Knee pain when squatting is a common problem among individuals who engage in strength training exercises. Squats are a commonly implemented exercise for nearly all athletes, powerlifters, bodybuilders, and other physically active individuals since they are highly effective for building lower-body strength, muscle, and overall athleticism.

And since this age-old lower-body exercise is so effective and beneficial, it's worth performing. But that's easier said than done if you have pain or discomfort in your knee. But if your knee hurts when squatting, don't sweat it; it's a surprisingly common issue many lifters face.

Knee pain from squats often arises due to the complexity of the human body and the technical nature of the squat; there are plenty of issues that can arise within the knee, making it painful every time you attempt the movement. Essentially, a lot can go wrong, and there is not much room for error. But you're in luck!

In this article, I'll discuss the common causes of knee pain when squatting and provide my professional expertise as a physical therapist and strength and conditioning specialist for proven ways to prevent knee pain from squats and cover effective treatment strategies to help you overcome this issue and continue with your strength training program safely.

Causes of knee pain when squatting

It may not appear so to the average individual, but the squat is a surprisingly technical movement. And despite the knee looking like a simple hinge joint that bends and straightens, there is much more at play underneath the skin and within the body as it goes through the squat.

For simplicity's sake, I'll break down the common causes of knee pain into two distinct categories:

• Squat technique issues (poor movement control, body positioning, etc.)
• Intrinsic factors within the knee and surrounding tissues.

To be clear, either of these two categories will produce pain within your knee during squats, but the solutions for getting rid of your knee pain will look entirely different depending on what's causing the underlying issue to arise.

Let's start with the form and technique required to keep your knees healthy and avoid knee issues altogether. Then, I'll examine the common issues that can arise within the knee joint itself.

[Related: Knee Noises: Knee Popping When Squatting | Good or Bad?]

Improper squat form and technique

While an entire article could be written on how to optimize, perfect, and individualize your squat technique, doing so is beyond the scope of this article. What follows are the foundational aspects that must be considered and implemented for any lifter or athlete looking to keep their knees safe and pain-free during the squat.

Optimizing your squat stance for improved knee mechanics

The most important aspect to understand with squat technique is that, while there are general guidelines to follow, every lifter will need to experiment with fine-tuning their squat stance to determine what feels best for their knees.

Two primary factors should be considered for your squat stance:

• The width of your stance (how far apart your feet are from one another);
• The degree of toe-out or "flare" you have (whether your toes point directly forward or in a slightly outward direction).

Despite what others might advocate, taking a strictly dogmatic approach with stance width and toe positioning isn't ideal. That's like saying everyone needs to eat the exact same diet; our skeletal structures are different enough that what works for one lifter might not work for another. Proper squat form can be a highly individualized concept.

Changing either of these factors can drastically change the biomechanics within the knee, influencing your knee pain for better or worse.

As a general rule, your squat stance should be roughly shoulder-width, and a slight outward pointing of your toes will get you in the ballpark of what's most commonly utilized for the squat. But don't be afraid to play around with either of these factors.

As an additional point of insight: don't let your heels lift off the floor when squatting – this will place unnecessary stress on the front of the knee, including the quadriceps tendon and the patellar tendon.

Ensuring perfect knee-tracking

Setting up in an ideal squat stance is only half the battle – the other half is ensuring your knees stay in ideal alignment throughout the entire movement. After all, the perfect squat stance won't do anything to prevent knee issues if your knees move into a poor position during the exercise.

For this article, "knee tracking" refers to preventing your knees from caving in or collapsing inward, which is referred to as a valgus knee position. You may often hear lifters refer to knee tracking as maintaining an ideal "stacked" position or "alignment."

Your goal throughout the entire squat is to keep each knee stacked directly above the top of its respective foot. If your knees cave inwards (a common squat error), they'll no longer be stacked directly above, which leads to nasty amounts of torque and stress within the knee joint itself.

Finding your perfect squat depth

One overlooked aspect of pain-free squatting is the depth to which the squat is taken. While squatting through a full range (deep squats) can have certain training benefits, it may be that your knees won't tolerate undergoing such an extensive range of motion (known as knee flexion), especially when squatting with heavy weight. Larger ranges of motion during the squat can cause knee pain for lifters with certain tendon issues (discussed later in the article) or previous knee injuries.

As a result, you'll need to take the time to experiment with optimal squat depth to determine what feels best for your knees.

Orthopaedic conditions arising within the knee

With technique-induced knee pain issues having been discussed, let's now look at what can specifically happen within the knee itself that can make it painful to squat. There are numerous structures and tissues within the knee, which means that many potential issues can arise. And while I can't cover every knee condition, I will discuss the most prevalent issues that painful knees can be afflicted with when squatting.

