How to Fix Knee Pain When Squatting

Knee pain during squats is a common issue that can affect anyone, whether active or inactive, young or old. Whether you’re an athlete, a fitness enthusiast, or someone whose daily activities put pressure on the knees, knee pain can be incredibly discouraging. This article explores the potential causes of knee pain during squats, preventive measures, and ways to manage this issue.

Anatomy of the Knee

To understand why knee pain occurs during squats, it’s crucial to understand the knee’s anatomy. The knee joint is a complex structure consisting of bones, cartilage, ligaments, and tendons. The major components include:

  • Femur (thighbone): The femur’s head forms part of the hip joint, while its lower end forms the upper part of the knee joint.
  • Tibia (shinbone): The tibia is the larger and stronger of the two lower leg bones, forming the lower part of the knee joint.
  • Patella (kneecap): This small, triangular bone in front of the knee joint serves as a protector and increases the leverage of thigh muscles.
  • Meniscus: The knee has two crescent-shaped pieces of cartilage, the medial and lateral meniscus, which cushion the joint and reduce friction.
  • Tendons: These connect muscles to bones. The quadriceps tendon connects the quadriceps muscles to the patella, while the patellar tendon connects the patella to the tibia.

Common Causes of Knee Pain When Squatting

Knee pain related to squatting can stem from various conditions, each with distinct causes and characteristics.

1. Patellofemoral Pain Syndrome (PFPS)

   PFPS, also known as “runner’s knee,” is characterized by pain around the kneecap due to overuse, improper kneecap alignment, or muscle imbalances. Squatting can exacerbate this condition by putting extra pressure on the patella. Factors contributing to PFPS include:

  • Overuse: Excessive pressure from activities like running, jumping, or squatting.
  • Muscular Imbalances: Weak quadriceps or hamstrings, or tight hip muscles, can misalign the kneecap.
  • Biomechanical Issues: Flat feet or other foot problems can increase pressure on the patella.

2. Tendinitis

   Tendinitis involves inflammation of the tendons, commonly around the patellar region (“jumper’s knee”). This condition is prevalent among athletes and those engaged in regular jumping activities. Squatting can strain these inflamed tendons, causing pain. Key aspects include:

  • Overuse: Repeated stress from sports or squatting.
  • Symptoms: Pain and tenderness below the kneecap, especially during activities like walking or climbing stairs.

3. Meniscus Tears

   The menisci are cartilage discs that act as shock absorbers within the knee joint. Meniscus tears can result from acute injuries or degenerative changes over time. Squatting can exacerbate symptoms by increasing joint pressure. Important points include:

  • Acute Injury: Sudden twists or turns, often seen in sports.
  • Degenerative Changes: Cartilage wear over time increases tear susceptibility.
  • Symptoms: Pain, swelling, and a feeling of catching or locking in the knee.

4. Arthritis

   Osteoarthritis, a degenerative joint disease, can affect the knee, causing pain during movements like squatting. Arthritis leads to joint inflammation and decreased mobility. Key factors include:

  • Cartilage Breakdown: Gradual cartilage deterioration exposes bones to friction.
  • Inflammation: Chronic pain and stiffness.
  • Symptoms: Pain, significant swelling, limited movement, and a feeling of instability.

5. Bursitis

   Bursae are small fluid-filled sacs that reduce friction between tissues. Bursitis, the inflammation of these sacs, can cause knee pain, especially during activities like squatting. Key points include:

  • Types: Prepatellar bursitis (inflammation in front of the kneecap) and infrapatellar bursitis (below the kneecap).
  • Causes: Repetitive kneeling, overuse, direct injury, or infections.
  • Symptoms: Swelling, warmth, and discomfort, especially during knee flexion.

6. IT Band Syndrome

   The iliotibial (IT) band is a thick tissue running along the thigh’s outer side. IT band syndrome occurs when this band becomes tight or inflamed, causing pain on the knee’s outer side. Squats can intensify this condition by increasing pressure on the IT band. Important aspects include:

  • Function: Stabilizes the knee and hip during movement.
  • Causes: Overuse, improper footwear, running on uneven terrain, or low flexibility.
  • Symptoms: Sharp or burning pain on the knee’s outer side, worsening with movement or exercise.

