All hail the knee: It's our biggest joint, and responsible for our ability to walk, run, jump, climb stairs, sit, and stand back up. 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 or a couch, 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 more from the back and the hips instead of the 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 to help your knee stay strong.

Why Does My Knee Hurt When I Squat? And How Bad Is It?

Knee pain during squatting can happen for a lot of reasons, including a sudden uptick in physical activity, repetitive workouts, 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. Many people experienced this during the COVID-19 pandemic, for example. “During the early days of the pandemic, many people were not as active. And an increase in home deliveries meant we were less likely to be in the store, squatting to get things off the shelf. As people started to go back to their usual routines, they may have found that squatting caused pain when it didn’t before,” says Dr. Anderson. 

Knee pain when squatting may feel like a dull ache, a pulling sensation, or a sharp pain. One common misconception is that a sharper pain must mean a bad injury and worse outcome, but this is not necessarily true, says Dr. Anderson. “A sharp pain in the knee 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 necessarily 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 occurring in the future. 

• Patellar tendinitis. The patellar tendon is located just below the kneecap. Repetitive force through the patellar tendon from activities like repeated jumping (often called jumper’s knee) can contribute to inflammation or swelling just below the knee. This can contribute to knee pain when squatting for some people. 

• Quadriceps tendinitis. The quadriceps tendon is located just above the kneecap and connects the quadriceps muscles (front thigh) to the top of the kneecap, helping you straighten your knee during activities like climbing stairs, walking, running, and jumping. If the quadriceps tendon becomes strained or irritated, you’ll feel pain just above the kneecap.

• 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. Just as it’s normal to develop gray hair on your head or wrinkles on your skin, it’s normal for the cartilage that cushions the knee joint 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. If you have pain with squatting and your knees cave inward during a squat, try strengthening your glute muscles to see if it helps, suggests Dr. Anderson. Start with the standing side leg raise (instructions below). Know that knees caving inward during a squat isn’t necessarily a bad thing, or something that contributes to pain, 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 ankle has 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 (see prevention tips and exercises below).

• Too little movement throughout the day. Staying in the same position for too long can be irritating to your joints and make them stiffer. There’s no right or wrong way to sit or stand throughout the day. The most important thing you can do to prevent and manage stiff joints is to change positions and move throughout the day. If you have to sit a lot during the day, make sure to change positions and take movement breaks. Same with standing. That’s why our Hinge Health physical therapists always say your next position is your best position.

Treatment Options for Knee Pain During 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.

• For an overuse injury, try modifying your activities. You may need to scale back on certain activities that cause a noticeable uptick in your pain to give your knee time to recoup, but it’s important to keep moving in some capacity. Movement delivers healing nutrients to the joint and ensures that it stays strong and resilient.  

• For inflammation, try: 

  • Icing your knee for 10 minutes after activity. 

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

  • Compression (like a knee sleeve), to potentially help to keep the swelling under control. 

• For stiffness try using heat before activity, such as a heating pad for 10 minutes. Warming up the tissues can help make them more pliable and resilient when moving. 

When to See a Doctor

Most cases of knee pain during squatting are nothing to worry about and resolve with activity modifications and other conservative measures. If you have excessive swelling that lasts for several days and happens in conjunction with squatting, see your medical provider. There may be an underlying medical issue that requires evaluation, says Dr. Anderson.

The Truth About the ‘Best’ Way to Squat

Spoiler alert: 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. The squat technique below is commonly recommended as it works for most people. However, there may be good reasons your body has trouble following these instructions to a tee. The important thing is to listen to what your body is telling you during a squat so you can adapt your squat to meet your own unique needs. 

General Squat Form Recommendations: 

• Keep your feet flat on the ground. Think about the inside and outside balls of your foot and your heel — these three points should all be 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. 

What It Means If: 

• You are very upright. An upright position when squatting tends to mean you’re heavily engaging the quadriceps muscles (top of the thigh). This could happen because of your body mechanics — if you have a long torso and shorter thigh bones (common in powerlifters, for example). Or, you may not be fully engaging your glute muscles.

• You are very bent forward. This means you are engaging your hips and back more than your quads and knees. This could mean you have an opportunity to increase your knee range of motion, or that you’d benefit from strengthening your quads. (Start with the knee extension, below).

Squat Myths to Bust

Myth: It’s really bad if your knees go over your toes. 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 knee 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. The knee naturally goes 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 knee does go over your toes, you are not damaging the joint. You are just challenging your knee more.

Myth: You shouldn’t let your knee cave inward (known as knee valgus) during a squat. In excess, knee valgus could signal weak muscles or poor form. But variations in movement are normal. If you are naturally a bit knock-kneed, for example, your body may be used to your knee moving inward. “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 may not need to correct this,” says Dr. Anderson. 

Myth: It’s bad to turn out your toes. If your toes turn out when you squat, it may be because of how your hip bones are aligned. In that case, it’s okay to do what feels most natural for your body. In fact, turned-out toes can actually allow you to squat deeper with less stiffness. 

How to Prevent Knee Pain When Squatting

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. The CDC recommends a minimum of 150 minutes of cardiovascular exercise a week, and strength training twice a week can keep your muscles strong and protect your joints from stress. Here are specific ways to make sure your physical activity nurtures strong, resilient knees.

Indulge in ‘movement snacks.’ Since prolonged sitting can irritate the 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 at night,” says Dr. Anderson. Set an alarm on your phone to remind yourself to take hourly mini-breaks for movement, whether it’s walking around the block or just to the bathroom, or stretching near your seat. 

Improve knee mobility — gently. “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. Here are two ways to help your knee bend to 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.  

• Knees to chest stretch: Lay on your back and pull your knees to your chest, grasping the back of your thighs or the top of your shin bones. Breathe deeply and hold for 30 to 60 seconds. For an even gentler stretch, do this one leg at a time. 

• Child’s pose. This popular yoga pose mimics a squat — but without supporting the weight of your body. Kneel with your knees shoulder width apart, feet together, and buttocks down toward your heels. Lean forward and place your hands on the ground for support, and breathe deeply. Hold for one to two minutesImprove ankle mobility. Because the knee and the ankle work together to move the leg, improving ankle mobility helps your knee stay in optimal alignment as well. Improve your ankle’s range of motion with a knee-to-wall stretch. Here’s how to do it: 

• Place your bare foot flat on the floor about three inches from the wall, then bend your knee forward until it hits the wall. Move your foot back a half inch or so until you can no longer touch the wall with your heel on the ground. 

• Slowly rock your knee toward the wall and hold for three to five seconds. Relax back to the starting position and repeat six to eight times before repeating on the other side. 

• If your knee begins to touch the wall during the repetitions, this is a sign your ankle mobility is improving. 

Engage 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,” says Dr. Anderson. And sometimes, simply becoming more aware of how you’re moving and using your muscles can make a big difference. Get started with the standing side leg raise below.

These exercises recommended by Hinge Health physical therapists take you through a low, medium, and high load to build up to doing full squats. Start by doing these three days a week, and slowly increase to every other day or daily. 

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.

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 during 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.

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