How To Squat Correctly
Learn how to avoid adding pain to sore knees caused by arthritis by following simple steps for proper squatting and building strength.
Learn how to properly squat and build leg strength to avoid added knee pain.
Squatting is a functional move. It helps you do activities in your daily life, such as getting pots out of a bottom cabinet or picking up shoes off the floor. Squatting also helps build strength in the legs and hips, and stronger muscles mean more stable joints.
But if you dont squat correctly, it can be painful to sore knees. Too many people compensate for sore knees by bending over at the waist, which can lead to a sore back, says Cynthia Harrell, physical therapist and clinical coordinator of the arthritis and osteoporosis programs at the Duke Center for Living at Duke University in Durham, North Carolina.
The Right Way to Squat
For example, when you go to reach into a low cabinet hold on to the countertop and sit down, using the muscles in your arms and buttocks for lowering and pulling yourself up. If squatting this way is still painful, place a chair in front of the cabinet or area where you need to pick something up. Reaching to the floor from a seated position is much less stressful on the knees, says Harrell. Build Strength with Wall Squats
1. Stand with your back flat against a wall. Feet should be shoulder-width apart and heels 18 inches away from wall. Keep knees in line with heels, not out in front of toes.
Arthritis Of The Knee
Arthritis causes the joints to become painful and inflamed. Different types of arthritis can affect almost any of the joints in the body, including the knee.
Cartilage is the flexible, firm tissue that surrounds the joints and enables them to move smoothly. Osteoarthritis develops if this cartilage breaks down.
People with knee osteoarthritis may experience pain and swelling around the knee and feel as though the joint is stiff.
Osteoarthritis is most common in people over the age of 65 years.
Rheumatoid arthritis is an autoimmune condition that affects joints all over the body. The immune system attacks healthy tissue surrounding the joints, causing pain, swelling, and stiffness.
Post-traumatic arthritis can happen after an injury to the knee that damages the joints or ligaments. If an infection spreads to the knee, it can cause infectious arthritis of this joint.
What Causes Quadriceps Tendonitis
A majority of quadriceps tendonitis injuries are due to overuse from playing sports such as volleyball, running or soccer. Quick turns, starts, stops, jumping and running contribute to quadriceps tendonitis. Other factors that contribute to quadriceps tendonitis: Excessive frequency, intensity or duration of training.
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How Do I Fix Pain Above My Knee
To help relieve your pain and speed recovery, you can: Rest your knee. Ice your knee to ease pain and swelling. Wrap your knee. Elevate your leg on a pillow when you sit or lie down. Take NSAIDs, if needed, like ibuprofen or naproxen. Do stretching and strengthening exercises, especially for your quadriceps muscles.
Get Rid Of The Obvious Suspects
Squats do not cause knee pain all by themselves, but bad squats or squats overdone may. Assuming you are not engaged in high-rep, high-impact activities, the first and most obvious suspect for knee pain from squats is your form. If you are low bar squatting, there are two main issues you want to eliminate from the lineup of possible problems. The first is not bending over enough during the descent. The second is leading upward with your chest from the bottom of the squat.
Not bending over enough when during the low bar squat causes a lifters knees to shift forward near the bottom of the movement. When the knees shift forward, the bar moves forward. When the bar moves forward, the lifters weight shifts toward the toes. A coach, seeing someone who complains about knee pain, who is also trying to low bar squat with a vertical torso, will likely address that form issue before making other changes to the persons lifts or programming.
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Front Of Knee Pain With Running Or Squatting We Can Help 6 Tips To Get You Back To Your Physical Best
In most cases anterior knee pain when running or squatting is the result of patello-femoral joint syndrome.
Patellofemoral pain syndrome is one of the most common knee complaints we see here in the clinic.
Its the umbrella term for pain felt behind your kneecap, where your patella articulates with your thigh bone . This joint is known as your patellofemoral joint.
Patellofemoral pain syndrome is the result of excessive pressure between your knee cap and thigh bone from poor patellar alignment, which over time affects the joint surface behind the kneecap and leads to dysfunction and difficulty participating in the things you love.
The Next Step: Changes To Exercise Selection
There are two ways to change your exercise selection when it comes to squatting. First, if you are high bar squatting and experiencing knee pain, consider learning how to low bar squat instead. At the same weights, the low bar squat takes some of the moment force off of the knee, making it a little bit more knee-friendly movement. That is not to say high bar squats are bad for your knees, but if you compare a well-executed high bar squat with a well-executed low bar squat , the low bar squat will show a more knees-back position at the bottom and a more bent over torso. The low bar squat puts more of the work on the bigger muscles that extend the hip, shifting some of that work from the knee extensors. Patellar tendonitis or some form of knee pain that increases with mechanical loading of the knee may improve from the switch to low bar. Making this change, you should give it a little bit of time before deciding whether it worked for you.
