The Knee Pain Checklist for Squats

Quick Tips on How to Continue Squatting while Having Knee Pain

Walk into the gym with headphones on and mark squat rack as territory. Warm up, throw on some plates, and squat. Bust out some sets, SIZZLE. Knee is on fire. Day ruined. Back to the drawing board. Looks like squats give you knee pain from now on.

If this has ever happened to you, you know these feelings of frustration and aren’t happy with having pain interfere with your hobby, or sport. Squats, being a vital part of this “hobby”, are no fun when if they can’t be performed. Squats don’t get you stronger if they hurt too much to execute.

Knee pain squats.Think you’re having a bad day?

Luckily, a few things can be done to relieve some of this pain. Squats can be made more bearable and less damaging to your knee, giving that poor joint a chance to heal – barring that you don’t have severe pain or instability (which, if you do, then stop reading right now and go see a doctor). Without further ado, here’s a checklist for preventing squat-related knee pain.

Fix Your Technique

This point goes without saying, but I’ll say it anyway – if your squat technique sucks, you are potentially setting your knees up for injury. Faulty movement places additional stress on the knee ligaments, which is bad because a regular squat with heavy weight ALREADY places enough stress on them in the first place. For example, the ACL always experiences some strain during a squat, but with a technique error known as “knees caving in”, the ACL will then get stretched like a rubber band while squatting.

Poor form is like a knee strain “multiplier”. That’s a real-life “video game power-up” that you want to avoid like the plague.

Enough said. Fix your technique. Stop knee pain during squats.

Cut Down on Volume

For every rep you perform with a squat, the knee joint accumulates microscopic damage. A few reps is nothing to worry about, but the damage starts to add up if you’re doing something crazy like 10 sets of 10. Cutting back by a few reps per set, or by a set or two, may give your knees some breathing room.

Joint repair.The reason for this is explained by the idea of “training not too little, not too much”. Our bodies have a capacity to recover from the microscopic damage induced by exercise. However, too much damage will result in injury because our bodies can’t recover quickly enough, whereas too little damage may result in detraining and a loss of strength. The right amount of damage is the perfect stimulus for our joints and muscles to grow stronger.

So, if squatting for 5×5 is too much for your knees to handle, then cutting it back to 5 sets of 3 or 3 sets of 5 may help, as the reduced volume may match your body’s capacity to recover.

Reduce Intensity and Tibial Shear

Referring back to the graph above, another way of controlling the amount of “stress” our knees endure is through intensity. The more weight you squat with, the more stressful it will be on your knees for each rep. Cutting the weight back gives your knees a break from your squat workout. It’s as simple as that. Whether you need to reduce the weight by 5% or 50% is something you need to figure out during your time at the gym.

Different variations of the squat – the low-bar, the high-bar, and the front squat – stress the knee differently, meaning that one variation may be more “harsh” on the knee joint than another variation, despite less weight being used. As explained by Mark Rippetoe in his book, Starting Strength: Basic Barbell Training, the more upright the torso is and the more “forward” the knees are during the squat, the less engaged the posterior chain is and the more engaged the quads are. So what does this even mean? It means that the ligaments of the knee, particularly the ACL, are under more stress.

Squat variations.From left-to-right: low-bar back squat, high-bar back squat, and front squat.

The reason for this is because when the quadriceps contract against a load, the ACL is strained because the quad pulls the tibia away from the knee. This is known as tibial shear. The hamstrings actively resist this type of tibial shear if they are contracted – the more the hips are bent and the less the knees are, the more contracted the hamstrings are. What isn’t resisted by the hamstrings is passively resisted by the ACL.

Moral of the story: if one squat variation bothers your knees, a less “quad-dominant” squat variation may not hurt as much, or at all.

Use Compression

Further emphasizing the point about tibial shear, anything that pulls the knee joint out of alignment places stress on its ligaments. Besides switching to a more “knee-neutral” variation of the squat, as mentioned earlier, compression can help keep the knee joint in alignment, ultimately reducing the strain on the ligaments. How do you get compression? You get it by using a compressive knee sleeve.

I’d compare using compression to using scotch tape to fix a broken pencil. Just as the tape keeps the two pieces of the broken pencil from separating, the compressive knee sleeve assists your ligaments in keeping your knee from going into misalignment. The knee sleeve “takes over” and gives your knee ligaments a break.

