Got Knee Pain? Think You Can’t Squat or Shouldn’t Squat? Think Again!

 A common thought is that all knee pain requires rest, and you should not consider any exercise until the pain has passed. Now, don’t get me wrong this might be true, particularly with any trauma or acute injury, a sprain, or acute swelling, then yes, rest is going to be your best friend. However, exercise is a great treatment option in most cases.

Firstly, let’s give the knees some love! They are large joints involved in all major lower body movements; bending and straightening, compounded by the pressure of body weight, reacting to twists and turns. It is no surprise the knee is a common site for osteoarthritis with 18% percent of over-45s having arthritic knees.

Knees are commonly the innocent middleman between your ankle and hip. Issues from above and below will have a huge impact on how your knees function and feel. This commonly leads to pain or discomfort. For example, weakness in the hip muscles may cause increased pressure on the knee as it tries to compensate. By strengthening the muscles around the hip joint, relief can be felt in the knee. Equally, not using your feet properly and poor calf muscle activation will require more effort at the knee, which again, commonly leads to discomfort or pain at the knee.

As we age our muscle mass naturally shrinks, and they weaken. Strength training i.e., loading your body, stimulates new muscle fibres to grow which makes them stronger. Robust muscles will act like scaffolding, off-loading stresses, providing structure and stability when under load. It gets better; increased muscle mass and strength can indirectly resolve other issues related to muscle weakness such as poor balance, fatigue, and muscular or joint aches and pains. So purposeful strength training is necessary to guard against the aging process.

What Strength Training Can Be Done With “Bad” Knees?

Before you panic and stop reading, strength training isn’t only about lifting the heaviest weight possible. You can stop those images of huge weights and sweaty gyms right now! Therefore, so many of us are put off doing something that is hugely important to guard against the aging process. Resistance training, strength training, joint loading all means the same thing. They are often used interchangeably which can be really confusing. Adding the word “functional” into this type of exercise simply means training your body under load using functional tasks such as squatting, lunging, and lifting / carrying. Things you day every single day and are a requirement for maintaining mobility and independence.

The biggest challenge for anyone is knowing where and how to start the process of strengthening. For most, you’ve tried and failed to do exercise and build your muscles. It feels too hard, hurts, or simply doesn’t make you feel good. The biggest problem is that you start with exercise that is too much load or too demanding for your muscles to tolerate. Because the muscles can’t tolerate it, the body compensates, loads other structures and this then leads to pain or discomfort. If you feel sore doing strength training exercise either at the time or after, it doesn’t encourage you to keep doing it! Training with pain or discomfort is absolutely to be avoided. This is in any exercise. It is your body telling you something isn’t quite right.

Heaps of research has shown that both aerobic exercises (walking, cycling, and swimming) and resistance strength training are an effective means of pain relief and functional restoration in mild and moderate cases of osteoarthritis. This is great news when arthritis is a normal part of the aging process!

Let’s Be Specific

These next 2 exercises are a FAB place to start with strength training the legs. They target the right muscles to get everything working together.

1. Glute Bridges for your calf, hamstrings, and bottom muscles
2. Squats for calf, thigh, and bottom muscles.

If you struggle with loading your joints using your body weight only, then you shouldn’t start with using additional load from resistance bands, free weights, or machines. These are great tools to use once you’ve built up some initial strength in the right places.

The best idea is to start at a low level of load, just using your body weight, before progressing movements by increasing the load.

Bridge Up

The bridge often called the glute bridge has become incredibly popular in fitness culture for develop the glute muscles- your bum. But when correctly performed your hamstring and calf muscle will also be rewarded. The calf should be starting this movement, followed by your hamstring and then bottom. The correct technique involves lying on your back with your arms by your sides, your knees bent, and your head supported. Push down through your midfoot (not heel); Imagine you’re pushing down on an accelerator pedal. You should feel your whole back of your leg switch on, from calf to bottom. For some of you this will be enough to get your bottom muscles firing.

Aim to start with 2 sets of 6-8 repetitions. If this is too hard or you experience cramp than start with less repetitions. If the cramp doesn’t ease after a few days of doing this exercise, it is a sign that your muscles aren’t used to working together in the right way. The quickest way to change this is get some hands-on work to desensitise the cramping muscles (commonly the hamstrings or calf). Continuing this exercise for weeks, hoping that the cramp will ease in time with doing the exercise more generally doesn’t work. Cramp is a sign the muscles don’t know how to work properly and in sync with the other leg muscles and may be why you are sore in your knees.

Once the bridge feels easier, to progress the exercise, from the same position, push through the midfoot to raise your hips off the floor. They only need to come off 1cm. It isn’t far. But this will increase the loading in your bottom muscles. Please avoid working your back. Be aware if you want to brace your back and try to allow it to relax and you isolate the leg muscles alone. This is a super exercise to develop knee supporting muscles without excessive pressure on the knees making it a popular choice for increase knee strength and control. Weights and resistance bands can be added to progress the exercise, alongside holding the position for longer.

