Knee Pain When Squatting: Causes and Exercises for Pain Relief

All hail the knee: It's our biggest joint, and is responsible for our ability to walk, run, jump, climb stairs, sit, and stand. So it’s natural to worry when your knee starts to hurt — and hurt during specific activities like squatting. Just about anyone can experience this type of pain, because we squat so much as part of our day. “Every time you sit or stand from a chair, you’re squatting,” says Cody Anderson, PT, DPT, a physical therapist at Hinge Health. 

If squatting irritates your knee, you may start to unintentionally — or intentionally — avoid that movement. “If you’re retrieving something from a low cabinet, for example, you may bend at your back or hips instead of your knees,” says Dr. Anderson. While this is an understandable adaptation, this change in mechanics can lead to other problems down the road, and can actually prevent your knee from getting stronger and more resilient. 

Here, learn about some common causes of knee pain while squatting, myths about the “perfect” way to squat, and exercises from our Hinge Health physical therapists to help your knees stay strong.

Why Do I Have Knee Pain When Squatting? 

Knee pain when squatting refers to discomfort experienced in the knee joint during the motion of squatting down. This can happen for a lot of reasons, including a sudden uptick in physical activity, repetitive workouts, muscle imbalances, or an underlying issue in the joint. Lack of activity or a sedentary lifestyle can also cause the knee joint to lose mobility and range of motion, making it more sensitive to pain when you squat. 

You may feel a sudden, sharp knee pain when squatting, or a dull ache or a pulling sensation. You might also experience swelling, stiffness, and a sense of instability. One common misconception is that a sharper pain must mean a worse problem, but this is not necessarily true, says Dr. Anderson. “Sudden, sharp knee pain when squatting usually indicates a more notable irritation or flare up compared to a dull ache that builds. A sharp pain is the brain saying, ‘I’m not ready for that movement right now,’” says Dr. Anderson. But it doesn’t indicate that an injury is worse or will take longer to heal.

Common Causes of Knee Pain When Squatting

Here are some common contributing factors to knee pain when squatting. No matter what the primary cause of your knee pain when squatting is, movement and targeted exercises are usually a first-line treatment for each of these issues. They help strengthen the knee to reduce pain and prevent pain flares from occuring in the future. 

• Tendinitis. You can experience tendinitis (inflammation of a tendon) anywhere there’s a tendon in your body, including the patellar tendon (just below the kneecap) and the quadriceps tendon (just above the kneecap). Repetitive force from activities like repeated jumping (often called jumper’s knee), muscle imbalances, or normal age-related changes to the knees can contribute to tendinitis and knee pain when squatting. 

• Patellofemoral syndrome. This condition can cause a dull ache behind or around the kneecap and is caused by irritation in those areas. It may get worse during activities such as squatting and climbing stairs. It can also be referred to as runner’s knee because it’s common among athletes, but anyone can develop patellofemoral syndrome, regardless of activity level. 

• Meniscus tear. The meniscus is a rubbery, C-shaped disc of cartilage that helps to cushion your knee. Just as it’s normal to develop gray hair on your head or wrinkles on your skin, it’s normal for cartilage to change with age. While these changes are often unnoticeable, they can contribute to knee pain, stiffness, swelling, or reduced range of motion for some people. You may also feel a catching or locking sensation. 

• Osteoarthritis. Similar to the meniscus, it’s normal for the articular cartilage that cushions the knee joint to change with age. If these changes contribute to friction in the knee joint, you may experience aches or stiffness that can make everyday movements, including squats, more difficult. 

• Weak glute muscles. Research shows that working the glutes, inner hip, and inner thigh muscles can help reduce knee pain with squats. If you have pain with squatting and your knees cave inward during a squat, it may help to try strengthening your glute muscles, suggests Dr. Anderson. (Start with the exercises below.) Note: It’s not bad if your knees cave inward during a squat, but it may indicate a lack of glute strength which can be a factor in the bigger picture of your knee pain. 

