Knee pain when squatting

Being able to squat correctly is important in our daily lives as we perform a squat to do many functional tasks such as getting into/out of a car, sitting down, going to the toilet and picking things up. One of the first things to look at if you are experiencing knee pain when squatting is alignment on your lower extremities during the motion. Often times the knees will drop inward (valgus motion) or move to far forward past your toes which can create excess stress on the medial and/or anterior knee.

This can happen due to the positioning/anatomy of your foot, a lack of mobility at the ankle and hip and/or weakness in glutes and quadriceps. If you have a flat (pronated) foot this can cause an inward motion (adduction and internal rotation) of the lower leg causing the knee to drop inwards as you squat. This can put stress on the soft tissues on the medial aspect of the knee and cause altered tracking of the patella. Another cause of this inward motion can be a lack of functional strength at the glutes. When there is a lack of strength in the lateral glutes the thigh can drop inward which will cause similar medial stress on the knee. Focussing on lifting slightly through the arch of the foot when squatting and working on functional glute strengthening will help improve alignment.

Another common thing we note that causes knee pain when squatting is the knee moving too far past the toes. This can occur due to altered motor control and biomechanics or due to a lack of mobility at the ankle and hip and poor proximal strength. Decreased ankle dorsiflexion and hip flexion can limit the depth of the squat and it is common to compensate with driving the knee’s further forward. This causes increased compression forces on the patellofemoral joint. Focus on sitting the hips back (like your sitting back into a chair) and flexibility of the foot and hip to help improve alignment.

Correct alignment when squatting:
Knee is in line with the 2nd/3rd toes and hip. Knee stacks over the ankle joint. Even weight between both feet.

Written By: Paula Lamont, PT, DPT, CAFS, RYT