Are Squats Supposed to Hurt your Knees?

by Chris Centeno, MD /

Receive a Regenexx® Patient Info Packet by email and learn why it's a superior regenerative solution.

Are Squats Supposed to Hurt your Knees

Are squats supposed to hurt your knees? I was in an exercise class yesterday and my left knee was hurting a bit while doing squats. Thankfully, I was able to correct the muscle activation sequence and my knee stopped hurting. But given the fact that squats are a mainstay of every cross fit or exercise class, learning how to squat properly is critical. As a physician who sees knee arthritis patients all day, the advice all over the internet seems to be missing the main point of how to perform a squat that won’t actually fry your knee cartilage.

Most of the squat-related information is centered on the structure of the squat. For example, making sure your knee is aligned with the hip, or making sure your knee is in front of your ankle. While controlling your knee position is important, all of that misses the main problem of poor muscle activation patterns.

The Perfect Squat is Driven by the Hamstrings and Butt

When most of my knee arthritis patients perform a squat, they universally recruit the thigh muscles. So does just about everyone squatting with weights, or as part of the latest cross fit exercise. That’s because we all conceptualize that the reason we’re doing squats is to build up the quadriceps. However, a squat isn’t supposed to work that way. The hamstring and butt muscles are actually supposed to be the main driver of the squat, not the quads, with the front thigh muscles only acting as a secondary helper.

Check out the video to the right. In the first few squats, the concentration is on the quads, while in the last few it’s on the butt and hamstring. When you focus on your quads, the knee cap is pulled into its groove and this puts too much pressure on the cartilage underneath. Any inability to control the knee’s lateral movement, or how muscles are activating, can cause the knee cap to get out of position in its groove, further increasing the pressure on the cartilage. The last few squats on the video shows the focus on the butt and hamstrings, which takes the pressure off the knee cap.

The Long Term Effects of the “Quad Dominant Squat”

It’s no coincidence that the most common knee problem in low back pain patients is arthritis under the knee cap, which fits in with this quad dominant squat. Most of those patients have low level nerve irritation (that they don’t notice) at the L5 and/or S1 nerves. This takes the butt and hamstring muscles off line and makes it harder to unconsciously activate them. All of that leads to a quad dominant squat, which in turn wears down the cartilage under the knees. So paying attention to how you’re doing squats becomes doubly important if you have any kind of back problem.

So how can you protect yourself? My left leg has some very low level issues from an irritated nerve in my back (but my back doesn’t hurt much), so my gluts and hamstring tend to shut off. I practice focusing on my butt and the back of my thigh every time I climb stairs. This becomes a conscious thing to kick those muscles back into action. I also do that in exercise classes or while engaging in cross fit. I literally focus my attention to the back of the leg and butt and away from the quadriceps. Give this a try first.

After you master this part, you can then worry about your hip, knee, and foot position. So the sequence would be:

  1. Initially focus on the butt and hamstring and away from the quads
  2. Knees shoulder width apart, but you may need to adjust this position as you squat to keep them more inside and prevent them from drifting out
  3. Feet are turned out to a comfortable position
  4. Push your butt back with a straight back (which sometimes doesn’t apply if you’re squatting as part of a specific exercise)
  5. As you go down and up, continue to focus on recruiting the butt and hamstring, they should be driving the power of the squat

The upshot? There’s a ton of advice on how to squat from many sources, but not a lot of information from physicians who see the consequences of a lifetime of bad squats. Learn how to focus your attention on the back of the thigh and butt and away from the quads. Your thighs will still get toned and more powerful, but without the knee cap arthritis!

Category: Knee

Leave a Reply

Your email address will not be published. Required fields are marked *

2 thoughts on “Are Squats Supposed to Hurt your Knees?

  1. Helen Davis

    A year after a fractured ankle, I am still having pain in both knees when rising from a regular height chair.
    Just tried this suggestion regarding which muscles to engage and rising from the chair was much less painful.
    Otherwise knowledgeable people did not make this leg muscle distinction for me and the recommended exercises were creating more pain. This article was very enlightening and helpful. Thank you.

    1. Regenexx Team

      Helen,
      Thank you, so thankful to be a help! Reading your comment will help someone else.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.