FAQ - My knees hurt when I do squats.  Are there other alternatives?

First, if you feel any pain anywhere, whether you're doing squats or other exercises, you should never work through it. Sharp pain could indicate an injury or strain, so always stop what you're doing and check with your doctor, if the pain doesn't go away. Also, if you have a diagnosed knee injury or strain, squats may not be right for you.

But, if you have healthy knees and are avoiding squats because you don't want injuries, you might change your mind when you learn that squats can actually strengthen the knees, if you do them correctly. Squats can also strengthen the hips, knees and ankles while targeting almost all of the muscles in the lower body, which is one reason we love them so much.

If you don't have any chronic knee or joint problems but still feel pain when you do squats, you do have some options.

1. Check Your Form

1. Stand with feet about hip or shoulder-width apart, toes at a natural angle forward or slightly out.
2. If you're using weights, hold dumbbells at your sides or rest a barbell on the shoulders. If you're a beginner, you may want to start with no weights and take the arms out, as shown, for balance.
3. Bend the knees and squat, pushing your rear out as though you're about to sit in a chair. Your knees should stay behind the toes.
4. As you're squatting, keep the knees going in the same direction as the toes and avoid arching or rounding the back. Instead, keep a neutral spine and pelvis.
5. Squat as low as you can or until the thighs are parallel to the floor. Some advanced exercisers or athletes may be able to do full squats, but parallel squats are usually recommended for the average exerciser.
6. At the bottom of the movement, make sure your feet are flat on the floor, your knees are still in line with and behind the toes and that you aren't arching the back.
7. Push back up, concentrating on squeezing the glutes as you stand.

Practice your form and spend some time going through the motion to get a feel for your own strength and flexibility. Go slowly to keep the knees straight and see if that makes a difference in any knee pain you've been feeling. It not, you can try one of the other options below.

2. Try a Modification

Wall Slides You can use a wall to help support your back while you slide into a squat position.  Make sure the knees stay behind the toes and only slide down as far as you comfortably can.

Chair Squats Use a chair as a guide for your body to follow and to provide support at the bottom of the movement. You can even (briefly) sit down each time to take the pressure off the knees if needed.

Ball Squats Like wall slides, a ball can provide support for your back, helping keep your knees from going too far forward.  Just make sure you walk the feet out enough that the knees stay behind the toes.

Quarter Squats Sometimes, just shortening your range of motion and only squatting down a few inches can help protect the knees.

Squats with a Ball Between the Knees Many people find it easier to keep the knees in alignment by squeezing a ball between the knees. This will also involve more inner thigh.

Squats with a resistance band If your knees tend to fold inward, tying a band around the knees and pushing against the resistance may help.

One-Legged Squats Because your range of motion is naturally shorter in one-legged squats, you may be able to do these without knee pain.  For this move, you only squat a few inches and you still need to push the rear backward to keep the knee from going over the toes.

Plie Squats Changing your stance can also make a difference.  For these, you take the feet very wide, angling the toes out.  As you squat, the knees should follow the same line as the toes.

You can view a full list of pictures and exercises in my Squat Photo Gallery.

3. Try a Substitute

Lunges Lunges are one option if squats tend to hurt your knees, but they're challenging and can also cause knee problems if you don't use good form. Take the feet far enough apart that when you lunge down, the front knee stays behind the toe, just like a squat.

Ball Leg Press This move is like a supported squat, so there's less body weight to tweak the knees. This is a good choice if you can't do standing squats, but you may need to hold weights to make these challenging enough.

Leg Press Resistance Bands This move actually mimics a leg press, which is an exercise similar to a squat.  This is a great choice if weight bearing exercises won't work for you.

Step Ups Like lunges, step ups are tough but, because the movement is different from traditional squats, your knees may find them more comfortable.

_Sources

Escamilla RF. Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc. 2001 Jan;33(1):127-41.

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