Knee Pain prevents Squats

I received an e-mail from a fellow trainer asking for my help with a client of hers.  After reading over the e-mail exchange I decided to put up a blog and maybe help a few others out.

“Hi Chris, I have a 38 year old female client with bad knee pain. I would like to get her squatting to repair her knees but even the bench bodyweight version is tough for her to endure.  What can I start with to get her going?”

The basic background details: 38 y.o F, no history of past knee trauma, within healthy bodyweight for  height.  Clients physician diagnosed patellofemoral pain syndrome of the right knee.(aka “Runners Knee”.) Client has been released by her physical therapist for training.

Patellofemoral pain syndrome is characterized by pain the front of the knee.  In the initial stages of physical therapy deep bending (as in squats) is avoided while stretching and isolated quadricep strengthening is emphasized. Low resistance cycling without full extension of the knee are also treatment options.

Programming: The new minimum-minimum squats when dealing with knee pain.


Suspension Squats Technical Points:  I like for the shin to remain vertical throughout the squat and for the athlete to “earn” her depth by first squatting less than 90 degrees and earning her depth to the 90 degree minimum-minimum as her confidence increases.  Once the athlete earns 90 degrees largely on her own, you can place a plyo box or physio ball beneath her glutes so that each squat reaches the same depth. Have the athlete squeeze her glutes and abs while pushing her hips forward into the neutral postion and exhaling at the top of the motion.  The vertical shin will limit how much bending the knee can go through and the suspension unit will lessen the load on the joints as well as provide a feeling of safety once you demonstrate how sturdy a good suspension unit can be.

Initially I have the athlete continue squatting for a given amount of time.  In some cases this is not a safe option and you should issue low-rep sets building towards higher reps instead.

Avoid the following exercises: The seated adbuctor and adductor machines.  Both can tighten the athletes IT band, which is already suspect given the nature of her injury and possible pull the patella out of alignment.  I personally advise against the use of leg extension machines or the leg press.

If the clients occupation involves long bouts of sitting this can further exacerbate the knee pain since the knee remains bent for long periods.  Advise the client to develop the mini-habit of getting up and moving around.


2 thoughts on “Knee Pain prevents Squats

  1. balancebio

    Checking and working on ankle mobility is also helpful to encourage proper mechanics and gluteal activation. Yoga and/or myofascial massage are great options for this. Great post, so many clients have the same complaint. – Lori

  2. mytrainerchris Post author

    Hello Lori, Thank you for commenting and great seeing you again! Many of the clients I’ve consulted for, or worked with that didn’t have history of direct knee trauma largely seem to have desk bound jobs. The effects prolonged sitting has on the body seems to be getting more attention in the last few years. Your Yoga and Myofascial massage recommendations are spot on, for me flexibility and mobility are two of the early strategies I use before moving into isolation and functional movement and strength training.


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