The other way to change your exercise selection is to choose a supplemental lift that might take some of the mechanical loading off of your knee, either for the short- or long run. Two options for this are the box squat and the pin squat.
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Is Squatting Good For Your Knees
Just like the muscles in your legs, the passive structures within your knee all have the capacity to adapt and become stronger. As you gradually expose them to increasing loads over time, they get stronger, making them less prone to injury.
For this reason, the squat one of the best exercises on the planet for improving knee joint health.
However, there are a few caveats around this:
1) Your exercise technique needs to be sound2) The increases in load must occur in a gradual and safe manner
Understanding The Biopsychosocial Modelof Pain
There are many factors at play that could be causing your knee pain, and using the biopsychosocial model is one way to dissect why your knee is causing you pain.
- From a biological perspective, the most obvious is having some type of physical trauma as tearing your ACL , which is a ligament that prevents anterior displacement of your patella. Furthermore, something mechanical can be causing your pain such as issues with knee tracking, patellar tendonitis, or perhaps you may even have an impinged nerve in your lumbar spine resulting in a radiculopathy causing referred pain in your knee.
- From a psychological perspective, your own beliefs and perceptions of pain could be affecting your pain experience. For example, if you associate that you hurt yourself squatting, you believe that squatting will cause you more pain when you do so.
- From a social perspective, your environmental factors can be causing you stress. For example, perhaps you got a new job that entails more physical exertion or your family is going through some trauma. This can all affect your pain experience and what you feel when squatting.
The point is, pain is multifactorial and subjective, so focusing solely on pain is a slippery slope. Furthermore, where you feel your pain may not be where the problem is like the example with lumbar radiculopathy .
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Does Quadriceps Tendonitis Go Away
While anyone can get quadriceps tendinitis, athletes have a higher risk. The repeated movements of jumping, running, and squatting can inflame the quadriceps tendon. Quadriceps tendinitis often gets better within several weeks. For best results, get lots of rest and follow a physical therapists recommendations.
Should I Squat With Knee Pain
As long as youre able to practice with minimal knee joint discomfort, its safe to include squats in your exercise routine. People with arthritis may find the most benefit in wall squats, since squatting against the wall can help reduce your risk of putting unnecessary or incorrect pressure on your knees.
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Where Do You Feel The Pain From A Torn Meniscus
In a typical moderate tear, you feel pain at the side or in the center of the knee, depending on where the tear is. Often, you are still able to walk. Swelling usually increases gradually over 2 to 3 days and may make the knee feel stiff and limit bending. There is often sharp pain when twisting or squatting.
How Do You Strengthen The Outside Of Your Knee
Quad sets Sit with your affected leg straight and supported on the floor or a firm bed. Place a small, rolled-up towel under your knee. Tighten the thigh muscles of your affected leg by pressing the back of your knee down into the towel. Hold for about 6 seconds, then rest for up to 10 seconds. Repeat 8 to 12 times.
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Are Squats Bad For Your Knees
For a deeper dive into the mechanics and physiology of squats and knee pain, check out this article by DPT and Barbell Logic Coach, Liz Zeutschel.
If you struggle with getting the full range of motion your squat, check out some tips here.
And view the rest of our Before Barbells Playlist for some more beginner movements.
Still experiencing knee pain when squatting? Sign-up for a free form check and have one of our coaches help you out.
Carlesso, Seal, Frey-law, Zhang, Na, Nevitt, Lewis, and Neogi, Pain Susceptibility Phenotypes in Those Free of Knee Pain With or at Risk of Knee Osteoarthritis: The Multicenter of Osteoarthritis Study, Arthritis & Rheumatology, vol. 71, No. 4
Mitchell, J., On the Means of Discovering the Distance, Magnitude, & c. of the Fixed Stars, in Consequence of the Diminution of the Velocity of their Light, in case Such a Diminution Should be Found to Take Place in any of Them, and Such Other Data Should be Procured from Observations, as Would be Farther Necessary for that Purpose, Philosophical Transactions of the Royal Society, 74, 35-57
Montgomery, Orchiston, Whittingham, Mitchell, Laplace and the Origin of the Black Hole Concept J. or Astro. Hist. & Heritage, 12, 90-96
Sanchis-Alfonso, Vicente, Pathophysiology of Anterior Knee Pain, in: Zaffagnini S., Dejour D., Arendt E. Patellofemoral Pain, Instability, and Arthritis, Springer, Berlin, Heidelberg
What Causes Pain In The Knee When Squatting
There are several possible underlying causes of knee pain when squatting. Patellofemoral Pain Syndrome , has been called The Black Hole of Orthopaedics because its mechanisms are not consistent from person to person . PFPS accounts for most of what we think of as patellar tendonitis due to acute injury or overusesometimes called runners knee, jumpers knee, or anterior knee pain. Osteoarthritis is the most common cause of knee pain in adults over 50 years old. And bacterial infection rounds out the big three causes of chronic knee pain. The problem is that pain does not always neatly line up with one of these causes clearly or suggest an easy treatment by its presentation.