Muscle imbalances within the thigh

There are numerous muscles within the thigh (the front of the upper leg). For the knee to move in an optimal state and without pain, a balance of strength and mobility is required across each one. It's very common for some muscles within the thigh to become stronger or weaker than their counterparts, often referred to as muscular imbalance. The goal is to keep each muscle that crosses the front of the knee strong and mobile, which helps create optimal knee movement and function.

Think of this like the tires on your vehicle; if some are under-inflated while others are over-inflated, it will lead to steering and alignment issues when driving and even abnormal wear on your tires. The same concept holds true for knee tracking when squatting; if your kneecap (the patella) can't track properly due to abnormal muscular tension, it can lead to issues such as patellofemoral pain syndrome (PFPS), where the cartilage and surrounding kneecap tissues become irritated and painful.

Mobility issues in your ankles or hips

Limited ankle or hip mobility can place excessive stress on the knees when squatting. When the ankles or the hips lack the mobility to move through their full range of motion, compensatory movements can occur at the knee, which can cause discomfort or pain in the knee during the squat. Ankle and hip mobility exercises designed to target and improve restricted movement can help improve ankle range of motion and alleviate knee pain.

Knee osteoarthritis and knee arthritis

Like any other part of our body, the knee is prone to wear out or break down as we progress throughout our lives. There are numerous ways in which these breakdowns can occur, and the most common degenerative condition within the knee is known as osteoarthritis. This refers to the breakdown of cartilage that sits on the end of the thigh bone (femur) and the shinbone (tibia), where these joint surfaces interact with each other.

When this breakdown occurs, the knee often becomes painful when moving (since the cartilage is no longer smooth) or when moving against heavier resistance since the unhealthy joint is now being compressed.

As such, squats can be very painful for arthritic knees. The extent of knee pain experienced and when knee pain arises will largely depend on the extent of arthritic change within the knee.

Patellar tendonitis and knee bursitis

Tendons and bursas are two specialized pieces of tissue that help the body function efficiently and painlessly. A tendon is a piece of tissue that anchors the end of a muscle onto a bone. A bursa is a small, liquid-filled sac that helps to reduce friction in joints by allowing tendons and similar structures to slide and glide without irritation arising.

The body is filled with hundreds of tendons and bursas, with the knee containing a few that are critical to healthy, pain-free knees. Particularly, the two tendons that can become painful are the patellar tendon and the quadriceps tendon. This can lead to painful conditions known as tendonitis or tendinosis.

For bursas, the pre-patellar bursa and the pes anserine bursa can often become irritated and painful, leading to a condition known as bursitis (inflammation of the bursa).

Both of these issues, while common, can be tricky to resolve at times without guidance from a qualified healthcare professional, so seek advice from a qualified professional if you suspect your knee pain is from either of these issues.

Previous injuries affecting knee function

Previous knee injuries often lead to dysfunctional and painful movement within the knee. The reasons for this occurring are far beyond this article's scope. Still, it's worth knowing that injuries can alter movement within the knee joint or even prevent the knee from moving. And, as you're likely aware, altered movement or function can create pain within the knee.

While the knee can experience a near-infinite number of injuries that lead to this circumstance, injuries involving the meniscus are arguably the most common.

The meniscus is a ring-like piece of fibrocartilage that sits between the knee joint. Each knee has two of these shock-absorbing structures that are integral for optimal knee health. A torn (traumatic injury) or degenerative meniscus (age-related) can lead to mechanical changes within the knee, and they're often quite painful, producing sharp, pinching-like sensations when the knee is bent or straightened.

If you suspect you have a meniscus tear or have any other knee injury, it is crucial to consult with a sports medicine specialist or orthopedic surgeon for proper diagnosis and treatment.

Prevention and treatment strategies for knee pain

A comprehensive approach is necessary to prevent or alleviate knee pain when squatting. Let's explore some effective prevention and treatment strategies:

Strengthening exercises for thigh muscles and muscle imbalances

Targeting the quadriceps and addressing muscle imbalances is crucial for preventing knee pain. Various quadriceps and patellar tendon exercises can help strengthen these muscles and stabilize the knee joint. Additionally, engaging in overall thigh muscle-strengthening exercises, like squats without weights or lunges, can help correct muscle imbalances.

Proper squatting form and technique

Many patients, athletes, and gym-goers I treat and work with are surprised how the nagging or annoying knee pain they experience when squatting can be drastically reduced or even eliminated by cleaning up their squat technique. Small positioning changes can produce profound effects on knee mechanics and knee pain.

