGHT IS TOO HEAVY.

Check out the video to learn more about weight shifting during squats.

Like a ton of bricks

Do you know someone that falls back onto a chair or the couch every time they sit down?

Do you know someone that tends to tip backward when they are squatting and always feel like they are falling?

The bad news is that is not a good way to sit or squat.

The good news is that it is really easy to fix. 

The issue is that you are getting your torso too vertical which causes you to fall back. This issue has very little to do with strength and has more to do with physics. 

Once your torso gets too vertical, you will fall back. You also limit the ability of your glutes (butt muscles) to contribute to the motion.

This is one of the reasons why doing squats with a ball behind your back or smith machine squats are not great options. 

Ball squats = meh.

Smith machine squats = meh.

One of the focuses of your squat should be digging your heels into the floor and sitting back through the hips.

This should create a forward lean of you trunk through the hip joint. This will allow you to maintain your balance throughout the entire squat. 

Check out the video to see how the vertical torso impacts your squat.

Going to low, low, low

Another reason that squatting can cause pain in your knees is due to a reason that is completely avoidable.

Squatting too deep for what your body will allow is like playing with fire, scarecrow.

Squat depth is highly variable from person to person and one of the reasons your squat may be limited is due to something you have no control over.

Your skeleton.

Bonjour.

Your hip anatomy is one limiting factor in terms of how far down you can squat.

Performing a bodyweight squat where you sit all the way down is very different than when you squat deep with some kind of external load. 

Do not let any knucklehead force you to squat deeper than your body will tolerate. 

Find a depth that is comfortable for you. One of the ways to do this is to squat to a box or a bench or something. 

It is not uncommon to gain depth after improving your overall squat mechanics. And this improved depth does not come with a breakdown in your technique

Check out the video that shows how to manage finding a proper squat depth.

Wide. Narrow. In. Out.

Just like forcing squat depth is a completely avoidable problem that can cause knee pain, this next problem is also completely avoidable.

Have you ever noticed that you find a certain hip or foot position to be more comfortable, just in general?

This is not some sort of accident. 

Just like your squat depth is, in part, limited but your skeleton, the foot and hip position you find most comfortable is partly dictated by your skeleton.

Some people will find squats more comfortable with a wider stance. Some more narrow.

Others will like their toes turned out slightly. Some prefer their toes to be pointing straight ahead.

All of them are correct. 

Forcing yourself to squat from a position that is uncomfortable from the setup is never going to feel good and you will always have a hard time progressing with the exercise. 

As you work to find the right depth, work on finding the best hip and foot position for you. If someone else tells you that you MUST squat a certain way, they are an idiot. Do not listen to them.

Check out this video on hip and foot position.

Squatting in high heels?

Imagine trying to squat while wearing high heels. Go ahead and imagine. I’ll wait.

If you think it looks ridiculous and dangerous, you would be absolutely correct. 

When your heels come off the ground, you basically shut off your glutes (butt muscles) and put a ton of stress on your knees.

The position is also when your ankle joint is the most unstable due to the laxity of the ligaments. 

This is not a position to try and squat from, especially if you are squatting with weight of any kind.

So why does this happen? There are two culprits for this.

The first one is that your ankles are so stinking tight that they cannot move through enough motion without the heels coming up.

This is not good.

But it is pretty easy to diagnose. The video will explain how.

The second issue is your poor ability to execute a proper hip hinge. If you fail to get your weight back through your hips your weight will shift forward from your heels onto your toes. 

As we have already discussed, this is so not cool.

Check out the video that will break down why squatting in high heels is a poor choice. 

Back squats

I wish I could have put some powerful classical music to the header. Lots of strings. Booming drums.

A true royal introduction. 

Back squats are one of the oldest and most storied exercises of all time.

Getting under the bar and squatting until you pass out or someone else had to help you stand back up seems like some primitive rite of passage for lifters.

It is thought to be a total-body muscle-building movement. 

It is a good one no doubt. 

But is it good for everyone? Actually, no.

You see, the back squat requires some prerequisite mobility just to get under the bar that not everyone has. 

Like we have talked about with the squat in general terms, forcing the movement is not the way to go.

So, force-feeding the back squat is a surefire way to need a physical therapist, not a personal trainer. Thankfully, I do both.

In addition to the problems we have talk about so far, I offer a simple test to see if you should be doing back squats.

If you cannot do this simple test, I would skip to the next section for some back squat alternatives.  

Check out the video to see what this simple test looks like. 

Back squat alternatives

As majestic as the back squat is, it doesn’t work for everyone. 

That’s ok. It does not diminish its status as king of the iron jungle. 

So how do you load up your squat if you cannot back squat with a bar? Easy.

Here are three options to work around your back squat blues.

Front squats - the difference between front and back squats starts with the bar position (in back of the head and in front of the head). 

The bar setup takes some getting used to but this is a great option for getting under the bar if you cannot get into the back squat position. The video below will go into more detail.

Yoke bar squats - if you have never had the pleasure of using a yoke bar, you really are missing out.

You get all the benefits of the back squat but with a more favorable arm and shoulder position. 

The one difference with the yoke bar is that it likes to drop down so you need to keep some upward pressure the handles as you squat. The video below will go into more detail.

Goblet squat - the goblet squat is the first progression I use with my clients after they understand how to perform good bodyweight squats. 

Do not look at goblet squats as only a beginner’s movement. 

You can load it up pretty heavy and there are some other advanced progressions to have your quads singing a tune of fiery betrayal. 

The video below will go into more detail.

Big knee wrap up

If you were having knee pain during your squats, you should now be equipped to tackle it head-on and be able to squat pain-free in no time. 

First, try to assess where you are and what steps are going to be the best for you to start.

Trying to fix five things at once is going to prove to be frustrating. 

Start with the deload and definitely squat to a box, a bench, or anything you have handy. 

Go slow with the movement and cut your weight temporarily. I know that may sound blasphemous but it is going to help you make the necessary corrections to your squats. 

As always, if you have questions or need some help breaking down your squat, reach out to me via the CONTACT PAGE, on FACEBOOK or INSTAGRAM.

Until next time,

Dr. Tom