You can get imaging and professional help, but as Coach Jayson Ball mentioned in the Barbell Logic Podcast, when it comes to imaging the resolution might not be fine enough to tell you whats happening in the nervous system. And it is in the nervous system where pain lives. As an example, imaging may show the malalignment of your patella and femur, suggesting a risk factor for PFPS, but many people with malalignments experience no pain in their sports or activities . Similarly, some people with osteoarthritis have minimally disruptive pain, while others can only ever expect pain management sufficient to stay active and healthy and will never be without pain or the need for NSAIDs completely if they want to lift .
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What Are Some Common Causes Of Injury
A plain fact of strength training, and really life in general, is that injury and symptoms are always a possibility. But you can hugely reduce the risk of injury by doing the right things.
Nick says: “There are a lot of factors that can contribute to issues related to injuries and knee pain weightlifters may experience during heavy squats.
These include a history of previous injuries or managing current or other injuries and symptoms.
Overuse and overloading is a really common cause of injury too.
Dont underestimate the importance of full-body conditioning either. Your body may not have conditioned or adapted well enough to start adding on the plates!
Biomechanics or poor technique may cause issues too. Especially if there are imbalances or muscle weaknesses. In this instance, the body is weak in one area and therefore the body is relying on other areas to compensate. Also, what is happening with the knees? Are they falling outwards or flexing beyond your toes? Both suggest poor technique, Nick continues.
Flexibility and muscle tightness or being hypermobile may also cause symptoms. Poor ankle dorsiflexion may cause issues as having flexibility in this area is the secret to a good technique and a deep squat. But poor flexibility will lead to more pressure on the knee.
What Is The Goal
The optimal state for training is progress with as little complexity as possibleinducing sufficient systemic and localized training stress to build muscle and get strongerand progress without worsening some underlying condition or causing decommissioning levels of pain. The farther a person is from being a post-pubescent teenager with few of lifes witness marks, those aches and pains from living life, the less likely the person is going to train in an optimal state. But the goal of strength training always remains the same.
We do not know that strength improvements will fix knee pain, but we do know that pain thrives in weakness. The loss of muscle mass and the resulting instability around joints does not make pain better in the long run. The do-nothing, avoidance approach to pain management risks trading short-term, fleeting comfort for long-term pain, frailty, and drug dependence. With training, you are often giving yourself the best chance at bouncing back and mitigating the pain. But setbacks like knee pain requires adjustments.
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Whats Happening In The Knee Joint When You Squat
The squat is a compound exercise involving multi-joint movements which work a high number of muscles simultaneously.
Nick says: The joints needed to complete a squat include the shoulders, back, hips, knees and ankles and engages muscles in the upper and lower back, core, quadriceps, glutes, hamstrings, adductors, calves and more.
Theres basically a lot going on in one movement and its a great test for strength, flexibility and balance all in one.
Nick says that, in his practice, one of the first things he asks his patients to do is to complete a series of squat lifts as he says it reveals a lot about their physical abilities which all contribute towards symptoms.
The knee joint is a complicated structure and is one of the most loaded joints in the body, he says. “Its made up of four bones for mobility articular surfaces and meniscus for joint protection and prevention of friction forces. Its also made up of ligaments and joint capsules for stability.
This make up shows us that the joint was designed to move, bend and squat!
When we squat, the pressure on our knees is approximately eight times our normal bodyweight, and this rises to twenty times during a jump squat, he adds.
During the motion of a squat, the muscles, tendons and ligaments in and around the knee all kick in to help the knee remain in a stable position. This includes many muscles that contract to help with the lowering phase, the lifting phase and the stabilising of the movement.
What To Do When Experiencing Knee Pain When Squatting
Based on the biopsychosocial model of pain, there are several ways that you can modify your training program, technique, and environment, in order to reduce the amount of pain youre experiencing. Once we can rule out that the pain isnt caused by a fracture or tumor, then the goal is to get back to squatting in a pain-free way as quickly as possible.
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Try Box Squats And Sumo Squats
Rather than traditional squats, you can try the slightly modified forms, either box squats or sumo squats to help take stress off of your knees. For box squats, you’ll add a plyometric box behind you during your squat exercise: Slowly lower your body until you’re sitting on the box at the bottom of each squat. “Remember to sit back towards the box,” Hadley advises to minimize knee pain.
Sumo squats, on the other hand, place more focus on your glutes than your quads and hamstrings. “Sumo squats are a variation of a normal squat that are a good alternative,” says Isaac Robertson, cofounder at Total Shape. “Unlike a normal squat, your legs are placed wide apart in a sumo position. Keeping your back straight, sit and go down like a normal squat.”