Training | POSTED June 30, 2024

Are Squats Bad for Your Knees?

Have you ever been told “Squats are bad for your knees?”. Perhaps instead you’ve been told “You can squat, but your knees shouldn’t go past your toes!”. Whatever the case, there’s a prevailing myth that performing a squat is dangerous to one’s knee, causing knee pain. Knee pain itself commonly manifests as either non-specific “Patellofemoral Pain Syndrome” (PFPS) or Knee Arthritis. PFPS is when pain occurs around the patella during load bearing on a flexed knee. Arthritis is an umbrella term that refers to a wide range of inflammatory conditions that affect the bones, muscles, and joints. In Australia, arthritis alone affected just under 3.7 million people (14.5%) in 2022. At Ivy Training we love squats as a way to load up the knee. Today we’ll discuss why in fact, if you have knee pain, squats, or any exercise that loads the knee, may be the answer for you.

Train for strong knees

Pain is a complex topic that we will not cover in today’s article. However, it’s good advice that if a movement clearly exacerbates pain, modification is necessary. Importantly however, individuals should strive to be as active as possible. For PFPS in particular, a Cochrane Review found the following: “patients who exercise generally have improvement in short-term and long-term pain, both at rest and with activity, when compared with those who do not exercise”. Moreover, this review advised that exercises focussed on the trunk, hip and knee would be beneficial. For osteoarthritis in particular, “exercise can help improve symptoms”. Clearly, there’s a case for exercising to get stronger knees.

Squat ’til you drop

As Flo Rida said, get “Low” (I know, terrible joke). Unlike what you may have heard, deep squats are not injurious. In fact, as Hartmann et al found, “Provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity.” Moreover, in a randomised control trial, it was clear that improving knee extension and flexion strength positively affected knee pain symptoms in those dealing with osteoarthritis. As suggested earlier, exercise that focuses on the trunk, hip and knee are beneficial. Enter the squat. It’s a movement that simultaneously loads the trunk, hip and knee musculature through a large range of motion. Although the squat can be hard to master, it’s well worth learning.

Just get moving!

Ultimately, you don’t need to squat. There are many ways to develop knee flexion and extension strength, hip and trunk strength. Leg Presses, Leg Extensions and Curls, Lunges, Plank Holds & Sit-Ups are all valid exercises which may contribute to knee strengthening. We like how Vincent and colleagues summarised their paper on knee osteoarthritis: in regard to which exercise to pick, it can be “determined by preference, goals, tolerance to the contraction type, and equipment availability.” If you’re dealing with knee pain, however it manifests, we can most likely help. We have helped many of our clients who have come to us with pre-existing knee pain recover and become stronger. Reach out to us today to enquire about training with us.

References

  1. Eccentric and Concentric Resistance Exercise Comparison for Knee Osteoarthritis – PubMed (nih.gov)
  2. Patellofemoral Pain Syndrome | AAFP
  3. Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load – PubMed (nih.gov)
  4. Arthritis, 2022 | Australian Bureau of Statistics (abs.gov.au)
  5. Chronic musculoskeletal conditions : Osteoarthritis – Australian Institute of Health and Welfare (aihw.gov.au)
  6. Crossley KM, Stefanik JJ, Selfe J, et al. 2016 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839-843.