Hi, I'm Dr. Molly with Your Goals Physical Therapy. I speak to hundreds of people every month and a common theme is that people don't like to, or don't do squats because they feel that their knees are bad, meaning their knees hurt while they're doing squats. This is very alarming because squats are very important. So I thought I would go over and explain one, why your knees hurt while you're squatting. Then two, why it's important to work on getting through that pain, like figuring out what's causing the pain and then getting to where squats are not painful.
First let's make sure that we're all talking about the same thing. I often find out after evaluating and asking people “Where in the motion during the squat do your knees hurt?” “How often does it hurt and/or does the number of squats you do matter?”
Then I asked them to demonstrate the squat so they can show me exactly where the pain is. One of the things that I've noticed is that the first thing that people do when I tell them I'd like them to do a squat, is they do this,
In my world it is not a squat. I would call that kind of stooping because if I continue down, I would end up stooping on the floor. In other words I'd be on my hands and knees. That's not a squat
A squat for my definition is when your hips go back and your knees stay over your feet, they don't go in front of your feet. So again, your hips would go back and then you would sit down essentially.
And that is exactly why squats are so important, because if it hurts every time you stand up and sit down from a chair. Every time you stand up and sit down from a toilet and some of those toilets we know are really low, then you're constantly agitating your knees. And that can cause other problems. The other thing is being able to hinge at your hips, (ie you can bend your hips and sit your hips back) is the foundation for every type of lift.
If I want to pick something up off the floor. If I want to help somebody carry a box up the stairs. If I want to pull the groceries out of my car. Being able to bend my knees enough and flex my hip, that's how I saved my back. What I’ve noticed is that people who feel that they can't bend their knees end up also having some pretty severe, low back pain.
And it's because the thing that helps stabilize their back is compromised, i.e. it hurts when you bend your knees. Which causes other things to start to bother you.
Now, why is it that your knees would hurt while you're squatting? Well, if you're thinking of a squat as that stooping motion which many people do. The pain is coming from taking out all the flexibility of your thigh muscle. Basically you just hit the end of the length of your thigh muscle, causing you to pull together compressing the knee joint.
And since you probably have some arthritis, that extra compression is not helping your knees out. Squatting this way is not pleasant, but if you can learn how to sit your hips back which reduces the stress on your knees it will be less unpleasant. When you learn how to squat properly then your thigh and knee muscles will lengthen and strengthen reducing the pain in your knees while allowing you to sit down lower and lower.
There can be other things that cause knee pain while squatting, but I would say that if I had to give one general thing, the number one reason people believe that squats hurt is that they are “stooping” and not “squatting”.
Why would people want to stoop down versus sitting back? That is a very complicated question that I help people navigate through all the time. There could have been an injury that made you move in a different way.
There could be hip tightness. There could be an old hamstring injury. There could be hundreds of reasons why people change that movement pattern from sitting back, which you did as a kid.
Squats are super important because they are almost a foundational movement that translates to how you live your life. Being able to bend and stand over a sink, vacuuming, going up and down stairs, all of these things that we don't even think about.That starts with being able to squat. The ability to seat your hips back even if it's not squatting all the way down to the floor, or getting your knees parallel is the foundation of so many other daily activities. It is important that you can move through that motion without fear and without pain.
That confidence will make a huge difference in how you do everything else. It will reduce back pain and improve your overall endurance. There are just so many things that are made dramatically better by being confident in being able to do a squat. So if this is something that you've been struggling with, if your knees have been giving you fits for years, every time you try to do squats, there are a hundred ways to help you get through that.
I would love the opportunity to speak with you about that. So if you are dealing with that, feel free to use some of my contact information from the show notes below. And I hope to talk to you soon.
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WE HELP ACTIVE ADULTS OVERCOME THEIR ACHES AND PAINS TO GET THEM BACK TO THEIR FAVORITE ACTIVITIES WITHOUT MEDICATION, INJECTIONS OR SURGERIES.
Dr. Molly McDonald