Why Do Your Knees Hurt When You Squat?

From heavy lifting and bodyweight strength training to HIIT, yoga and Pilates, squats are one of the most common exercises you’ll find in almost every training style. As a compound exercise that recruits several major muscle groups, a functional exercise that mimics many everyday movement patterns, and an exercise that has lots of potential for progression, there’s a lot to love about squats and what they can do for your body. Something we don’t love? When we hear they make your knees hurt.

Although having sore knees after squats is a common complaint, squats aren’t inherently bad for your knees. Experiencing knee pain isn’t normal and shouldn’t be something you brush off or push through - that’s just an injury waiting to happen!

As much as we want you to love your squats, knee pain during or after squats is begging for your attention as it can indicate poor form, muscle weakness, an injury or a more serious condition. If the pain is intense, ongoing or getting worse, your first port of call should always be a professional physiotherapist, but here are some of the common culprits and tips to get you squatting with happy knees.

Poor form

Like any strength training exercise, mastering your form is paramount if you want to get the most out of the movement and avoid injury. When it comes to squats, there are a few common form errors that can put additional pressure on your knees and cause niggly issues. Whether you’re doing bodyweight squats or are loading up your squats with additional weight, it can help to stand in front of a mirror so you can check your form throughout each stage of the movement and tick these boxes:

• Start standing with your feet hip-width apart. Having your feet too close together can make it easy for your knees to cave inwards.

• As you lower into your squat, make sure your knees are tracking out over your toes, not caving in towards each other.

• Send your hips backwards as if you’re sitting on a chair and think about dropping your weight into your heels and glutes with your feet flat on the ground. Moving your weight forward into your knees, toes and quads can load up your knees and put excess pressure on the joint.

• Maintain a neutral spine by keeping your shoulders back and your chest proud.

• As you push up out of your squat position, think about pushing your knees out over your toes to prevent them from caving in.

• Squeeze your glutes for power rather than using your quads which will put more strain on your knees.

Muscle weakness or imbalance

When you think about squats, which muscle do you think you’re primarily targeting? Your glutes, right? Correct! But for many people, their glutes don’t get as much of a workout as they should. If your glutes aren’t strong enough or you’re quad dominant, you might find you’re actually recruiting your quads to compensate and push yourself out of the squat - especially if you’ve added more weight than your glutes can handle. Hello, knee pain! So what should you do?

• If knee pain regularly pays you a visit during your squats, try dedicating more time to

  your warm-up. Start with some light cardio to increase your body temperature and blood flow, then move on to hip and glute activation exercises such as banded clam shells, side shuffles and glute bridges. Focus on what it feels like to squeeze your glutes so you’ll know when your glutes are engaged during your squats, too.

• If you’re squatting with additional weight and your knees are hurting, reduce your weight or try bodyweight squats to focus on your form and glute engagement.

• Avoid adding more weight until you can squat without your knees hurting.

• Try to incorporate a variety of glute exercises into your workout routine to continue building your strength.

• The Arthritis Foundation also recommends doing wall squats as a safe alternative and a good way to build your lower-body strength if you’re experiencing knee pain.

• In the Sweat app, you can also use the exercise substitutions feature to try something else instead until you feel more confident in your glute strength.

Limited ankle mobility

This might sound like a bit of an odd one, but great squat form actually requires great ankle mobility. Think about it - when you bend down into the squat, your feet should stay planted flat on the floor as your knees track slightly over your toes. Without good ankle mobility, this movement is impossible and can mean compensating by lifting your heels or tilting your posture too far forward - both of which can load up your knee joint.

If your ankle mobility is what needs work, check out this simple exercise you can do with or without a dumbbell, or try Kelly MacDonald’s program in the Sweat app - Mobility & Strength in Motion.

Strains, sprains, tears and tendonitis

Your knees take the brunt of a lot of your daily movements and workouts, and poor form during a lift, overuse or an awkward landing can strain the ligaments or tendons surrounding your knee. In this case, your knee pain won’t be limited to your squats. You might notice some swelling or tenderness and will feel pain during other exercises or even have difficulty walking. Injuries like this aren’t asking for better squat form or reduced weights - they need time to heal and in some cases have the guidance of a professional.

For minor knee injuries, keep the RICE method top of mind and part of your routine until you’ve made a full recovery - rest, ice, compression and elevation.

Osteoarthritis

One of the most common forms of arthritis, osteoarthritis is when the cartilage that cushions the ends of your bones and helps your joints to move smoothly breaks down. When you squat down, that space where the cartilage should be gets compressed, making it painful for your knees as the friction increases between your bones. Icky.

This condition tends to affect people over the age of 65, hence why some older people struggle to squat down, and tends to be accompanied by swelling and stiffness.

Runner’s knee, aka Patellofemoral syndrome

Before any non-runners skim over this one, it’s not strictly limited to runners. The name simply came about as it mostly affects people who do a lot of running, high-impact sport or even cycling. With runner’s knee, there is misalignment around your kneecap area which can cause issues with movement and pain during squats.

A professional physiotherapist is the best person to diagnose this and provide you with a personalised course of treatment, but rehab exercises often have a heavy focus on stretching and strengthening your quads, hips, knees, hamstrings and hip flexors.

IT band syndrome

If it’s the outside of your knee that’s causing your grief, your IT band could be the primary issue. Running from your hip down your outer thigh to the outside of your kneecap is a thick band of fibrous tissue called your iliotibial (IT) band. When this band is tight or inflamed, it can pull on your kneecap during squats, causing pain and messing with your form. Although this is common for runners, it can also happen as a result of not warming up properly or stretching enough.

Keep your body in check by bookending your workouts with a warm-up and cool-down, or dedicating a bigger chunk of time each week to a stretching and foam rolling session.

Happy knees, happy workout

If your knees hurt when you squat, they’re not asking you to push through and ignore the pain - they’re trying to tell you something. Aside from the burning in your muscles, strong squats should be pain-free squats. Warm up properly, work on your form, prioritise stretching and recovery, and always check in with a professional if a niggle in your knee is bothering you. It’s better to be safe than sorry!