Rehbands - knee pain squats.The Rehband knee sleeve – arguably the best product on the market for joint compression.

The Rehband knee sleeve is probably the most popular option for joint compression. It’s a staple for Olympic weightlifters, powerlifters, and other strength athletes. Don’t take my word for it, just check out the 350+ 5-star reviews on Amazon for these knee sleeves.

Not only does compression give your knee support, it also provides warmth, which we will discuss next.

Always Warm-Up

There’s a damn good reason why your phys-ed teacher from grammar school always made you and your buddies warm-up at the start of gym class. In 2006, a review of 5 different studies concluded that there is some evidence supporting the notion that warming up before physical activity reduces the likelihood injury. (Fradkin, et. al)

The act of warming up increases blood-flow to the muscles, as well as the flow of synovial fluid within the joint capsule. Movement forces synovial fluid in-and-out of the joint like a water pump, bringing nutrition and heat to the soft-tissues within the joint. (Tandon, et. al) This “warmth” increases elasticity, allowing the ligaments to have more “give” when they are strained. Elasticity allows the ligaments to stretch instead of tear when strained, ultimately preventing injury.

Using a couple of warm-up sets prior to squatting heavy sounds like a good idea then. Start with the bar only, then add some weight, and then a little more weight, and so on, until you approach the desired weight of your working sets. Remember, knee sleeves provide warmth, too. So make sure to check out those Rehbands for passive prevention of squat-related knee pain.

Improve Your Capacity for Recovery

Decreasing volume and intensity, as well as using less quad-dominant variations of the squat, all reduce how much “stress” our knees have to recover from. If the stress is too much for our knees, we can easily manipulate those variables to give our knees a break. But what if our ability to recover is compromised, and adjusting those “variables” will only serve as a temporary fix?

Factors, particularly nutrition and sleep, affect our capacity for recovery. Athletes who pull off two training sessions per day, 6 days per week, don’t get by with a crappy diet and 6 hours of sleep per night. According to American Olympic weightlifting coach, Glenn Pendlay, his athlete Jon North was training that frequently, and required 8-9 hours of sleep every night, with additional time spent resting or napping between the first and second training sessions of the day. (Pendlay) Also, he had experts design a specific nutritional plan for him to ensure optimal recovery.

Could Jon North, as an athlete, afford to eat like crap and not sleep that much? NO, because he wouldn’t be able to recover from his two-a-days, which were completely necessary for peak performance in his sport. Imagine how wrecked his body would be if his recovery weren’t top-notch. All of the squats would destroy his knees and be incredibly painful.

You don’t want to be stuck training once or twice a week, do you? I didn’t think so.

You’ve got to examine your sleeping habits and as well as your nutrition. Set a bed-time schedule for yourself and get to bed early each night. Track your nutrition and see what’s missing in your diet. Magnesium deficiency is common for a lot of people and needs to be supplemented for. You can’t go wrong with chelated magnesium from Doctor’s Best – this is the product I use. As someone who’s experienced injury after injury, I find it prudent to use a glucosamine/chondroitin/MSM supplement as “insurance” – again, I use the Doctor’s Best brand, as they use the sulfate form and have minimal fillers in their product.

Don’t just work on the “stress” part of the equation, work on the “recovery” part of the equation as well. Doing this will allow you to maintain your current frequency/intensity of training, if not increase it.

Conclusion

Manipulating training variables, using compression, warming up, and ensuring recovery is up to par allows  our bodies to take a beating and keep going. Tweak your program, use the accessories, monitor your pain and progress, and squat like a champ.  “Knee pain” and “squats” should never be said in the same sentence ever again.

References:

1. Fadkin, AJ, et. al. “Does warming up prevent injury in sport? The evidence from randomised controlled trials?”  Sports Medicine Australia. 9.3 (2006): 214-220. PubMed. Web.

2. Tandon, PN, et. al. “A study of nutritional transport in a synovial joint.” Department of Mathematics, Harcourt Butler Technological Institute, Kanpur 208002, India. 17.7 (1989): 1131-1141. Elsevier. Web.

3. Pendlay, Glenn. “Training Lesson from Jon North”. Stronglifts. 10 January 2011. Web.

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