• Limited ankle mobility. Everything in the body is connected. So if your ankles have a limited ability to flex forward or adjust side to side, it ultimately affects the angle at which your knee bends and it may force your knee to assume a position that’s more stressful for you. Simple at-home exercises can improve your ankle’s range of motion. 

• Too little movement throughout the day. Staying in the same position for too long can irritate your joints and make them stiffer. There’s no right or wrong way to sit or stand throughout the day. You just want to make sure you change positions and move around periodically. That’s why our Hinge Health physical therapists always say your next position is your best position.

Treatment Options for Knee Pain When Squatting 

If you overdid it and your knee is inflamed, these remedies can help you through the worst of the pain, until you're ready to resume your normal activities again.

• Strengthen, strengthen, strengthen. No matter what’s contributing to knee pain when squatting, strengthening the structures around your knee is important in reducing pain. Stronger muscles provide better stability to the knee joint and act as shock absorbers to reduce stress on the knee. Regular strength training exercises help stimulate the production of synovial fluid, which acts as a lubricant to reduce friction between the bones and cartilage within the knee joint. 

• Temporarily scale back on problematic activities. “If certain movements cause a noticeable uptick in pain, it’s okay to scale back on those things while your knee calms down a bit, but it’s important to keep moving in some capacity,” says Dr. Anderson. Inactivity can actually make the pain worse as muscles weaken and the joint stiffens. But movement delivers healing nutrients to the joint and ensures that it stays strong and resilient. 

• Ice, ice baby. Both ice and heat can be beneficial for knee pain when squatting. Icing in particular reduces swelling and inflammation. It may help to apply ice for 20 minutes at a time if you are sore after activity that involves squatting. 

• Warm up before activity. Literally. Applying heat (like a heating pad) to stiff knees before activity can help make your tissues more pliable and resilient when moving. It’s also a good idea to do some warm-up exercises before activity. 

• Use pain relievers. Over-the-counter (OTC) medication such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) to help reduce knee pain and swelling. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• See a physical therapist. A PT can work with you to strengthen your knee muscles to help reduce your pain when squatting and improve function. Physical therapy can be especially effective in preventing future knee pain flares and injuries. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The above exercises recommended by Hinge Health physical therapists help you build up to doing full squats. They focus on stabilization and mobilization of the knee, and also strengthen the areas around your knees to prevent further knee pain with squats.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

How to Prevent Knee Pain When Squatting: 5 Tips

Put simply: Motion is lotion. To keep your knees healthy and strong for life, the key is to stay active in whatever way works for you. Here are specific ways to make sure your physical activity nurtures strong, resilient knees so you can better prevent knee pain with squats. 

• Indulge in ‘movement snacks.’ Since prolonged sitting can irritate knees, it’s crucial to stand up and move around frequently, even if it’s just for a minute or two. “Giving your knees movement throughout the day is actually better than if you sit all day and then hit the gym sporadically,” says Dr. Anderson. Set an alarm to remind yourself to take mini-breaks for movement, whether it’s walking to the bathroom or stretching near your seat. 

• Target knee mobility. “When we’re talking about improving knee pain, a lot of times we’re really talking about improving your range of motion,” says Dr. Anderson. The knee to chest stretch and child’s pose are great movements to start with. They put your knee through its full range of motion while using little or no weight. This can help you bend your knees more deeply during activities like squatting and build up your confidence about moving the joint. 

• Strengthen your hip muscles. “Some people naturally do a very knee-dominant squat, meaning they are very upright and they are just not used to using the hip muscles,” says Dr. Anderson. ”Sometimes, if we give people hip exercises, they become better able to engage their hip muscles and adjust so they can get some pain relief.” And sometimes, simply becoming more aware of how you’re moving and using your muscles can make a big difference.  

• Don’t forget about ankle mobility. Because knees and ankles work together to move your legs, improving ankle mobility helps your knee stay in optimal alignment. Try doing exercises such as ankle pumps (pointing your foot toward your body then away from your body repeatedly) to increase ankle range of motion and reduce stiffness. You can do this movement sitting at your desk at work, standing in line at the grocery store, or when watching TV. 

