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What to do About Squatting and Knee Pain

6

Filed Under (Fitness, General) by Rick Kaselj



While at the gym, I got some questions on knee pain and squatting.

I gave my typical answers but wanted to check my answers when I got home by looking at the research.

I dug into the research and here are a few things that I found. (It is great to do this again as it has been some time since I have done a post like this.)

How Deep to Squat with a Painful Knee?

What They Looked At

Medicine-Science-in-Sports-ExerciseThey looked at the knee forces in the tibiofemoral joint (the thigh bone moving on the shin bone) and the patellofemoral joint (knee cap on thigh bone) when it related to squatting.

What They Found

  • Parallel squat (thigh parallel to floor) is recommended over a deep squat as the injury potential to the menisci and cruciate and collateral ligaments increase with a deep squat.
  • Quadriceps, hamstring and gastrocnemius activity increased with knee flexion during the squat.
  • They recommended for the rehabilitation of the knee is movements be performed from 0 degrees to 50 degrees of knee flexion. Which they classified as functional range of the knee.

Recommendation

The squat is safe for ligament injuries but when moving into a deep squat there is great risk of injury to the inside of the joint and the ligaments. This needs to be considered when the knee is injured and in a knee rehabilitation situation. The cost/benefit needs to be considered for a healthy knee.

Where to get more information: Escamilla RF. (2001). Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc. 2001 Jan;33(1):127-41.

What Happens to the Knee Joints when Squatting with Weight?

What They Looked At

JOSPTThis research looked at healthy adults that performed a single repetition bilateral squat with knee flexion reaching 90 degrees. They looked at the patellofemoral joint forces without external load and with external load (35% of subject’s body weight.)

Fifteen healthy adults performed single-repetition squats to 90 degrees of knee flexion without an external load and with an external load.

What They Found

  • Patellofemoral joint forces increased with knee flexion (increase in squat depth).
  • Addition of external load increased patellofemoral reaction forces.

Recommendation

If you have patellofemoral or anterior knee pain, you can decrease the stress on the joint by decreasing the squat depth and reducing or eliminating load.

Where to Get More Information: Wallace DA, Salem GJ, Salinas R, Powers CM. (2002). Patellofemoral joint kinetics while squatting with and without an external load. J Orthop Sports Phys Ther. 2002 Apr;32(4):141-8.

What Effect do Leg Exercises Have on the ACL?

This was a fascination article with so much information.

What They Looked At

They looked at the research that was out there and reviewed it to see what it had to say about exercises and the forces they put on the ACL.

What They Found

  • There was greater stress on the ACL during non-weight bearing exercises (seated knee extension without¬†resistance) versus weight bearing exercises (squatting).
  • ACL is loaded more during 10 to 50 degrees of knee flexion compared to 50 to 100 degrees.
  • Squatting with knees pass the toes and heels off the ground lead to an increase in load on the ACL.

Recommendations

This is a great article. If you work with people with ACL injuries or you have one, I would suggest getting your hands on it. It highlights ACL stresses for leg extension, barbell squat, leg press, wall squat, single leg squat, lunging, walking and jumping.

Escamilla RF, Macleod TD, Wilk KE, Paulos L, Andrews JR. (2012). Anterior cruciate ligament strain and tensile forces for weight-bearing and non-weight-bearing exercises: a guide to exercise selection. J Orthop Sports Phys Ther. 2012 Mar;42(3):208-20. doi: 10.2519/jospt.2012.3768. Epub 2012 Feb 29.

Lots of great research out there when it comes to squatting and its effect on knee pain.

Rick Kaselj, MS

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Comments posted (6)

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Thanks Rick!

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Hollis Reply:

This article also states “Squatting and lunging with a forward trunk tilt tend to decrease ACL loading, likely due to increased hamstrings activity.”
I wonder what the approximate degree of “trunk tilt” may be used to be effective in decreasing ACL Loading… ?

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Great report, Rick! Most interesting for me was the load on ACL was less on deeper squats. Also, the other way of reporting on squat form’s effect on the ACL load would be that bearing the weight on the heels with knees behind toes, lessens ACL load and, by inference, potential for ACL injury due to form.

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Rick Kaselj Reply:

Peter, thank you.

Rick

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What about using a knee brace for 90 degree squats for relatively light weight–15-20 reps?

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I had a inner quad tear about a 18 months ago, and although is it a lot better now I still feel uncomfortable squatting, Which of your excercise programs should I purchase? My Ankle’s Pronate, when I hurt my knee the kneecap would click evertime I took a step especially going downstairs, this has now stopped for the most part. But Squatting still makes me nervous. Mind you I learned to do Clean & Jerk, Snatch and had no trouble with 150lb+, while with a simple 45lb bar back squat I feel uncomfortable

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