3 Reasons Your Knees Hurt During Squats

Working with high school athletes, I hear a lot of excuses. “My dog ate my homework.” “I forgot to eat breakfast this morning.” “My boyfriend broke up with me so….” And most times my response is, “Excuses are like butts, everybody has one and they all stink.” In the fitness world you hear a lot of excuses as to why one can’t do squats.

I have a bad back so I can’t squat

My hemorrhoids are flaring up so I can’t squat.

Me knees hurt when I squat so I don’t do them.

One of those three excuses I won’t touch with a ten foot pole, but I will tackle the knees excuse. Now if you have been diagnosed with arthritis of the knee or some sort of other orthopedic injury that limits your ability to squat then I won’t judge you. But I will add that most knee pain while squatting can be cured, through proper execution of the lift.

Here are 3 reasons your knees hurt during squats and how to fix them!

Squatting through your knees

It’s story time kids! During my years working as a college athletic trainer there was an exceptionally athletic men’s basketball player. He had a vertical jump that I could only fantasize about. And when I say he had bounce, his second and third jump when fighting for a rebound were often times as impressive as his first jump. He had hops that many NBA players dream about.

One day he walked into our athletic training room looking frustrated. “Mitch, my knees hurt when I squat.” Now mind you at the time this institution did not have a strength coach to teach and correct form so our athletic training staff had to play a bit of a dual role. I asked the young man to show me his squat and my knees immediately begin to scream upon watching him “squat”. His weight shifted forward, knees shot forward, and he began to come up on his toes. His “squat” looked more like a knee bend than a squat.

His form put a lot of force and stress through his knees. Specifically his patellar tendon and patella(knee cap) were taking an absolute beating. Not surprisingly after teaching him proper form, guess what?? His knees felt like new! It wasn’t an immediate fix but through practice he soon became a pretty good squatter for 6’5″.

No matter the style of squat you prefer (front, back, high bar, low bar, etc.), your performance depends on the bar or center-of-mass remaining over your base of support. If the COM moves to far backwards, you’ll tip backwards and end up on your back. Your COM moves forwards and your knees begin to scream or you end up on your face.

Squat Variations
Notice that no matter the variation, the center of mass stays over the midfoot

How to fix:

  • Squat should begin with a “break” of the hips
  • As hips sit back, work to sink butt between feet.
  • Center of gravity over the mid foot.

Below is a video showing a forward weight shift(first two reps) compared with a “break” of the hips to initiate the lift.

Stiff ankles

Mobility is affected through two different mechanism: muscle stiffness and joint restriction. Muscle stiffness, or tightness, is ability or inability for a muscle to lengthen. Muscle pliability can be altered due to acute injury, overuse, or imbalances. Joint range of motion can also cause a lack of range of motion within a joint. Previous injury, surgery, and immobilization can create restrictions in joint range of motion.

For proper squatting mechanics and form the ankles must be mobile, especially in dorsflexion. Stiff ankle can cause a forward weight shift causing the “squatting through the knees” described earlier. When a joint lacks the range of motion to complete a task, joints above and below must compensate to get the job done.

How to fix:

There are two issues to address when it comes to working on ankle mobility, joint restriction and soft tissue restriction. Joint mobilizations are the weapon of choice when trying to correct joint restriction and the kinematics of the joint. Soft tissue work like foam rolling, stretching, and massage can help in “releasing” the muscles. For the ankle we primarily focus on the often tight gastrocsoleus complex or the calves. The calves are made up of two muscles: the gastrocnemius, or the larger muscle that we think of when we see the muscle, and the soleus which is deep to the gastrocnemius. Here are two calf stretch variations and an ankle mobilization to utilize to increase ankle mobility.

Pre-workout ankle mobility

30 Knee Drives

3×30-40 sec straight-leg calf stretch

3×30-40 sec bent-leg calf stretch

Soleus Stretch: passive dorsiflexion with bent knee
Soleus Stretch: passive dorsiflexion with bent knee
Passive dorsiflexion with straight knee.
Passive dorsiflexion with straight knee.

