What Physical Therapists Want You to Know About Squats and Knee Pain

On the whole, squats are not bad for your knees—they’re actually good for keeping the joint lubricated and mobile, explains Claire Whitlock, P.T., M.P.T., O.C.S., a physical therapist at Trimetrics Physiotherapy. “Squats are an essential movement for performing daily activities and are perfectly safe when performed correctly,” she says. “Some people benefit from analysis of their squat movements to improve alignment, weight distribution, or to learn modifications to ensure safety and comfort.”

In that same vein, squats should be approached carefully (and ideally, with professional supervision from a trainer or therapist) if you have acute knee or hip injuries, explains McKenzie. Even then, squats can usually be modified to meet most fitness levels, she adds.

“Squats take knees through a full range of motion (from a full bend to straight), so they are a great movement to help improve or maintain your mobility,” explains Milicia McDowell, D.P.T., doctor of physical therapy and VP of Operations at Gait Happens. They also engage your hamstrings, quads, glutes, and abs, making them a “fully comprehensive way to train your lower body,” she adds.

Squats also work to strengthen your hips and improve balance, adds Whitlock. “As a weight-bearing activity, they help with maintaining bone density,” she continues, which can help prevent osteoporosis. In fact, a 2019 study published in BioMed Research International found that participants with osteoarthritis who performed static, low-angle squats over two years experienced pain relief and improved range of motion, muscle strength, and knee stability.

An ACL injury is a tear or sprain of a ligament that connects the thigh and shin bones, per the Mayo Clinic, and it usually manifests, at least partly, as swelling and pain in the knee. For that reason, ACL rehabilitation often involves careful squats. “I have used a ton of of squats and squat variations to help train folks after ACL surgery,” says McDowell. “Mini-squats are one of the first movements we train patients to do post-surgery as you’ve gotta be able to sit in a chair and sit on a commode, which are specialized types of squats.”

Avoiding injury while performing squats is all about proper form. “There are several ways to perform a squat,” explains Whitlock. But the most basic, according to Whitlock, is:

• Stand with your feet shoulder-width apart, weight evenly distributed
• Engage your core gently as you reach the arms forward and bend at the knees
• Hinge your torso forward slightly as you use your hips and thighs to control the descent into the squat position
• Keep your spine in a neutral position and make sure your knees point in the same direction as your toes
• Drive through your feet and return to the start position

According to our experts, there are many ways to modify squats depending on your ability. You can lower into a chair, lean against a wall, widen your feet, or use the help of props like a ball wedged between the legs for stability or a resistance band around the legs to keep proper alignment.

At the lowest level, pain during squats indicates improper form, McDowell explains. In worse cases, the pain could be due to joint dysfunction, instability, or muscular strain, adds Whitlock. “If performing a squat is painful, having a professional analyze your movements and make needed adjustments can help you progress to a pain-free movement,” she concludes.