The short answer to the question of whether it’s normal for the knees to hurt while squatting is “no.”
When done correctly, a squat should be a safe, functional and highly effective exercise that improves strength, power and even central nervous system function. Knee pain during or after squats generally indicates that something is amiss.
In my clinical practice, I often assess the following conditions when people come to me with concerns about knee pain during squatting exercises.
• Patellofemoral pain syndrome, also known as runner’s knee or jumper’s knee, causes pain on the front of the knee due to damage to the kneecap.
• Patellar tendinitis develops due to inflammation in the tendon that connects the kneecap to the top of the shinbone.
• Iliotibial band syndrome, due to inflammation in a long band of tissue running from the hip to the knee, causes pain on the side of the knee.
It’s not always possible to predict when or why you may experience knee pain while squatting, but certain factors can increase your risk of developing it, including insufficient warm-ups, not using proper form (an absolute must for this compound movement), lifting too much weight for your current ability level and pre-existing alignment or posture abnormalities, such as feet that are too flat or hips that are too internally rotated.
The only way to know for sure what’s causing your knee pain is to work with a movement specialist such as a physical therapist. A PT can help you identify the cause of your problem as well as the underlying factors contributing to it, which may include hidden postural imbalances you never knew existed.
Of course, understanding why your knee hurts is only part of the journey. Knowing what to do about it is the next important step.
To rest or not to rest?
Many people are told to rest and take pain medication when they are experiencing acute knee pain. But what does “rest” mean? And will it actually help you resolve your injury and return to an active lifestyle?
Many people assume that “resting” means they should stop exercising altogether until their knee pain goes away. The problem with this approach is that even if your knee starts to feel better, nothing is being done to find and address the underlying cause of your pain. In all likelihood, your knee will start hurting again when you get back into the gym.
I tell my patients that as long as you don’t have a knee injury that has caused severe damage, you should actually move, not rest. When we don’t move our joints, they become stiff and immobile, which can cause inflammation and make knee pain even worse. Plus, becoming sedentary may cause you to gain weight, which we know from research can increase the amount of force on your knees and lead to more joint damage over time.
Managing knee pain: What to try instead
But what types of exercises should you do?
If you’re experiencing daily annoying knee pain, there are some gentle bodyweight exercises that are appropriate based on findings from an evaluation. I also advise people to implement dynamic warm-ups and flexibility exercises to help prepare their bodies for exercise and maintain proper range of motion, especially in the hips and ankles.
Knees are meant to bend and help us walk, kneel, squat, jump and go up and down stairs. Despite the well-meaning advice you may receive, knees are not meant to stay still and rest all day. Although it may feel like knee pain is something you’ll have to learn to live with, or that rest and pain medications are your only solutions, there is a way to get back to living a life you enjoy.
If you want more quick tips on how to ease knee pain and keep active without needing pills, injections or surgery, download the free Knee Pain Guide at physiofitpt.com/knee-pain.
Kim Gladfelter is owner, physical therapist and Pilates instructor at PhysioFit Physical Therapy and Wellness, 1000 Fremont Ave., Suite 108, Los Altos. For more information, call 887-6046 or visit physiofitpt.com.