Knee Drive: Ankle Dorsiflexion Mobilization

 

Bambi Knees

Topic Of The Day: Knee Control! This video shows 3 different lifters with 2 completely different levels of knee stability. The first lifter shows very poor knee control. Poor technique like this sets the athlete up for injury. Period. Coaches need to keep an eye out for this type of movement. An athlete moving this bad NEEDS to be stopped from further barbell squatting. There is no such thing as a beneficial knee collapse. A knee collapse will lead to harmful forces to the knee joint. This collapse is also mechanically inefficient. It’s a lose-lose situation. The second 2 athletes show great knee control. During their entire squat their knees track in good alignment with their feet. This is ideal technique. It's mechanically efficient & allows their body to move tremendous weight in a safe manner. As a coach, if you see someone lifting with poor technique, stop them. Work on fixing their technique. Until that athlete is able to show good technique, don’t load up the bar. Lifting heavy weights poorly will make you stronger. However, it will make you stronger in the wrong way by reinforcing poor technique. It’s time to teach our athletes that it doesn’t matter how MUCH they can squat, if they can’t squat WELL. While technique perfection is something most of us will never achieve, we should always strive to attain it. _________________________________ Squat University is the ultimate guide to realizing the strength to which the body is capable of. The information within these pages are provided to empower you to become a master of your physical body. Through these teachings you will find what is required in order to rid yourself of pain, decrease risk for injury, and improve your strength and athletic performance. _________________________________ #Squat #SquatUniversity #Powerlifting #weightlifting #crossfit #training #wod #workout #gym #biomechanics #exercisescience #fit #fitfam #fitness #fitspo #oly #olympicweightlifting #hookgrip #squatfail #functionalmovement #biomechanics #exercisescience #physicaltherapy #sportscience

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Looks like it hurts right??? Even I got a tad bit queasy seeing this the first time, and I have seen a few gruesome injuries in my time as an athletic trainer. This is what we in the sports medicine and fitness world call valgus knee collapse. This occurs because of hip addition and internal rotation causing the knees to cave in during descent(most common) but also see during ascent like seen in the video from Squat University.

Why is this bad? First, this is a mechanism for an ACL injury. These mechanics over time can also lead to overuse injuries. Due to the increased valgus angle of the knee the patella, or knee cap, will be pulled laterally. This can create uneven pressures on the back side of the knee cap and causing pain due to wearing down of the underside of the knee cap. The IT band can also become painful because of its path over the greater trochanter of the hip with increased tension on it due to the hip adduction.

This knee valgus occurs primarily for two reasons; weak hips and over pronation of the feet. Overpronation is a collapse of the arch in the foot which leads to internal rotation of the lower leg which creates compensation up the chain. The hip internal rotates and adducts adding to the knee valgus collapse. Below is a diagram for you visual learners

Overpronation of the foot during squat

How to fix:

The cure for overpronation of the foot during squats is achieving an active foot versus a passive foot. A passive foot will collapse creating a “flat foot” leading to compensation up the chain. An active foot will help fight overpronation of the foot as well as turn on the hips(which will often fix muscle control of the hips). To achieve an active foot the goal is to create a tripod of pressure points with the foot. The pressure should be evenly distributed between the heel, the head of the 5th metatarsal(pinky toe), and the head of the 1st metatarsal (big toe). This will help fight the collapsing of the arch in the foot. Another cue used to cue an active foot is to corkscrew the feet into the ground. You should feel like your feet are “fixed” into the ground and not actually spinning the feet outwards. This often will help cue proper knee tracking as well as activate the hips.

Pressure should be evenly distributed among the 3 points shown in the feet. Corkscrewing your feet will stabilize the knee and help cue a knee out
Pressure should be evenly distributed among the 3 points shown in the feet. Corkscrewing your feet will stabilize the knee and help cue a knee out

The knee is a victim of both the feet and the hips. Having a strong base will help stabilize the knees but you must also have strong or active hips. Specifically the glutes and external rotators must be strong and contracting at the right time to stabilize the knees during activity. The glutes and external rotators help stabilize the knee against adduction and internal rotation. Weakness can be the primary issue but usually people have improper patterning during squats.

How to fix

Achieving an active foot will often time cleaning up bad knee tracking. Corkscrewing the feet into the ground will “turn on” the hip external rotators and abductors, helping to stabilize the knee.

“Knees out” is an often overused cue by many trainers and coaches. The cue can be helpful in proper knee tracking but can be overdone. You do not want to end up pushing knees out so far that you end up on the outside of the foot, instead I tell people to not let knees go inside of the second toe.

Reactive neuromuscular training (RNT) is a tool that can be used when verbal cues do not seem to work. RNT uses external resistance, or feeding the fault, to turn on a desired response. To used RNT you apply a force, whether manual resistance or by using bands, in the direction of the faulty movement patter. So in the case of a valgus knee collapse, you would apply a force that would try to push the knee further in. The body’s natural survival mechanism will turn on and fight against this over pressure of bad mechanics. Your body will fight to keep its knees out, therefore correcting the valgus knee. Below is a picture of an example of using RNT to correct a valgus knee collapse during a squat.

RNT squat with band around the knees
RNT squat with band around the knees

 

The squat is a fundamental movement pattern that should be apart of all fitness and strength training programs. It is important to move well before moving often. Have questions about the squat or any other fundamental movement?? Interested in making sure your form is correct? Contact me below with your questions or if you are interested in a weight training consultation.