This happens all the time; I have people tell me that they can’t squat because it’s bad for their knees, or that it hurts their knees. Now, those are actually two different things, but I’m going to tackle them with a classic physical therapist answer; “It depends.”
MOST of the time, I will say that’s not true (I tend not to say ‘never’ or ‘always’ because only a Sith deals in absolutes).
So, for most people, squats are not bad for you. And before you start think it’s you, don’t.
Let me explain.
Squatting is a complex motion; it requires ankle, knee, and hip mobility, as well as core strength. It requires good control and strength at these joints. Our lower quarter is essentially a super mobile hip and a super mobile ankle separated by a hinge knee joint. If the ones above or below aren’t functioning, our knee tends to catch the buck with extra load, and then wham, it hurts.
Now, does that mean your knee is bad or faulty, or that this movement is ‘bad’ for you? Absolutely not. It means you’ve got some mechanics that aren’t as efficient as they could be, and some muscles that aren’t working the way they should be.
So, there’s strength, and there’s form, which are big factors.
When you squat, I see a lot of people shooting their knees forward without ever trying to engage their hips. It’s basically an “ankle first squat,” where their knees pop forward and their chest is straight up. Yikes. That puts your knee joint far away from your center of mass, creating a long lever from your knee and your center of mass, requiring increased force to be exerted at the knee. Now, that’s not necessarily bad, but it does put more pressure on the knee, which could be painful if your body isn’t prepared for it, or you’ve got other injuries going. With any movement, we need to make sure our center of mass stays between our feet, which reduces any torque on our various joints.
What’s the correction for this knees first squat technique? Counter balance with your chest, and bring your center of mass forward again (with our knees shooting forward, our weight shifts to the center of the foot, and things get weird). We correct by bringing our center of mass back over the foot with a forward lean. We also shift our weight from our forefoot to the center of our foot when the hips hinge backwards. It’s not just chest forward, it’s hips back. Thus, we are accounting for keeping our center of mass over our feet, and centered in our foot.
Most people who have knee pain are shooting them forward too early.
But wait! If we have knee pain, that comes from the knee going past the toe, we solve the problem by just keeping the knee over the ankle, right?
Yes, we do reduce the movement happening at the knee that way, and reduce the forces in the knee if it doesn’t move. If you’re sending your hips back without the forward trunk lean, you’re creating an equally huge amount of torque at the hip, which can lead to all kinds of discomfort. And if you have forward trunk lean, congratulations, you’re performing a deadlift!
So, your knee going over your toes is not the problem. Your control of your forces and where your center of mass is.
Now, what if you’ve got arthritis?
There’s a good deal of evidence that active movement through pain free range of motion, and full range of motion improves outcomes. A study of 100 adults with moderate OA found that working on muscular control and activities that included driving the knee over the toe. At the end of the 8 weeks, the majority of patients had a decrease in pain, or no change, but all of them had an increase in functionality. IE, they had an improvement in symptoms and/or an improvement in their capability. And I would argue a keep component was conditioning their control of their knee moving over their ankle, as well as controlling knee position.
Oh, sound familiar? Controlling where the knee is, relative to the center of mass, is key to a healthy and happy knee. And having control of the knee typically comes from the hip and ankle.
The other thing that I love to empahsize to people with osteoarthritis or arthritis, or any cartilage damage to a joint is that muscles help create space in a joint. Cartilage and menisci cushion our joint and approximate it, helping distribute the forces as the joints glide over one another. But muscles can actually act as a vacuum suction cup, pulling those joints apart from one another. Quadriceps strength directly correlates with joint narrowing in older women with OA, and consistently, the strength of the knee musculature (quads and hamstrings) was correlated with the joint space of knees following a meniscectomy. IE, how strong you are is the best predictor of how narrow that space gets.
In other words, you’ve got knee pain or arthritis? Let’s get you stronger, cause that’s where the best outcomes are.
Now, what if you’ve got a meniscus injury, or your arthritis is pin-pointed, so you’ve got a particular spot where it just ‘ouches’ when you bend over it?
Strengthening in tolerable range of motion is key for individuals with meniscus injuries, ACL, or PCL, pin-point arthritis, or more complex conditions. And, talk to your physical therapist about how to best prepare for big and complex motions. As one of my coaches used to say, there is no bad motion; there’s just a body unprepared for motion.
The big takeaway? If your knees are hurting, look up and down the chain at your ankle and your hip and think about where your center of mass is relative to your knee.
If you’ve got questions, or you want to start training your knees to stay strong and pain free for the rest of your life, contact us so we can get you scheduled and we can tackle those problems head on.