Jessica Bento, Physical Therapist (Co-creator of DVRT Restoration, Pelvic Control, and Shoulder Course)
One of the top complaints that I get as a therapist and as someone in the health and fitness industry is knee pain. Specifically knee pain when squatting. I hear a lot of times people just stop squatting due to how bad it hurts, I even hear therapists that just tell their patients not to squat, which drives me crazy because I know there are easy fixes to helping someone with knee pain squat better and to squat pain free. Telling someone to just stop doing something should be a last resort, in my opinion, especially when it comes to a foundational movement pattern such as squatting! Don’t get me wrong, there are cases where the knee joint is just too destroyed, but this is rare, I had people say to me they have “bone on bone” and they will never squat again…and guess what?! They end up squatting paint free with a lot of the drills we will go over.
Getting great hip mobility, strong legs, and NOT have the knee pain that so many think comes with squats comes down to really understanding movement.
So why do people have pain when they squat? Well, for me, there are three reasons (I could go into more, but let’s just start with three so this doesn’t turn into a novel ). Number one, the hips! Why would the hips have anything to do with knee pain??? Well, as physical therapist Gary Gray says, “the knee is a rather dumb joint…it does what the hip and foot tell it to do.” It really is a dumb joint and I hate to use such a word but its true, the knee really only flexes and extends, kind of the middle man.
If you look at the joints above and below, for this instance the hip, the hip has so many degrees of range of motion and has some of the biggest power houses when it comes to muscle activation. So poor hip strength and poor hip mobility can really cause poor knee control and stability, the knees can “cave” in, they can move into painful positions. That is why we focus so much in DVRT on core and hip strength especially when it comes to getting people to squat better and be pain free.
So what’s the second reason people have knee pain when it comes to squatting? Well, like I said the knee does what the hip and foot tell it to do, so we are talking about the foot. When someone has poor ground engagement, poor foot/ankle mobility and or poor control at the foot and ankle complex the same thing can occur, the knee gets all crazy and gets pushed into positions of pain, positions not ideal when squatting.
Lunging and squatting knee pain is often related to first and foremost not engaging the feet right to give us that strong foundation.
And lastly, what else can cause knee pain when squatting??? Well, a bad squat will cause pain. Poor form, poor understanding of the movement, poor load placement for the individual can all cause increase discomfort. Also as mentioned a bad squat can also occur from hip and ankle issues too. May times it can be all three of what I talked about causing issuess.
So lets not completely stop doing squats because our knees hurt, lets first figure out if can problem solve the issue by fixing the above three things.
So how can improve on our squat? I talked about foot engagement, and that’s a great place to start, so many times a simple cure such as, “grab the ground with your feet” can instantly improve ones knee pain, I know for myself, if I loose that foot engagement I can easily get discomfort in my knees as I have torn meniscus. So gripping the ground with your feet, that’s where you can start.
You can even place a mini band under the foot to help understand what gripping the ground means, having someone try and pull the band out from underneath the foot will really tell you if you are truly getting the ground engagement.
Placing mini band around the legs just below or above the knee will also add in allowing the individual to create tension and push the band out when descending into that squat. Cuing “push the knees out” will help create that stability the knees crave.
When it comes to load placement, a great place to start is with our DVRT Press Out Squat as it helps to counterbalance the individually with out placing load upon the body, it also creates the upper body and core tension that is needed to help stabilize in the squat.
Below are several drills to focus on the hip and core to get a stronger squat and to progress with that knee stability.
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