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5 Tips For Pain-free Squatting From A Qualified Brisbane City Physio

The squat is one of the most universal and fundamental moves that you can perform at the gym. When done correctly, the squat has great benefits that can be carried over into everyday activities. However, if done incorrectly, the squat can lead to various injuries in different joints.

Knee pain during or after a squat is a common sports physio complaint in our Brisbane City physio clinic. Usually, the issue involves poor movement or methods when performing the exercise, which leads to acute and long-term injuries. While every patient is different there are ‘typical patterns’ leading to knee pain that can be resolved by using the following tips for pain-free squatting.

1. Make sure you have enough ankle movement

It’s important to start by looking at the foot and ankle, as it’s essential to have an appropriate range of motion around the ankle joint. When performing a deep squat (below 90 degrees with heels on the ground) your ankle needs a significant amount of dorsiflexion (ankle range allowing knees to go over toes).

Typically speaking, people with a history of ankle sprains or other ankle injuries will have poor dorsiflexion. Usually, this will be compensated by the knee moving inwards, which places a large amount of stress on the inside of the knee.

 

The knee-to-wall test is one of the easiest ways to find the range of motion for your ankle dorsiflexion. Start by placing the end of a tape measure or ruler against a wall, and then put your toes against the wall, making sure to keep your hips and trunk square. Place the other foot slightly behind the body. While trying to keep your back heel on the ground, move the knee over your toes and touch the wall. Move further back until you cannot keep the heel on the ground.

 

Studies have found that those who scored 11cm or more on the test were able to perform a deep squat.

Scoring less than 11cm doesn’t mean that you’ll never be able to do a squat, it just means that there’s room for improvement. One of the best ways to increase dorsiflexion is to perform the movement and stretch it past the end of the available range. However, there are multiple reasons that may be stopping this ankle movement and we recommend consulting one of our Physios before attempting this. 

Tie a large resistance band to a table or chair (you might need to place heavy objects onto the table or chair to stop potential movement). Step into the loop of the band and place it just under the malleoli (bones that stick out either side of the ankle), then move away from the table until you feel the band pulling you back. Using a stride position, keep your heel on the ground and move the knee over the toes until the heel is about to lift (this is the end of your range). At the end of your range, start to oscillate (small millimetre type movement) your knee over your toes using your hands and body weight. Continue for 60 seconds and repeat 3 times.

2. Have good foot stability

Poor foot stability can also lead to knee problems. Generally, people who have the arch of their foot moving inwards (pronating) will unconsciously move their knees inwards (known as a genu valgus position). Under load and tension, this position can prompt knee pain. The best way to analyse whether pronation is an issue is to see your local Brisbane City physiotherapist. Based off assessments, such as gait screenings, they will determine whether poor foot stability is the underlying cause.

Gait assessment - 5 Tips For Pain-free Squatting

3. Have strong hip muscles

Moving higher from the knees to the hips, it is imperative that there is enough strength in the hip external rotators and abductors (glutes) to keep the knees from travelling inwards. Resolving this may be as simple as cueing yourself to slightly push the knees outside the line of your ankle or foot while squatting. 

However, the underlying issue of hip strength will still need to be addressed. If you’re still experiencing significant knee pain when squatting it may be best to strengthen the external hip rotators and abductors in an unloaded position.

A great way to start in an unloaded position is to perform the clam exercise. To do this, lay on your side and bend your knees up so your feet are in line with your bottom. Keeping your feet and ankles together, lift the top knee off the bottom one, ensuring the hips don’t roll backwards. Once you can perform 3 sets of 15 repetitions without losing form, place a theraband around the top of the knees for added resistance.

Theraband squats 225x300 1 - 5 Tips For Pain-free Squatting

Next is to progress from the clam exercise into a squat exercise.

If you have had a sore knee then first let it settle down under the guidance of your Brisbane city sports physiotherapist.

It is essential to teach the body safe biomechanics while performing the squat, or else you risk opening yourself up to further injury. Standing with your feet and knees together, tie a theraband around the top of your knees (this will need to be quite tight) and place your feet shoulder-width apart. Here you will start to feel the tension of the band wanting to pull your knees inwards. Push your knees out against the band and perform the squat. The band gives a tactile cue to ensure your hips move into external rotation, promoting the use of the hip abductors and avoiding the knee valgus position while also gaining a deeper squat.

4. Make sure your hips are mobile

A majority of people spend most of their day sitting or at a desk, which can lead to tight hip flexors, adductors and loss of external rotation around the hips. This combination can cause the knees to come into valgus; again placing increased stress through the inside of the knee, as well as decreasing the depth in a squat.

It’s important to mobilise the hips to gain more range through the adductors, hip flexors and external rotators. The frog stretch mobilises these areas quite well while in an unloaded position. On the ground, come into a 4 point kneeling position with your hands under your shoulders and your knees slightly behind and outside the hips. Gently move back as if you were going to sit onto your heels. Hold this position for 30 seconds and repeat 4 times.

5. Build up to a full weighted squat

Overloading your joints when you don’t have the strength or flexibility to complete a loaded full squat has potential for injury. Work on the four tips above and progress the depth of your squatting to get the most out of the squat and minimise injury.

Below are our suggestions on how to progress to a full squat.

Once you are able to tolerate loaded knee bend with the shins vertical, a deadlift is a great way to keep up the strengthening of the glutes without going into too much knee flexion.

As the pain-free knee flexion range improves it is possible to progress onto box squats, moving closer to a loaded back squat.

The box squat is a great way to reduce the angle of knee flexion, keeping the knee in a pain-free range while also reducing the amount the knee has to travel forward. Depending on where the knee is painful will determine how high or low the box is.

Set a box or stool up behind the squat rack. De-rack the bar and walk back so that your feet are almost up against the box. Squat down until you are sitting on the box (the shins should remain relatively vertical). Pause for 1-3 seconds, this removes the use of the stretch-shortening cycle concentrating on glute power and development. To stand, drive the heels into the ground, push the knees slightly outside the ankles and drive the hips through until you are vertical again.

When sitting on the box, it is imperative to keep your foot positioning the same. Moving them behind or in front will change the angle of knee flexion either causing pain or making it difficult to perform the squat.

For sets, repetitions and weight progressions consult with your Brisbane City sports physiotherapist at All Care

 

In summary:

  • It is important to have enough ankle dorsiflexion range to perform a safe squat
  • We need appropriate hip strength and mobility to ensure our knees don’t cave inwards when doing a squat
  • Once the pain-free range of knee flexion improves, it’s possible to start loading the knee safely
  • Consult with your All Care physiotherapist for appropriate progressions, treatment options and home exercise program to ensure you’re back squatting without pain

Contact us today for personalised advice or book in for a physiotherapy session in our convenient Brisbane City physiotherapy clinic.