• Adjust your squatting form if needed. This is important: There is no such thing as a “perfect” squat. “People’s bodies are so variable that it’s really hard to come up with one form for everyone,” says Dr. Anderson. If, however, your squatting technique isn’t working for you (a physical therapist can help you determine if this is the case), you may consider adjusting how you squat, whether that’s at the gym or when picking something up off the floor. The following squat technique is commonly recommended as a starting place, but it’s important to listen to what your body is telling you so you can adapt your squat to meet your own unique needs. 

  • Keep your feet flat on the ground. Think about the inside and outside balls of your foot and your heel — try to keep these three points on the ground, says Dr. Anderson. 

  • Stand with your feet hip width apart.

  • Keep your knees in line with your feet. In other words, you want your knees to rest over your feet, not forward or behind them.  

  • Hold your chest up and keep your core engaged. 

  • When squatting, move your hips back, as if you are about to sit on a chair behind you. 

  • Try to keep the middle of your knees in line with the space between your second and fourth toes throughout the entire movement. 

PT Tip: Try This High-Heel Squat Trick 

It’s true that general squat form recommendations include keeping your feet flat on the ground. But if you have knee pain when squatting, there’s a modification you can try that may help: Raise your heels off the ground. You can do this by resting your heels on a very small step (about two inches), a piece of plywood, a book, or anything else you have lying around the house. You can also do your squats barefoot and place your exercise shoes behind you so you can place your heels on the toes of your shoes. 

Elevating your heels can help knee pain in a lot of ways, such as allowing you to increase squat depth, increasing the range of motion at the knees, and increasing activation of the quadriceps. High-heel squats can also be especially helpful for people who struggle with ankle mobility because it can improve their alignment during a squat, says Dr. Anderson. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

Frequently Asked Questions

Why do my knees crack when I squat? 

If your knees have ever “snap, crackle, and popped” during movement, you’ve experienced something known as crepitus. It’s a common phenomenon that occurs in joints all over the body.  While the sound can be alarming, it’s typically not cause for concern, and it’s not a reason to fear movement or using your knees for exercise. Our joints thrive on movement, which helps keep them well-lubricated (think of it like applying WD-40 to a creaky door hinge). So the more you can move, the better. 

Are squats bad for your knees? 

If you’ve been told to — or assumed you should — avoid squats because you think they’re too hard on your knees, it might be time to think again. You squat all the time in everyday life. Every time you sit down in a chair, get in or out of the car, pick something up from the ground, or climb a flight of stairs, you’re doing a form of squatting. And those activities are not harmful or dangerous — they’re just a part of living. To keep your body healthy, strong, and pain free for these things, the key is to stay active, both in your everyday activities and with targeted exercises. 

Why does my knee hurt when I squat but not when I bend it?

There could be several possible explanations. One common reason is that squatting involves not only bending the knee but also loading it with weight and maintaining stability throughout the movement. This means that your knee has to work a little harder. That’s not a bad thing, but if you have pain when squatting but not bending, strengthening exercises may make squats more comfortable for you. 

How do I fix my knee pain when squatting?

It’s important to realize that knee pain when squatting does not indicate that you’re damaging your body. So you don’t need to avoid squatting for fear of worsening your knee health. But if knee pain is really bothersome, there are some steps you can take to make the movement more comfortable. Start with strengthening the areas around your knees (such as quadriceps, hamstrings, and glutes) and doing mobility exercises to increase your range of motion. You may also need to gradually work up to doing a full squat. Start by practicing mini squats and gradually increase how deeply you squat or how much weight you use. 

Should I keep doing squats with knee pain?

