Squats And Knee Pain

By: Dr. Giovanni Silva DC

There are numerous reasons that people may experience knee pain in the gym or weight room. Frequently people come to my clinic complaining of knee pain, often following a strenuous workout that emphasizes squats. At times the pain may become so chronic that even the mildest of a squatting session brings on severe pain.

Patella-Femoral Pain Syndrome (PFPS)

The condition of knee pain that most commonly accompanies the squat is referred to as Patella-Femoral Pain Syndrome (PFPS). This syndrome is typically chronic in nature, usually brought on by repetitious, incorrect squatting technique.

The knee is the largest joint in the body, consisting of the femur (thigh bone), tibia (shin bone), and patella (knee cap). At the distal end of the femur a groove or notch exists. The under surface of the patella contains a protrusion that fits smoothly into the notch of the femur. This notch works as a tracking mechanism as the patella slides upward against the femur when the quadricep muscle contracts. This gliding taking place between the patella against the femur should be smooth and pain free.

Adding to the pain free movement of the knee is a protective covering on the under surface of the patella and on the surface of the femoral notch known as a fibrocartilagenous pad. This fibrocartilagenous covering acts as a cushion and aids in the smooth gliding of the patella on the femur.

Chronic knee pain due to PFPS occurs in a bodybuilder or weightlifter as a result of the bearing down or degeneration of this protective covering.

One way that this covering wears down is by continuous chronic grinding of the back of the patella against the groove of the femur. This often happens with improper performance of the squat. Executing the squat incorrectly causes the undersurface of the patella to come into close contact with the femur. As the quadriceps contract to balance the weight on the squatters shoulders, the contraction brings the patella even closer to the femur. As the squatter bends the knees and the knees travel over the toes, the squatter has just added more friction between the patella and the femur causing even more grinding to occur between the patella and the femur. Over months and even years of squatting in this manner the fibrocartilagenous covering wears down so much that at times even trying to do something as simple as kneeling or walking up or down stairs may bring on excruciating knee pain.

Prevention and Correction

To prevent bad tracking, as the squatter begins to make the descent movement with the weights on the shoulders, as the knee begins to bend, the squatter must make sure that the front of the knees do not travel over the toes.

One way to avoid the overriding of the toes by the knees is to extend the buttocks back as the the squatter descends downward making sure that the weight of the barbell is loading on the heels of the feet. So the key to performing the squat so as to avoid future knee problems is to avoid the overriding of the knees over the toes and keeping the load on the heels of the feet.

Some weightlifters refuse to perform the squat because they believe it will cause knee pain, but if the exercise is modified and performed correctly, the knee pain should be prevented or the pain should subside.

It is also important to remember to properly warm-up your legs prior to beginning the exercise through some type of light cardiovascular work that uses the legs. An additional recommendation is to perform a light quadriceps stretch before squatting.