Pain is one of the biggest factors that limits physical autonomy. Not only that, it also creates mental barriers throughout daily living. These challenges increase stress, limit confidence and reduce physical activity
levels which has an adverse effect on the body's overall orthopedic and systemic health. For many people across the United States, it's chronic knee pain that is their burden.
For those suffering from knee pain, it's common to feel as if many exercises are suddenly off the table. Eliminating essential lower-body movements
The squat is one such foundational and functional lower-body movements that is important to master. The list of our normal squatting movements
Instead of eliminating this movement from an exercise program to avoid pain, approach it intelligently with proper technique and pain-free training progressions to yield the best results.
The Squat Doesn't Hurt You. The Way You Squat Hurts You!
Throughout a lifetime, people encounter injuries, orthopedic limitations, surgeries, excessive sedentary habits and other challenges that can cause compensatory patterns throughout the entire kinetic chain. These variables cause micro-trauma and compensation in our musculoskeletal system which adversely affects how the body moves on a daily basis.
During exercise, those same compensations and limitations are present when additional load or range of motion is applied to the movement incorrectly, increasing the risk of injury. Instead of trying to force the movement or eliminate it all together, consider smart training methodologies, which will help improve your movement and work around any knee pain that might exist.
Squats are one of the most butchered movements at the gym, leading to pain, higher risk of injury and subpar performance. Some common mistakes include breaking at the knees first, limited ankle mobility and knee valgus collapse.
To properly perform a squat, the following components should be exhibited every time to maximize strength and power output while reducing the risk of injury:
- The spine must remain in a neutral position throughout the entire movement. There should not by any excessive flexion or extension of the spine.
- Keep the feet firmly planted on the ground, shoulder-width apart, throughout the motion. Do not let the heels rise up or let the feet move at any point.
- When an external load such as a dumbbell is added to the movement, the load should stay over the midline of the foot. This minimizes unwanted movement and stresses on the joints.
Pain-Free Squat Variations
To help work around the various challenges and restrictions that may be limiting you from performing a pain-free squat and foundational strength development, consider adding some of these variations to your strength training routine.
1. Coaching Cues
Sometimes all that is needed are some simple cues to clean up your squat pattern. There are countless cues that can be used to clean up someone's squat depending on what challenges they are facing, but before you attempt your first repetition, remember these basic cues:
- "Keep the core tight." You would be surprised how many people forget this one. Engage the core to provide further stability throughout the entire movement.
- "Break at the hips first." Let the hips initiate the first part of the movement, not the knees.
- "Push the knees out." It's common for people to allow their knees to fall inward (also known as a valgus collapse) when they squat. Using the strength in your outer quads, push the knees out prevent this and to provide more stability throughout the movement.
- "Drive through the heels." Working to drive through the heels while keeping the feet flat will help reduce pressure in the front of the feet, which will decrease the amount of stress that is transferred through the knees, in turn.
2. The Box Squat
The box squat is a great variation commonly used in both the physical therapy and strength training worlds. A box is utilized to allow for the trainee to sit down at the bottom of the movement, keeping the knees protected from a deeper range of motion that may not be accessible just yet.
A major factor that can also cause knee pain is limited ankle mobility. The box squat enables someone with ankle mobility restrictions to work in bigger and safer ranges of motion, as very limited ankle dorsiflexion is required to complete this movement.
Once adequate strength is gained from bodyweight training, an additional load may be introduced to this movement for further strength development.
- Start seated on the box or a chair with the core engage and tall posture.
- Place feet firmly on the ground underneath the knees.
- Driving through the heels of the feet, rising up from the box into a tall standing position.
- Break at the hips, controlling the eccentric portion of the movement back down to the box. Do not sit back down too quickly; the goal is to control both the concentric and eccentric portions of the exercise.
- Complete eight to 12 repetitions. As you build strength, you can add a weight to increase the challenge.
When building foundational strength, the TRX squat is a great option due to its aid in stability and progressive assistance when needed. Holding on to the handles provides more stability, while also reducing load throughout the movement to reduce stress on the knees. This variation also helps teach proper squat mechanics by making it easier to learn how to "break at the hips" at the beginning of the movement.
- Grasp the TRX handles slightly in front of the body and place your feet at the correct width for an optimal base of support.
- Engage the core musculature, break at the hips and go straight down into your squat position.
- Use the TRX system to assist in lowering you down to proper depth, as well as raising you back up to the starting position.
- Complete eight to 12 repetitions to start.
Another common factor among painful squatters is valgus collapse of the knees. When the knees collapse inward toward each other, rather than tracking straight over the ankles, high amounts of stress are placed on the knees and other surrounding structures. In addition, this can also limit your squat depth and cause further compensation during the movement, ultimately putting you at risk of injury.
Placing a mini resistance band around the legs right above the knees forces the knees to remain in the proper position. By pressing your knees outward against the band, you engage the glutes, abductors and other key stabilizers, taking the pressure off your knees and cleaning up your squat pattern.
- Place band right above the knees.
- Apply pressure using both knees to keep tension on the band and the knees apart.
- Engage the core, break at the hips and sink your hips straight down.
- Drive through the heels to come back to the starting position.
- Complete eight to 10 repetitions to start. After perfecting the motion, you can add a kettlebell or medicine ball for an extra challenge.
The purpose of this article is to help guide and correct common movement compensations and incorrect techniques that cause or increase the pain response at the knees. This is not a clinical diagnosis. Please consult with a licensed medical professional if you are seeking a medical diagnosis. These exercises are intended to help guide individuals who are struggling with chronic knee pain during exercise. If you need more guidance, please consult a movement specialist professional.