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At one point someone asked me a question about squatting with bad knees. I knew a little bit about it, but I wanted to get more professional opinions before I wrote a full response.
I have compiled the results here and would like you to also read the resources listed at the bottom of this post for more information.
Much of this information was comprised from articles written by Dr. Fred Hatfield (aka Dr. Squat) and from the training certification guide from the ISSA.
Squats are both difficult to defend and difficult to disparage. There are pros and cons to both sides. Let’s examine the facts.
- If you are an athlete, you should be squatting.
- If you are trying to gain muscle, you should be squatting.
- If you are trying to lose fat, you should be squatting.
- If you are trying to get stronger, bigger, leaner, quicker, or more powerful, you should be squatting.
- If you develop bad knees, it could be from squatting.
When you read that last statement you said, “What?! Blasphemy!”, but the reality is undeniable: years of squatting, especially with less than perfect form, could potentially cause damage to your knees.
On the other hand, you could squat with perfect form for 50 years and end up with stronger knees and legs than an elite 20 year old college running back.
You could also start out with bad knees and after squatting with perfect form for just a couple months, end up pain free and stronger than ever.
Squats are truly a remarkable exercise, but you must take the good with the bad; the risks with the benefits.
We must first understand exactly how the knee works so that we can insure that it will track properly in all planes of motion.
The knee is like a hinge that rotates on an imperfect axis. Since this axis is always changing we must remember not to lock it into any fixed axis exercises, which is why I’ve said time and again that the typical leg extension machine is one of the worst exercises for your knees.
The knee is comprised of seven different types of tissue: bones, ligaments, tendons, muscles, synovial fluid, adipose tissue and cartilage.
The leg bones femur and tibia form the outer structure of the knee, which the knee bone itself is called the patella.
There are 8 interior and 6 exterior ligaments that provide joint stability by connecting bone to bone. Along with cartilage, knee ligaments are often the focus of many injuries.
While there are obviously no muscles in the knee joint, the quadriceps and hamstrings act upon the knee for flexion and contraction, and smaller muscles around the knee contribute to some flexion and inward rotation.
Tendons are fibrous elements that attach muscle to bone. The knee’s 4 fibrous extensors connect the quadriceps and tibial tuberosity to the patella.
The knee has 12 protective fluid containing sacs called bursa sacs. These are located in areas that cause friction, often between prominent bones, and muscles or tendons.
- Adipose Tissue
Fatty tissue for padding.
- Articular Cartilage
There are 2 pieces of cartilage in the knee that provide shock absorption and smooth articulation between the bones that form the joint. Many knee injuries often involve problems with knee cartilage.
Three pieces of equipment that should be addressed when talking about the free standing barbell squat are shoes, knee wraps, and lifting belts.
Your shoes will be the foundation of your leg training.
Without stable, strong shoes, you risk pronating or supinating your feet depending on your weakness and your shoe’s lack of stability. This could cause serious injury to knee ligaments and could cause your patella to track improperly, which will cause a condition called condromalacia – a roughening of the underside of the patella. This is very painful to even walk with.
Another problem with broken down shoes is lack of support at the heel, which could again cause your feet to either pronate or more likely to supinate, again causing great stress on the lateral collateral ligaments. Even if your feet don’t roll, you are exposing your need to hundreds of pounds of direct downward force. If the heel support is broken down then the soles of your feet are stuck in an physiologically unnatural position.
Would you try to put car tires on a monster truck?
The good: provides additional stability to the knee and gives at least a 5-10% increase in strength when squatting. Wrapping before squatting significantly reduces the chance that the quadriceps muscle will tear or the quadriceps tendon will detach from the patella.
The bad: negates the adaptive benefits of lifting heavy by absorbing the stress of the load. Basically, your knees won’t get stronger because the wraps are taking the brunt of the trauma.
You should only be wearing knee wraps if:
- You have been diagnosed with knee problems and literally need the wraps to be able to squat.
- You are using a weight above 85% of your 1 rep max.
- If you use wraps with weights above 85% of 1 rm, you also periodically train without wraps with weights lower than 85% of 1 rm.
- You are wearing the wraps loosely just to keep the knees warm.
Guidelines for selecting knee wraps:
- Choose the heaviest knee wraps you can find, because more fabric means more protection. Avoid wraps that are bulky though.
- Choose wraps that stretch to at least 20 feet, because more coils means more protection. Avoid wraps shorter than 15 feet.
- Avoid wraps that are elasticized. Elasticity offers minimal support compared to fabric.
Dr. Squat’s guidelines to wrapping your knees are as follows:
- Sit on a chair or bench. Begin with the wrap completely stretched and rolled up (this makes the process much easier than fighting to stretch the wrap as you go).
- With your leg straight, start applying the wrap below the knees, working upward. Wrapping from “in” to “out,” (counterclockwise for the left leg, clockwise for the right — this helps avoid improper patellar tracking), anchor the wrap by applying 2 layers below the knees, then move upward, overlapping each previous layer by one-half the width of the wrap.
- Apply the wrap tightly as you move past the knee, stopping somewhere on the lower third of the thigh (powerlifting rules allow 10 centimeters above the patella).
- Most of the wrap is wound around the leg just above the knee joint in order to “pin” the quadriceps tendon to the femur below — better leverage). Tuck the end of the wrap under the previous layer to secure it. Repeat for the other leg.