Adopting proper form and technique is essential for preventing knee pain when squatting. Take the time to ensure your technique is absolutely on point. Whether you video yourself and watch your performance or hire a trainer to help you, do what it takes to squat with perfect technique for what your body needs.

Ankle and hip mobility exercises

Improving ankle and hip mobility is vital in preventing knee pain when squatting. Regularly incorporating movements and mobility drills can enhance the range of motion for your ankle and hip, thus reducing the compensatory movements at the knee during squatting. If you know you have an ankle or a hip that isn't moving as much as it should, make a dedicated effort to improve any limitation in movement, as a stiff joint above or below your knee can influence how your knee moves during the squat, often leading to knee pain.

Physical therapy interventions

Physical therapy can be incredibly beneficial for individuals experiencing knee pain when squatting. A physical therapist can prescribe specific exercises, movements and stretches tailored to your needs. They can also help reduce your pain and reduce or resolve the underlying issue with special therapeutic modalities and manual (hands-on) techniques. They can also help you know when to see a doctor and work with them for additional interventions.

Additional considerations for squatting with knee pain

In addition to the prevention and treatment strategies mentioned above, here are some additional considerations to keep in mind when squatting with knee pain:

Proper warm-up and tissue preparation

Engaging in a thorough warm-up and knee tissue mobilization can reduce the risk of injury and alleviate knee pain. An ideal warm-up sequence to keep your knees pain-free before a squat session is:

1. Mild-intensity cardio (such as riding a bike) for five minutes.
2. A sequence of dynamic stretches for the muscles in your legs.
3. Tissue mobilization around your knee, such as a quick foam rolling session of your quads, IT band, and calves.

A brief warm-up sequence such as this will go a long way to ensure your knees are moving well and prepared for your upcoming squat workout.

As an additional strategy, you may want to consider wearing knee sleeves when squatting since they can help retain warmth within and around the knee during your workout. Many lifters (including myself) find this to be a helpful strategy that feels good on the knees.

Modifications in exercise intensity and volume

If you experience knee pain when squatting, modifying the intensity and volume of your workouts may be necessary. Volume refers to the overall amount of work that you perform within your training session. You can calculate your training volume and adjust things accordingly if needed.

Volume = sets x reps x weight lifted

Reducing the weight, the number of repetitions, or the number of sets you perform will reduce your training volume and can alleviate strain on the knees while still allowing you to engage in strength training. Gradually increasing the intensity as your knee pain subsides is crucial to avoid re-injury.

Alternative squat variations to reduce knee discomfort

Sometimes, the knee just isn't willing to tolerate squats. Nearly every lifter goes through a season like this at least at one point in their lifting pursuits. I've been there myself plenty of times throughout my years of lifting. If you're in this season, don't worry – there are plenty of other highly beneficial leg exercises you can experiment with that your knee might favor.

Take some time to explore alternative leg exercises or squat variations. There are plenty of outstanding resources online that can expand your training horizons by showing you new ways to train and strengthen your lower body without lighting up your knees in the process.

Importance of rest and recovery for chronic knee pain

Whether your knees are healthy or painful, adequate rest and recovery must always be prioritized. However, If you experience acute (new) or chronic knee pain (pain that has been around for a while) when squatting, you need to be extra diligent with all facets of your rest and recovery. Continuing to train through persistent knee pain can exacerbate the issue and lead to further complications.

As a starting point, you'll want to consider:

• Ensuring ideal training volume (sets, reps, & weights) used for your squats;
• Adequate recovery time before your next squat or lower-body training session, likely no sooner than 72 hours after your previous squat workout;
• Dialing in your nutrition, ensuring you're eating enough macronutrients (fats, proteins, and carbohydrates) and micronutrients (vitamins and minerals) to help your body build and repair sore or irritated tissue;
• Prioritizing cool-down and recovery tactics such as foam rolling, mobility drills, and massage.

Each of these points can be a step in the right direction for ensuring you don't overload your knee in a manner that causes pain or discomfort while also ensuring it stands the best chance possible for recovering from any stress or strain it may be experiencing.

Conclusion

Knee pain when squatting can present a significant obstacle to individuals in strength training. Understanding the causes, prevention strategies, and treatment options is essential for overcoming this issue and continuing your fitness journey safely. By addressing muscle imbalances, improving squatting form and technique, enhancing ankle mobility, and seeking professional guidance and support, you can prevent knee pain, promote safe squatting practices, and effectively achieve your strength training goals.

Remember, listening to your body and seeking medical attention if knee pain persists or worsens despite your efforts is crucial. Stay motivated, make the necessary adjustments, and enjoy a pain-free squatting experience.