The Squat

Squats are often the first movement we try to steer clear of when knee pain strikes, yet we squat daily; when getting into a chair, driving, or manoeuvring to get down and play with the children. Despite our own beliefs and worries, squatting is good for your knees. It is essential for them and what they are designed to allow. The primary function of the knee is to be able to bend – so it is perfectly normal to keep on squatting. But you may need to consider your technique. For most, the reason squatting gives you discomfort, or pain is because,

1. a) You aren’t putting your weight where it should be on your feet
2. b) You aren’t working the muscles of the leg together in the right way
3. c) You need to start with a lower load exercise like the glute bridge first and build up to using the squat as a strength training exercise.

Listen to your body and note what range of motion (depth) you can perform without significant discomfort. There are very few exercises that are innately “bad” for our knees. It all comes down to technique and your ability to tolerate load. All movements under load need to be performed at the appropriate resistance, rest, and intensity level for the individual.

Key Technique for Awesome Squatting

The following principles apply to ANY squat movement, whether that is when performing the exercise OR during daily tasks like sitting / standing from a chair or toilet, getting in / out of the car, bending to pick something up. The essential thing with squatting is to get your weight where it should be as you go down and then back up. As you lower, bending your knees, hips and ankles, the weight should be more in your heels. As you rise and straighten your knees and hips, the weight moves to the midfoot.

Other myths we will bust right now are;

- Let your knees travel forwards over your toes. They are meant to fold. Letting them move and not restricting their forward movement will allow the ankles and hips to do the right thing also.

- Let your bottom travel backwards and down. Your hips need to fold too.

- Let you back relax and rounded. Too many of us brace the back as we squat which doesn’t let the leg muscles do what they should and could be making your squat more uncomfortable.

- Use your legs! Too often we let our muscles just collapse under use. Being more purposeful with how we switch the muscles on can make all the difference. Actively press your heels into the ground as you lower before transferring the weight to the midfoot and actively pressing through this region when you stand back up.

How to Make Your Squat Easier or Harder

Sometimes starting with a squat to strengthen your legs is too hard. Finding a half-way house between the glute bridge and a squat is easy when you know how! These adaptations make it easier to achieve and enable you to activate the right muscles to build being able to achieve a full squat.

Equipment provides the additional support. Using a TRX or placing a gym ball behind your back- to-wall squat are great alternatives to a free-standing squat. You will still work the right muscles namely, glutes, calf, hamstrings, and quadriceps – all needed for the knee to bend and straighten under load.

•  Squat and Sit – Use a secure chair, box, or bench that allows you to lower and raise without worry. Take a step away from your landing platform. Bringing your weight slightly more into the heel, let the knees come forwards, send your hips back, and lower to sit down. To stand up, push through your midfoot (like you were pressing on accelerator peddles in the car), to bring your hips up and forwards, whilst your knees straighten.
•  Gym Ball Wall Squat – Pin a gym ball between your back and a wall. Slightly lean the body into the ball with your feet out in front of you. Maintain a relaxed upper body position, lower the hips straight down. The movement should be smooth and controlled, with the knees at a 90-degree angle and lining over the ankles at the end motion. Push through your mid-foot to rise. If you can’t get that low, start with what you’ve got and build it up.
•  Assisted Body Weight Squat – Hold the handles of the TRX, weight over feet, elbows flexed and under shoulders- tension in the straps. Use the same foot pressures as above to lower and raise, but you now have assistance from your arms.

How To Train Safely

A valuable tool when building strength is recognising the differences in fatigue and soreness. Fatigue is a normal response to strenuous activity of any kind. Pain during or after exercise can occur for numerous reasons. Therefore, it is essential to maintain proper technique while doing the exercises.

Be sure to warm up, gradually and dynamically. Allow for rest when needed and if anything feels too much, listen to your body, and stop.

If you are unsure about a movement or are experiencing some knee pain and aren't sure where to start, you need to get some help. Squatting and using your legs is VITAL if you want to maintain your mobility, strength, and independence as you age. Keeping your legs strong will improve your balance, prevent against falling and keep your heart in good shape because you can do more physical exercise. Please don’t just stop doing things because you think you are making things worse. Get some help and guidance and what to do. Don't let your dodgy knees be the reason you stop!

Finally...

So, there is the basic information on why squats are good for us and a much-needed exercise, even when you have “bad” knees. The main reason most people don’t like them, and they hurt when doing them is because their technique isn’t good, their weight isn’t in the right place, or they need to build a bit more basic strength in the leg muscles before tackling the squat as an exercise to build strength. Every client who comes to see us at the HealthHub, no matter what the problem is going on, needs to be able to squat for day-to-day life. Even those with arthritis. When progressed in the right way, squats become pain free and a vital part of exercise training. There is nothing to fear. The first thing to get over and change is our own thoughts and beliefs about knees and squatting!

Next Step

If you would like some more information or have questions about how you squat, we are offering FREE “Discovery Appointments” with our therapist Abbie throughout April. This way you can be confident and certain in taking the next right step, to sorting out your knee and movement challenges. No doctor’s referral is needed for this visit.

We will gladly take the time to chat things through and make sure that we can help you with your particular problem. You can even do your Discovery appointment on the online if you would prefer.

To request and free “Discovery Appointment”, please ring us on 01548 852355 or email [email protected] and request a “knee & squat” free discovery appointment with Abbie our therapist.