Medial knee pain, or discomfort felt on the inner side of the knee joint, is a frequent complaint among people who incorporate squatting into their exercise routine. Squatting places significant force across the knee, and if biomechanics are less than optimal, that stress can concentrate on the medial structures. Understanding this specific location of pain is the first step toward correction, as inner knee discomfort often points to distinct anatomical and mechanical causes. The movement itself acts as a magnifying glass, highlighting underlying imbalances. Addressing this discomfort involves investigating both the structures inside the joint and the way the body moves during the squat.
Structural Causes of Medial Knee Pain
The sensation of pain on the medial side of the knee during a squat is frequently tied to stress on the soft tissues designed to stabilize that area.
Medial Collateral Ligament (MCL) Strain
A common culprit is a minor strain of the Medial Collateral Ligament (MCL), which runs along the inner side of the knee and resists inward forces. A slight “valgus stress,” where the knee caves toward the midline during the movement, places a tensile load on the MCL, leading to localized pain. This discomfort is often described as a sharp pull or general soreness during or immediately following the squat.
Medial Meniscus Issues
Another significant source of inner knee pain is the medial meniscus, the C-shaped cartilage that acts as a shock absorber between the thigh bone and the shin bone. Repetitive or high-pressure loading, especially with improper knee tracking, can irritate or tear this structure. Meniscal issues often present as a deeper, internal ache, sometimes accompanied by mechanical symptoms such as clicking, catching, or locking within the joint.
Pes Anserine Bursitis or Tendinitis
Pain slightly below the main joint line may indicate Pes Anserine Bursitis or Tendinitis. This involves the inflammation of the bursa—a small, fluid-filled sac—or the tendons of the sartorius, gracilis, and semitendinosus muscles, which insert together in this area. Deep knee flexion during squatting increases friction and compressive forces on the bursa and tendons. This condition is often characterized by tenderness to the touch about two inches below the knee joint on the medial tibia.
Underpinning many structural irritations is a mechanical fault known as dynamic valgus collapse, where the knee drifts inward during the descending or ascending phase of the squat. This inward motion shifts stress onto the medial components of the knee joint. The dynamic valgus position forces the MCL to stretch and compresses the medial meniscus, making it a primary mechanical contributor to medial knee discomfort. This movement pattern is a functional issue that places undue strain on the anatomical structures.
Immediate Assessment and When to Seek Help
When sharp or sudden pain occurs during a squat, stop the activity immediately to prevent further injury. For acute pain, the initial self-care strategy involves the R.I.C.E. protocol: rest, ice, compression, and elevation. Applying a cold pack to the inner knee for 15 to 20 minutes several times a day helps manage initial pain and swelling.
If the pain is minor and subsides quickly, a few days of rest and reduced activity may be sufficient before a gradual return to exercise with modified technique. However, certain symptoms are considered red flags and require professional medical evaluation.
You should seek immediate medical attention if you experience any of the following:
- Inability to bear weight on the affected leg.
- The knee feels unstable or gives way.
- Severe swelling or a noticeable change in the shape of the knee.
- An audible pop or snap occurred at the time of injury.
- The knee frequently locks, catches, or clicks painfully.
- Pain does not begin to improve within a few days of rest.
Corrective Strategies for Squat Mechanics
Long-term resolution of medial knee pain during squatting centers on correcting dynamic valgus collapse. This mechanical fault is often a compensatory strategy for insufficient strength in the hip abductors and external rotators, such as the gluteus medius. These hip muscles are responsible for maintaining the knee’s alignment and preventing it from collapsing inward under load.
Strengthening Hip Stabilizers
A primary corrective strategy involves targeted strengthening of these underactive muscles. Exercises like clamshells, lateral band walks, and glute bridges with a mini-band help activate hip stabilizers. Consistent activation establishes a stronger kinetic chain, allowing better control of the knee’s position during the squat.
Improving Ankle Mobility
Limited ankle mobility, particularly dorsiflexion (moving the shin forward over the foot), also contributes to poor knee tracking. Restricted ankle flexibility causes the foot to pronate excessively, encouraging the knee to fall inward to achieve squat depth. Mobility drills, such as deep lunge stretches or banded ankle mobilizations, improve dorsiflexion and enable a more vertical shin angle during the squat.
Technique Refinement
For technique refinement, focus on conscious cues to drive the knees outward throughout the range of motion, ensuring they track in line with the middle of the foot. Using a resistance band looped above the knees provides a physical cue, forcing the individual to actively push against the band to maintain proper alignment. This adjustment, combined with controlling the descent and ascent, integrates the newly strengthened hip muscles into the squat pattern.
Returning to full squatting should follow a gradual progression, beginning with partial depth, low-load squats. Gradually increase the range of motion and weight only as pain remains absent. This methodical approach ensures that corrected movement patterns become automatic, minimizing mechanical stress on the medial knee structures.