Knee pain during squatting is a common complaint. This discomfort can range from a dull ache to sharp pain, often signaling an issue within the knee joint or surrounding structures. Understanding the underlying reasons for this pain is the first step toward finding relief and ensuring comfortable movement.
Understanding Why Your Knee Hurts When Squatting
Knee pain during squatting often stems from mechanical issues or specific medical conditions. Improper squatting form can place excessive stress on the knee joint. Knees collapsing inward (valgus collapse) during a squat can increase friction between the kneecap and thigh bone. An excessive forward lean or insufficient squat depth can also alter the distribution of forces, leading to discomfort.
Muscle imbalances play a role in knee pain. Weak gluteal muscles can cause the knees to track improperly, allowing them to cave inward, while tight hip flexors or quadriceps dominance can pull the kneecap out of its normal alignment. Overuse, such as sudden increases in activity without adequate recovery, can also contribute to pain. This repetitive stress can lead to micro-tears and irritation in tendons and soft tissues around the knee.
Several common conditions are associated with knee pain when squatting. Patellofemoral Pain Syndrome (PFPS), also known as “runner’s knee” or “jumper’s knee,” causes pain around or under the kneecap. This occurs when the kneecap (patella) does not slide smoothly in the groove of the thigh bone (femur), often due to muscle imbalances or poor alignment. Pain worsens with activities like squatting, climbing stairs, or sitting with bent knees.
Quadriceps or Patellar Tendinopathy involves inflammation or degeneration of the quadriceps tendon (above the kneecap) or the patellar tendon (below the kneecap). Quadriceps tendinopathy presents as pain and tenderness just above the kneecap, worsening with squatting, jumping, and climbing stairs. Patellar tendinopathy, conversely, causes pain and tenderness directly below the kneecap, described as a dull ache that intensifies with squatting or straightening the knee.
Meniscal tears involve damage to the C-shaped cartilage cushions within the knee joint which act as shock absorbers and stabilizers. Tears can result from sudden twisting motions or impact, causing sharp pain, especially during weight-bearing activities like squatting. Other symptoms include swelling, stiffness, a popping sensation at the time of injury, difficulty fully bending or straightening the knee, or a sensation of the knee locking or catching.
Iliotibial (IT) Band Syndrome results from friction or inflammation of the iliotibial band, a thick band of tissue running along the outside of the thigh. If this band becomes tight or irritated, it can rub against the outer knee, causing pain, particularly during knee-bending activities like squatting. This condition is common in runners and can be exacerbated by weak hip muscles or improper squat mechanics.
Osteoarthritis, a degenerative joint disease, involves the gradual breakdown of cartilage cushioning the ends of bones in the knee. As cartilage wears away, bones can rub against each other, leading to pain, stiffness, and swelling, which can make squatting difficult, especially for older adults. While exercise, including modified squats, can help manage symptoms by improving joint function, deep squats may exacerbate discomfort in more advanced stages.
Initial Steps for Relief and Prevention
Addressing knee pain during squatting often begins with practical adjustments and self-care. Rest and activity modification are important. Temporarily reduce or avoid discomforting movements, such as deep squats or heavy lifting, to allow tissues time to heal. Opting for low-impact alternatives like swimming or cycling can help maintain activity levels without putting undue stress on the knee.
Correcting squatting form is a preventative and relief measure. When squatting, ensure your feet are shoulder-width apart and your weight is evenly distributed across your entire foot. Focus on initiating the movement by pushing your hips back as if sitting into a chair, rather than immediately bending your knees forward. Your knees should track in line with your toes, avoiding inward collapse, and your back should remain straight and neutral throughout the movement.
Stretching and strengthening exercises can improve knee function and support. Incorporate stretches that target the hamstrings, quadriceps, and hip flexors to improve flexibility and reduce tightness. Strengthening exercises for the quadriceps, hamstrings, and gluteal muscles are also beneficial, as these muscles provide stability to the knee joint. Examples include mini squats, straight leg raises, glute bridges, and hamstring curls, performed pain-free.
For acute pain or swelling, the RICE method (Rest, Ice, Compression, Elevation) provides relief. Rest involves stopping activities that cause pain to prevent further injury. Apply ice packs to the affected area for 15-20 minutes several times a day to reduce swelling and pain, always using a towel between the ice and skin. Compression with an elastic bandage can help limit fluid buildup, while elevating the knee above heart level promotes fluid drainage and reduces swelling.
When Professional Help is Needed
While self-care strategies can offer relief, certain warning signs indicate professional medical evaluation is needed. Seek a doctor’s opinion if the pain is severe, if you heard a distinct popping sound at the time of injury, or if you cannot bear weight on your leg. Other concerning symptoms include significant swelling, redness, warmth around the knee, a fever, or if the knee feels unstable, locks, or catches during movement. Persistent pain that worsens or does not improve within a few weeks of self-care also warrants a medical visit.
A healthcare professional will begin with a detailed physical examination, assessing knee range of motion, stability, strength, and alignment. They will ask about symptoms, onset, and aggravating or alleviating activities. Imaging tests such as X-rays, which can reveal bone abnormalities or arthritis, may be ordered. Magnetic Resonance Imaging (MRI) scans offer more detailed views of soft tissues like ligaments and cartilage, helping to diagnose tears or other damage.
Treatment options are tailored to the specific diagnosis. Physical therapy is a common and effective intervention, focusing on a customized program of exercises to strengthen the muscles around the knee, improve flexibility, and restore proper movement patterns. A physical therapist can guide exercises like single-leg squats, lunges, and specific strength training to rebuild capacity and prevent future issues.
Medications, such as over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can manage pain and inflammation. In some cases, corticosteroid injections may be administered directly into the joint to reduce inflammation and provide temporary pain relief, particularly for arthritis flares. Rarely, if conservative treatments are ineffective or if there is severe structural damage like a significant meniscus tear or advanced osteoarthritis, surgical interventions such as arthroscopy or knee replacement may be considered.