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Why Does My Knee Hurt When I Squat?!?!

We recently hosted a webinar on "Fixing your Knee Pain When Squatting." At Thrive-HQ we get the opportunity to work with many athletes that already are including lots of squats into their workouts. For those that aren't regularly squatting for strength training, we usually seem to find a way to sneak them in to the rehab process... :D


Without a doubt squatting is one of the most functional movements that every single one of us uses on a day to day basis. If you want to argue about this, then I would suggest you stop reading right now, because this blog post is probably not your cup of tea. Beyond it being a functional movement, squatting can easily be loaded with weight, making it an excellent movement to develop strength. With strength being the foundation for so many other skills and components of fitness, we believe it is critical that you are regularly squatting with load!


However, being active can come with some aches and pains. At Thrive HQ a common complaint we see is knee pain when squatting. Despite the knee joint being a relatively simple joint, it still can be a little tricky to figure out exactly what is going on... Although a quick Google search may provide some good suggestions, there is a fair chance that the suggestions may not be tailored to your situation.


Obviously as physical therapists, we are professional "figure-it-outers" for musculoskeletal aches and pains. Our years of education along with thousands of exposures to the nuances of knee pain makes it much easier for us to pinpoint the underlying issues and create a targeted rehabilitation program. Our goal with this post and webinar is to provide you with some information and tools to self assess your knee pain



Common Underlying Causes of Knee Pain when Squatting:

  • Poor movement patterns (technique/form)

  • Mobility limitations (typically at the hip and ankle)

  • Coordination and/or strength issues

  • Overload / Under-recovery

*Traumatic knee injuries with squatting are VERY rare with squatting in the gym!!



Common Knee Pain Diagnoses

Below is from our webinar where we relate the common underlying issues to the diagnosis you may be given by your healthcare professional.



Self Assessment:


Step 1 - Movement Screening:

Video record yourself performing a BODYWEIGHT SQUAT then a SINGLE LEG SQUAT:

  • Slow squat to full depth in your normal stance (for single leg, go as low as possible without losing your balance)

  • Hold bottom of squat for a few seconds

  • Slowly return to standing position

  • Repeat 5 times


What to look for and record (be a scientist here and get out the pen & paper... or your iPhone notes app and record some of the findings!!):

  • Is there any pain? If so, where and how intense?

  • Does one or both of your feet rotate out?

  • Does the arch of your foot collapse?

  • Does your knee cave inward?

  • Do your hips shift one way or the other?

  • What happens if you correct the movement issue(s)?




Step 2 - Mobility Testing:

FABER Test

  • Does the knee get closer to the ground on one side than the other??

  • If uneven, you have a hip mobility issue to work on, and this may be an underlying cause of your knee pain





90-90 Hip Internal Rotation Test

  • Does one side rotate in significantly farther than the other side?

  • If uneven, you have a hip mobility issue to work on, and this may be an underlying cause of your knee pain



5-Inch Wall Test

  • Perform WITHOUT shoes on

  • Goal = touch the wall with your knee without heel lifting off ground and without rotating thigh in or out

  • If unable to pass this test you have an ankle mobility issue to work on, and this may be an underlying cause of your knee pain






Step 3 - Coordination/Strength Screen:

For testing here, you will get to perform a "Single Leg Bridge Hold"

  • Lie on your back with one leg bent and the other straight (and lifted in the air)

  • Elevate your hips and hold the highest position for 10 seconds

  • Repeat on other side

  • Note which muscles you felt working hard during this bridge

  • If you felt anything other than your glutes working hard, you have a coordination and/or strength problem to work on


Step 4 - Load Screening:

Load screening is super helpful for helping pinpoint if your pain is from a movement technique issue or if you are dealing with a tendinopathy


If you have pain ONLY when moving, you should perform these jump tests


Double-Leg Tuck Jump

  • Perform 10 double-leg tuck jumps in a row, jumping as high off the ground as you can while lifting the knees up towards the chest, without resting between jumps

  • Did this increase the pain more than the squats?


Single-Leg Tuck Jump

  • If you can, perform 10 single-leg tuck jumps in a row

  • Did your knee pain increase again?

If your pain increased from the bodyweight squat to the single leg squat to the double leg tuck jump to the single leg tuck jump, then you can be pretty confident you are dealing with a tendinopathy



Now What?!?!

Hopefully the 4 step process from above was helpful in more accurately pinpointing your specific underlying issues that could be leading to your knee pain. This really is such a critical first step to making sure you have a successful rehab experience, since the underlying issues should, and will, have an impact on what you do to address it. If you are having difficulty with assessing your knee pain, we would LOVE to help out. We offer a FREE discovery visit where you can tell us more about your knee pain and what it is keeping you from doing. It is also a great opportunity for you to ask us any questions about the rehab process. To schedule a free discovery visit simply click one of the buttons below (either in-person or a phone call option).


Also, in our recent webinar on "Fixing your knee pain when squatting," we provided 3 tips to address your underlying issues and get you back to squatting pain free. If you would like to access this content and try to continue on the DIY rehab path, simply click the button below and enter your email to receive the recording with more details on the assessment and rehab process!





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