How to Squat Without Knee Pain

In Rehab, Squat by Michael Mash

Knee pain during squats is a very common complaint of many lifters, leading many to stop this exercise all together. Fortunately, by optimizing form, many can overcome this barrier and return to squatting without knee pain!

Chose the Optimal Bar Position
Squatting without knee pain starts with choosing optimal bar position. When it comes to the back squat, we have essentially two choices: the high-bar or low-bar position.

With the high-bar position, the bar is racked on a muscular shelf created by contraction of the upper trapezius muscles. This creates a squat characterized by a more upright torso and decreased hip flexion but INCREASED forward migration of the knee.

While there is nothing inherently wrong with forward knee migration, (it’s actually necessary for the high-bar squat) for those who struggle with knee pain during the squat, it would be best to choose a variation that limits this. Again, the idea here is PAIN-FREE squatting!

With the low-bar position, the bar is carried further down the back, on a muscular shelf created by the rear deltoids. This promotes a squat with more forward torso lean, more hip flexion, but LESS forward migration of the knee. Due to less forward knee migration and heavy posterior chain recruitment, this variation tends to be optimal for those who suffer from knee pain.

Optimize Your Stance 
Stance width and degree of toe-out can also be optimized for those who suffer from knee pain. Generally speaking, gravitating towards a wider stance with a larger degree of toe-out (20-30°) tends to be more tolerable for those who are dealing with knee pain.

Although there is nothing wrong with a narrow, knees forward stance, (left) it may not be optimal for those with current knee pain. Choose a wider, toes out stance (right) to take pressure off of the knees. 

A wider stance makes the squat more of a hip dominant movement, thus taking stress off of the knees. Additionally, turning the toes out, as you will see, will set the knee up for optimal alignment, limiting the amount of tibial internal/external rotation occurring at the knee. For more on this, check out why your should “Turn Your Feet OUT For a Bigger Squat.”

Ensure Efficient Knee Tracking 
In order to squat without knee pain, you should make sure your knee is tracking optimally with both the joint above (the hip) and below (the ankle). We’ve already discussed that a wider, toes-out stance is usually optimal for the cranky knee population, so this requires the knees to ALSO be pushed out to be in line with the toes, and the hips abducted to be in line with the knees.

Notice how the patella tracks right in line with the toes. This minimizes tibial internal/external rotation and is optimal for loading 

When we squat with the hips in an abducted position, this puts the hip adductor musculature in an optimal length-tension relationship to contribute to hip extension! This hip position is less stress on the knee because it utilizes MORE MUSCLE MASS. By utilizing this position, many with prior knee pain will begin to feel the squat in their adductors vs. the anterior knee.

Limiting Depth is NOT the Answer
One of the most common “solutions” I hear for how to squat with knee pain is to limit depth…and I couldn’t disagree more. Squatting to depth with:

  1. Low-bar position,
  2. Toes turned out (25-30°)
  3. Wider stance (just outside shoulder width)
  4. Knees pushed out to be in line with feet
  5. Femurs abducted

heavily recruits the posterior chain and hip adductor musculature to help take stress OFF OF THE KNEES. If we limit squat depth, this becomes a quadriceps dominant squat once again, a variation that is usually not tolerated well by those with knee pain.

Conclusion
There is nothing wrong with the high-bar, knees-forward squat. It is used successfully by many lifters and is beneficial for increased strength, hypertrophy, and athletic performance. However, if you are currently dealing with knee pain, the hip dominant squat variation may be the way to go for you!

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