By understanding the anatomy of the knee and the common causes of knee pain during squats, individuals can take preventive measures and manage any existing issues effectively.

Additional Factors Contributing to Knee Pain When Squatting

Beyond specific conditions, various other factors can contribute to knee pain during squatting. Muscle weakness and imbalance are significant contributors. For instance, the quadriceps muscles play a crucial role in knee extension and joint stability. When these muscles are weak, the knee joint is subjected to increased force, leading to pain. Additionally, tight hamstrings can pull the knee joint, causing improper positioning and discomfort. Similarly, weak hip abductors and external rotators can result in poor knee alignment and increased strain on the knee.

Poor squatting technique is another critical factor. Squatting with knees collapsing inward (valgus) places excessive stress on the knee joint and its structures. Squatting too deeply or too quickly can overstress the knee joint, increasing pain. Moreover, shifting pressure to the toes and foot area during squats increases stress on the knee.

Overtraining and lack of recovery also play a role in knee pain. Insufficient rest, resulting from failing to balance training with adequate recovery, can lead to chronic knee pain and injuries. Additionally, rapidly increasing the intensity, duration, or frequency of squatting exercises can result in knee injuries. Proper training and recovery protocols are essential to prevent knee pain associated with overtraining.

Professional Treatment and Interventions

If non-prescription measures are ineffective, professional care may be necessary. Options include:

Physical Therapy

A physical therapist can create a personalized rehabilitation program that addresses specific needs and targets key muscle groups to support the knee joint. This program typically includes strengthening exercises to bolster the muscles around the knee, enhancing stability and reducing pain. Flexibility and mobility work is also crucial, as it helps improve overall joint function and prevent stiffness. Manual therapy techniques, such as massage, mobilization, and dry needling, can be employed to relieve pain, reduce inflammation, and improve the knee’s range of motion and functionality.

Medications and Injections

Medications and injections can play a vital role in managing knee pain. Over-the-counter pain relievers like paracetamol or prescription NSAIDs are commonly used to reduce pain and inflammation. For more significant relief, corticosteroid injections can provide a Temporary alleviation of inflammation and pain. Hyaluronic acid injections are another option, particularly for those with osteoarthritis, as they help lubricate the joint and reduce discomfort. For advanced medication options, booking a consultation with Dr. Calvert at the Institute of Orthopedics, Spine, & Sports is recommended.


Acupuncture is an alternative treatment that involves inserting thin needles into specific body points to alleviate pain and treat various conditions. For knee pain, acupuncture can be particularly effective in reducing inflammation by stimulating the body’s natural healing response. It also improves blood flow, enhancing circulation in the affected area and promoting healing. Additionally, acupuncture can provide an extra form of pain management, offering both immediate relief and supporting long-term recovery. Appointments can be booked at Manhattan Physical Therapy, where acupuncturists focus on both immediate pain relief and preventing future injuries.

Surgical Intervention

In severe cases where conservative treatments fail, surgical options may be necessary. Arthroscopy is a minimally invasive procedure that allows surgeons to repair or remove damaged tissue within the knee. For meniscus tears, the treatment approach depends on the extent, location, and nature of the tear, with options ranging from repair to removal. In cases of severe osteoarthritis or significant knee deformities, partial or total knee replacement may be required to restore function and alleviate pain.


Knee pain while squatting can significantly impact daily activities. However, understanding its causes and adopting preventive measures can help manage and reduce pain. Strengthening specific muscles, improving technique, and seeking professional advice can minimize knee pain and potentially eliminate it, allowing you to maintain an active lifestyle. For prolonged or worsening knee pain, consulting a healthcare professional is crucial to determine the underlying cause and the best course of action. 

For foot problems, consider consulting New Jersey Foot Surgeons for specialized advice.

ersey Foot Surgeons for specialized advice.

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