The answer is most likely yes! Squatting can be a very effective way to build strength and manage joint pain, even if you have pain or discomfort when squatting. Start slowly and gradually build up how frequently or deeply you squat. If you have any concerns about your strength, mobility, or knee pain, work with a physical therapist. They can assess the musculoskeletal issues involved in your pain and design customized exercises to improve strength, flexibility, and mobility where you need it.

Is it bad to let your knees go over your toes during a squat? 

If you’re like most people, you’ve been told at some point to not let your knees go past your toes when you squat. It’s true that you might not be ready for your knees to go over your toes just yet, because there can be increases in knee pressure as your knees go farther over your toes. However, it’s not a bad thing to have your knees extend past your toes when squatting and this advice can make it seem really dangerous. Your knees naturally go over your toes all the time in daily life — like every time you go down the stairs, says Dr. Anderson. So just know that if your knees do go over your toes when you squat, you are not damaging your joints. You’re just challenging your knees more.

Why do my knees cave inward when I squat? 

Variations in movement are normal. If you are naturally a bit knock kneed, for example, your body may be used to your knees moving inward (known as knee valgus). “If you’ve been moving this way for 25 years with no problem, chances are this isn’t the main cause of your pain and you probably don’t need to correct this,” says Dr. Anderson. If your knees tend to cave inward in excess, though, it could signal a muscle imbalance or an opportunity to strengthen your knees. 

References

1. Almeida, G. P. L., Rodrigues, H. L. das N., Coelho, B. A. L., Rodrigues, C. A. S., & Lima, P. O. de P. (2021). Anteromedial versus posterolateral hip musculature strengthening with dose-controlled in women with patellofemoral pain: A randomized controlled trial. Physical Therapy in Sport, 49, 149–156. doi:10.1016/j.ptsp.2021.02.016

2. Bump, J. M., & Lewis, L. (2022). Patellofemoral Syndrome. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK557657/

3. Cannell, L. J., Taunton, J. E., Clement, D. B., Smith, C., & Khan, K. M. (2001). A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper’s knee in athletes: Pilot study. British Journal of Sports Medicine, 35(1), 60–64. doi:10.1136/bjsm.35.1.60

4. Caterisano, A., Moss, R. F., Pellinger, T. K., Woodruff, K., Lewis, V. C., Booth, W., & Khadra, T. (2002). The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. Journal of Strength and Conditioning Research, 16(3), 428–432.

5. Move More; Sit Less. (2022, June 2). Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/index.htm

6. Mulcahey, M. K. (2022, February). Common Knee Injuries. OrthoInfo — American Academy of Orthopaedic Surgeons.  https://www.orthoinfo.org/en/diseases--conditions/common-knee-injuries/

7. Deshpande, B. R., Katz, J. N., Solomon, D. H., Yelin, E. H., Hunter, D. J., Messier, S. P., Suter, L. G., & Losina, E. (2016). The number of persons with symptomatic knee osteoarthritis in the United States: Impact of race/ethnicity, age, sex, and obesity. Arthritis Care & Research, 68(12), 1743–1750. doi:10.1002/acr.22897

8. Sheth, N. P. (2022, April). Osteoarthritis. OrthoInfo — American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/diseases--conditions/osteoarthritis/

9. Wittstein, J. R. & Wilkerson, R. (2021, September). Patellar Tendon Tear. OrthoInfo — American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/diseases--conditions/patellar-tendon-tear/

10. Mulcahey, M. K., Hettrich, C. M., & Liechti, D. (2020, October). Patellofemoral Pain Syndrome. OrthoInfo — American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/diseases--conditions/patellofemoral-pain-syndrome/

11. Pereira, P. M., Baptista, J. S., Conceição, F., Duarte, J., Ferraz, J., & Costa, J. T. (2022). Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review. International Journal of Environmental Research and Public Health, 19(15), 9241. doi:10.3390/ijerph19159241

12. Raj, M. A., & Bubnis, M. A. (2022). Knee Meniscal Tears. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK431067/

13. Foran, J. R. H. (2020, June). Total Knee Replacement. OrthoInfo — American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/treatment/total-knee-replacement/