Do Deep Squats Cause Knee Pain?

By Ann Wendel
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Chances are you've heard this warning before

"Don't squat past parallel! Deep squats are bad for your knees!"

If you have, maybe it's left you wondering whether you should heed it, or ignore it. After all, you ask, isn't the human body designed to squat to full depth?

Prior to becoming a fairly sedentary society, we moved most of our joints into and out of full range of motion on a daily basis. Squatting was a normal part of everyday life—and still is, in many indigenous cultures. Activities of daily living and work activities required people to squat, and as a result we maintained the flexibility and motor control to accomplish a deep squat.

deepsquats-kneepain-neghar-ggsshirt-314x350In today’s society we spend more and more time sitting in chairs, which can contribute to loss of mobility in the hips and ankles, which greatly affects our ability to squat. Additionally, when we don’t perform a motor pattern on a regular basis, we lose the neuromuscular control to perform it.

Rather than demonize a particular movement pattern, the wise thing to do is recognize some of the issues that may make squatting a challenge, and then include work in our training programs to address our individual limitations.

Some folks have trouble achieving a deep squat due to lack of hip flexion range of motion, hip pain with deep squatting, or lack of ankle dorsiflexion. Others lack the motor control to keep their spine in a safe, slightly lordotic position at the end range of a squat. I previously discussed these issues in this article.

Other folks may experience popping and cracking in their knees with squatting.

If you experience hip or knee pain with squatting, please read the articles linked above, and see a physical therapist for an evaluation.

If you have no pain with squatting, try following the suggestions in the articles to increase hip and ankle mobility and motor control. Dedication to following a mobility program will pay off for most people struggling with squats. Our joints thrive when we take them through full range of motion in a pain-free, gradual process.

Squatting is a necessary movement pattern, and we shouldn’t be afraid to work toward a full squat.

The squat is a very effective exercise, as it engages the hips, glutes, quads, hamstrings, and calves, while also requiring coordination of the pelvic floor, deep central core, and spinal stabilizers.

deepsquats-kneepain-molly-450x340Deeper squats also activate more of the gluteus maximus during the floor to stand portion of the exercise.

I can say with confidence that squatting is not bad for your knees. As my friend Dean Somerset says, “squatting deeply will not hurt your knees; squatting poorly will hurt your knees.”

Deep squatting actually increases the contact area of the undersurface of the patella (kneecap) with the femur, spreading out the forces better than shallow squatting. This is good because it reduces the stress placed on any one area of cartilage on the undersurface of the patella.

Form is important with squatting, as it is with any exercise, especially when performed under load.

designyourself-mollygobletsquat-350x375Form may change depending on the type of squat you are performing, and you should be able to squat in a variety of ways, in a variety of circumstances. For example, the way you squat to go to the bathroom in the woods, will be different than how you squat while holding kettlebells or with a heavy barbell on your back.

When you perform a loaded squat, make sure that your knees are not collapsing in toward each other—this is a common problem I see with my patients, especially as they try to go deeper into squats. You should be able to maintain a wide knee position without letting the knees move toward each other. This requires a combination of hip strength (gluteus medius) and motor control. Additionally, you should maintain a slight lordotic curve (arch) in your low back throughout the squat.

As always, it's important to pay attention to individual differences and adjust accordingly. Depending on the structure of your pelvis and the way your hip fits into its socket, you may need to take a wider stance, and/or turn your feet out slightly when squatting to depth. You should never feel pain when squatting.

There are a variety of squatting options to choose from and they are all valuable in different ways. It is important to add variety into your squatting program which develops coordination and balance in different ways. Try a combination of front squats, back squats, goblet squats, single leg skater squats, and single leg pistol squats to a box. Variety in all of your workouts is a good way to prevent injury and also prevent boredom!

There are a variety of squatting options,

For those who have had a knee injury, or surgery such as an ACL reconstruction: have no fear! Squats are an important part of your recovery as you resume your active lifestyle. Physical therapist and ACL expert Julie Eibensteiner explains,

“There is nothing dangerous about squatting though a full range of motion provided a person has the prerequisite ankle and hip range of motion to do so without compensation and are absent of any underlying joint pathologies. In fact, the consequences of avoiding full range of motion and losing the benefits of mobility and the glute development that goes with it are almost more detrimental in my opinion. I use all kinds of squats with the crease of the hip getting deeper than the height of the knee with the greater majority of my ACL patients and they have fewer problems down the road as a result.”

If you are a coach working with athletes of any age, Julie has a neuromuscular-based program for teams to perform as part of their dynamic warmup. This is a great resource for reduction of injuries, especially for women’s sports teams.

Don’t be afraid to continue to work toward deep squats in a pain-free, gradual program. If you need assistance, you can ind a local physical therapist via the American Physical Therapist Association website.

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About the author:  Ann Wendel

Ann Wendel is an internationally-recognized women's health Physical Therapist (PT), a Certified Athletic Trainer (ATC), and a Certified Myofascial Trigger Point Therapist (CMTPT). In addition to owning and operating Prana Physical Therapy in Alexandria, VA, Ann writes, travels, speaks, and consults with other physical therapists and business owners. You can connect with Ann on Facebook and Twitter.

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