Let me tell you a story about a kid whose knees started to hurt when he started to squat all the time. So, one day he puts a little bit too much weight on the bar. He’s able to squat the weight for five reps but there was no way he could’ve done one more rep. A few days later he starts to squat again, and he starts to experience a bit more pain in his knees than usual, so he stops squatting for the day. He comes back the next day to try to squat again. Even more pain. So, he decides to take a week off from squatting. He comes back a week later. Loads about 50% of his max on the bar and decides he’s going to work up a bit slower than usual today. He starts feeling the pain again at about 60%. He gets frustrated and thinks the solution to his knee pain problems is to take two weeks off from squatting this time. He comes back two weeks later having not squatted in two weeks, loads up the weight, and by gosh darn it, NO PAIN. However, he comes back in the gym the next day and can barely get down on one knee because his knees hurt so bad. The kid is utterly disappointed and frustrated and decides that squats are just inherently bad for your knees, so he stops squatting all together. The kid never squats again for the rest of his life and therefore is never able to experience the true gains of leg size and strength in all their glory.
Let’s face it, we don’t want to be like this kid.
But, what does this story tell us? To me, this is how I see most of the rehabilitation, or lack thereof, done when it comes to knee pain when squatting.
We all know that some exposure to stress is how we adapt and make progress. You stress your cardiovascular system with some form of aerobic activity and your resting heart rate and blood pressure are likely to drop over the long term. You stress your muscles with resistance training, and they tend to grow. You stress your cognitive system with the reinforcement of information, and you form and strengthen the synapses in your brain. However, when it comes to joint health and/or performance we think the best the best approach is to avoid stress all together.
I understand that if your knees are in absurd amounts of pain it might honestly be impossible to squat, and a few days off might be what your body needs to recover. However, continually to take time off any time your knees hurt is likely not the most sustainable strategy that is going to get you to your goals. If you are a strength athlete, you know just how common squatting is and how you are going to need to be able to consistently squat to improve your numbers. So, what can you do if squatting is killing your knees?
Keep squatting. I don’t mean to say that you have to just mentally toughen up and push through the pain. That is just as detrimental as detraining by taking time off. You need the exposure to the stress of squatting. Find other ways to squat that don’t feel quite as bad. Front squat instead of back squat, use a safety squat bar, use tempo squats to reduce the overall load but can continually stress the area. We have many different options we can explore. The goal is to use the resources at your disposal to continue to train the squat with little or no pain. I personally love the use of the sissy squat in someone’s warm-up to work on building some tolerance to stress of letting the knees really drive over the toes. The reason most people struggle to do this, or their knees hurt when they get pushed too far forward is because they haven’t built any resiliency in that position.
I also often find tempo’s to be a great tool as well. This is because the load can stay light, but you can still get a great deal of exposure to stress without killing yourself.
The overall theme and message of this article is if you want something to stop hurting, you actually have to expose yourself to the movement that is hurting, but in the right way. To go back to my made-up story at the beginning, the kid’s knees continued to hurt because he actually continued to detrain himself in regard to the squat. He saw a glimmer of light but came back the next day with more knee pain because he was so detrained. Yes, the story is made up, but I would bet a lot of money many people have had this experience. Slowly, and gradually expose yourself to the necessary amount of stress so you can build some tissue resiliency in the squat. There will always be some tinkering in the process, but the one thing you cannot do is to stop squatting all together.
Now, go be excellent squatters.