Squatting can be one of the best thing to prevent cartilage damage. SOURCE: Click Image [Medical Xpress]

Key Takeaways

• Many people with knee pain avoid squatting for years because they believe the knees should never pass the toes.
• The body adapts to the forces placed on it, so avoiding the squat entirely may leave the knee less able to cope.
• People with sore knees or osteoarthritis can often start by squatting a little differently and progress slowly.
• Pushing the hips back, shifting weight slightly to the heels and keeping the shins upright can take some stress off the knees.

The squat is one of those movements that many people with knee pain are fearful of, and squatting with knee pain can feel like something to avoid at all costs.

A lot of people we see in the clinic, including many in our osteoarthritis clinic, have avoided this movement entirely for years, feeling like squatting is something bad and should never be done.

Is Squatting Bad for Your Knees?

For most people, no, even for those with knee problems. Squats can usually be adapted to suit sore knees. The reasons come down to how the body responds to load:

Origin of the Knees-Over-Toes Belief

The belief that squatting is bad for the knees typically stems from the notion that having your knees travel over your toes is bad for the health of the knee joint. The argument is essentially that when our knees go over our toes, there is more pressure on the knee joint. When we look at how exercise and specifically strength training actually works, we can begin to realise that this conclusion doesn’t hold up.

Law of Adaptation

Exercise works because our body is responding to forces. In the case of strength training, it’s concentrated force placed on a joint’s muscular attachment throughout a controlled range of motion that causes the favourable adaptations we’re after (including increases in bone density, ligament strength, hormonal and metabolic profile and muscle mass, to name a few).

Saying that we need to avoid squatting (or any movement) entirely because we’re in pain is simply an unhelpful way of thinking. Plus, it overlooks one of the most fundamental principles of physiology (the law of adaptation). It’s like saying that bodybuilders seeking large biceps need to avoid biceps curls because of the extra stress they place on the elbow joint.

Short-Term Case for Limiting Knee Travel

There is some truth to the idea that avoiding knees over toes might be a good idea (just not forever). In our situation, we see many people who struggle with knee pain, often from conditions such as knee osteoarthritis. For these people, a minor increase in the amount of force their joint experiences could leave them feeling incredibly sore for days.

What needs to happen for these people is a slow and gradual progression towards regaining their normal comfortable motion. For people who experience pain with squatting, the simplest way to begin this is to teach them to squat a little bit differently.

Over time, they can start to rebuild their body to be able to handle the forces associated with squatting (according to the law of adaptation) and for many people, the knee pain eases as that capacity grows.

Squatting and Long-Term Health

Squatting is one of the most beneficial movements we can do for our overall health and wellbeing. Research in middle-aged and older adults has linked the ability to sit down on the floor and stand back up with little support to a lower risk of death from any cause.

It is one of the most fundamental human movements, being an archetype of a lot of our daily movement, which is why we say squat well, move well.

How to Squat With Knee Pain

Squatting Is Simply Loaded Flexion of Our Knees. This Type Of Movement Happens When We do Just About Anything, From Walking to Lifting & Everything in Between

The squat is a highly functional exercise, since every time you sit down or stand up, it is the same movement pattern as a squat. Getting your technique right will go a long way in terms of reducing your hip and knee pain in day-to-day life. The areas to work on are:

Squat Technique

These cues help your hips and knees share the load as you lower into the squat and stand back up:

• Maintain even pressure throughout your feet. Be careful not to come up onto the balls of your feet or roll towards the inside or outside of your feet.
• Keep your knees in line with your toes. Be careful not to let them collapse inward during the movement.
• Keep your chest up. This will help straighten and support your back.
• Drive your knees out, so you keep the tension pushing out.
• Learn how to pull into your squat (see the video below).

Knee Unloading

The simplest way to unload pain from your knees during a squat is to shift some of the stress to your hips:

• Initiate the squat movement by pushing your hips back before bending your knees.
• Shift your weight slightly to your heels.
• Keep your shins as close to vertical as is comfortable so that your knees don’t travel forward much during the movement.

It is important to remember to spread your weight evenly throughout each leg, as most people favour their stronger side and shift their hips without realising. Try doing your squats in front of a mirror to get your movement right!

Our squat technique guide covers hip position, ankle mobility and form in more detail.

Trusting Your Knees in a Squat Again

After years of avoiding the squat, the first few sessions can feel uncertain, and it is natural to wonder whether each twinge means damage. For most people, it simply means the knee is being asked to do something it has not done for a while.

With a version of the squat that suits your knees today and a steady plan to progress it, everyday movements such as getting up from a low chair can start to feel ordinary again. An exercise physiology program can help set that progression for people managing osteoarthritis.

If you have been putting off squats because of knee pain, the team at MTP Health can assess your knees and talk you through the options that suit your circumstances, or your GP can help you decide on the next step.

Frequently Asked Questions (FAQs)

1. Is squatting safe with knee osteoarthritis?

For many people, yes, when the depth and load suit what the knee currently tolerates. Starting with partial squats or squatting to a chair, then progressing slowly, is a common approach.

2. How much knee pain is okay when squatting?

Mild discomfort that settles by the next day is often acceptable. Pain, stiffness or swelling that is worse the next day suggests the load, depth or volume needs reducing.

3. How long does it take for squatting to feel easier?

It varies. Many people notice squats feeling more comfortable within a few weeks of consistent practice, while strength keeps building over several months.

This article is general information only. It does not take into account your objectives, circumstances or health needs. Speak with your GP or a qualified health professional before acting on it or changing your training or treatment.