Although not related directly to knee healthy, wearing a belt does have two main important purposes:
- Reduction of stress on the lower back while lifting in an upright position.
- Prevention of hyperextension when pressing overhead.
Despite these benefits, I have never supported the use of lifting belts.
Not for deadlifts, not for squats, and not for overhead pressing.
It does this by compressing the core, which increases intra-abdominal pressure and provides added support around the spine. Because of this pressure, the spinal erector muscles will produce less force during the lift, which means less chance of lower back injury due to muscle strain, but which also means less load is placed on those muscles and therefore less strength adaptation.
Wearing a belt = weaker back muscles = a predisposition to lower back injury.
Worse yet, electromyographic research has found that wearing a belt causes decreased stimulation of the abdominal muscles. In this way, wearing a lifting belt is a vicious cycle of strength imbalances, causing your lower back and abdominal muscles to become the weakest links. Not good.
The indirect benefit of wearing a belt for the knees, is that you will be more likely to stand up straighter, keeping most of the stress in a straight line over the ankles, which ultimately results in far less stress on the quads and the knees.
Generally, belts should not be worn often during training, if at all. They are sometimes not allowed in competition either.
Avoiding muscle imbalances is one sure way to be proactive about injuries.
When your hamstrings and quads can contribute equally to a squat, you will find far fewer hamstring pulls, quadriceps tears, and improper tracking of the patella.
The rule of thumb is that your quadriceps strength should be roughly equal to, if not slightly weaker than, your hamstring strength. I don’t know that this is usually the case in experienced trained athletes, but it is a mark to shoot for.
While I have known a couple people who can squat more than they can deadlift, this is most often not the case. I personally can now, and always have been able to, deadlift more than I can squat. When my max pull was 500, I was still only squatting about 415.
Bodybuilding is really the only ‘sport’ where you see quad strength equal to hamstring strength, but this is often because bodybuilders favor the squat for leg mass but avoid the deadlift because they think it is not really necessary for bodybuilding purposes, opting instead for the stiff leg deadlift and the hamstring curl.
How to Place Your Feet When Training Legs
Stance variables are important in determining both the results of an exercise and the safety of your knees during that exercise.
While each individual will have their own physiological best stance for any exercise, purposely altering some variables will cause entirely different muscles to be activated on different planes of movement.
Consider the following stance variables:
- Use your athletic stance.
Bodybuilders squat with a close stance. Powerlifters squat with a wide stance. But what is correct?
The correct stance to use when squatting is your natural athletic stance, which is probably several inches wider than your shoulders and hips.
- Point your toes slightly outward.
Never point your toes straight ahead. By pointing your feet slightly outward you will help your quads activate more efficiently and your adductors will not be over recruited or under recruited, which means you can avoid associated problems with ligaments, cartilage, and patellar tracking.
- Keep your knees behind your toes.
This is not a myth, but in fact is a real concern for patellar health.
- Keep your knees in line with your toes.
Weak quads often mean the knees will turn in, while weak hamstrings result in the knees turning out. Neither of these situations is good for the ligaments of the knee. Acknowledge and fix your weaknesses if they exist.
- Warm up.
Like I mentioned earlier, a warm knee is a healthy knee. This is true for all the muscles, joints, and other tissues of the legs and core. You should warm up for at least 10 minutes before starting a squat workout.
You have to stretch. Just accept it. Many knee problems are traced back to tight quads and many back problems are traced back to tight hamstrings. You should stretch for at least 10 minutes after each workout.
- Set up for your squat safely.
Here is a goal you can really shoot for.
Unracking the weight and setting up for a squat should be a 3 step process:
- Lift the weight off the rack by standing up.
- Take one step back with one foot.
- Take one step back with the other foot.
By this point you should be in your squat stance and ready to descend for the first rep.
You should not have to take anymore than 1 step with each foot, and once that foot is placed you should not have to move it again.
Dancing around before your set or in between reps is one sure way to ask for an injury, which is probably not what you want.
How to Jump Safely
The correct way to land after jumping is in a half squat position. We want our tendons and muscles to absorb the force rather than our bones and joints.
This applies to all forms of jumping or concentric (negative or downward) force on your body including jump squats, depth jumps, plyometrics, explosive leg press, and Olympic lifting such as cleans and snatches.
Landing with straight legs is bad for your knees, back, ankles, and hips, so don’t do it.
Supplements for Knee Health
Fish oil provides the essential fats that help to protect us from inflammation.
Resveratrol is an up and coming supplement that offers important anti-aging and anti-inflammatory effects.
Glucosamine and chondroitin both help to strengthen connective tissue and lubricate joints.
1,000,000,002 Different Ways to Squat
Here is an excellent article by HealthHabits that describes all the variables that you can use to come up with new ways to squat: 1,000,000,001 Different Ways to Squat. The only thing he forgot is Jump Squats!
Here is your list of the 5 best quad exercises.
Here is your list of the 5 best hamstring exercises.
And here is a generic full body training program that you can use to put it all together.
What All Squatters Knee’d to Know by Dr. Fred Hatfield
10 Tips for Knee Health by Mehdi
Knee Pain by Mehdi
Squatting by various authors