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Common Causes of Knee Pain when Squatting and How Physical Therapy can Help

CrossFitter doing a front squat

Knee pain during squats is one of the most common issues CrossFitters deal with— but don't worry, it is also commonly "fixable". The key is understanding the root cause of the pain and why it’s happening. Hint Hint: it's not usually the KNEE'S fault! Once you identify the source, you can address the underlying limitations and get back to squatting pain-free.


So let's first talk about the most common types of squatting related knee pain that we see at Redemption PT, what typically causes them, and the top methods we use in the clinic to resolve them.


Common Types of Knee Pain During Squats


1. Anterior Knee Pain (Front of the Knee)

This usually falls under one of two categories:


Patellofemoral Pain Syndrome (PFPS)

This is pain is usually felt around or behind the kneecap. It can be as a result of:

  • Poor patellar tracking

  • Weak glutes

  • Limited ankle dorsiflexion

  • Tight or weak hip flexors and quads

  • Poor knee control (valgus collapse)

  • Improper training intensity or volume


*Patellofemoral pain is your classic “feels achy in the front of my knee when I squat” type of discomfort.


Patellar Tendonitis (“Jumper’s Knee”)

This is more of a sharp, localized pain at the bottom of the kneecap (over the tendon). It is usually as a result of:

  • Too high training volume or intensity

  • High-impact or explosive movements

  • Rapid increases in load that the body was ready for


*Patellar tendonitis tends to flare with heavy squats, jumping, or fast/explosive movements/eccentrics.


2. Medial Knee Pain (Inside Region of the Knee)

Pain along the medial knee is more often tied to movement control issues - like when your knees cave in (called: knee valgus collapse),


This often comes from:

  • Weak hip abductors or external rotators (especially glute med)

  • Poor foot arch control or over-pronation

  • Limited hip internal rotation mobility - if your body isn't geting the adequate mobility at the hip level, it is going ot get is from somewhere else (the knee) and cause movement pattern abnormalities to do so.


*When the knee caves inward, the medial structures can take on more stress that what they are capable of, creating irritation and pain over time.


3. Lateral Knee Pain (Outside of the Knee) – "IT Band Syndrome"

Lateral knee pain during squats is commonly referred to as IT band irritation. While the IT band itself doesn’t “stretch,” it can become over-tensioned when the glutes—especially the glute med—aren’t doing their job.


Poor glute firing and strength leads to:

  • Poor hip stability

  • Increased friction at the lateral knee due to poor movement patterns at the knee


Our Top 5 Solutions to Fix Knee Pain During Squats


*CHECK OUT OUR YOUTUBE CHANNEL FOR VIDEOS OF THE EXERCISES BELOW!


1. Strengthen Your Ass Muscles — Especially Glute Medius

Glute strength controls femur (leg) positioning, knee alignment, and overall squat stability. The better your glutes are firing, the better movement patterns down the chain we can have. Exercises like the following are great accessories for glute strengthening:

  • Lateral band walks

  • Single-leg and double leg RDLs

  • lateral Step-downs

  • Hip Airplanes

  • Reverse Lunges


2. Improve Ankle Dorsiflexion

Limited ankle mobility forces your knees and hips to compensate.

Try these out if you have stiff ankles:

  • Knee-over-toe lunges

  • Banded ankle dorsiflexion mobilization

  • Squat holds with a focus on driving knees forward


3. Improve Hip Mobility

Tight quads, hip flexors, and limited hip rotation can all alter squat mechanics. Improve your hip mobility with some of our favorite hip drills:

  • 90/90 hip CARs

  • Hip airplanes

  • Banded Elevated Pigeon Stretch

  • HIP STRENGTHENING - YOU DON'T SAY!


4. Use TEMPO to Build Control and Awareness

Tempo is one of the most underrated tools for improving squat mechanics. Slowing the movement and/or adding pauses builds strength, control, and awareness of positioning.


5. Modify Training Volume, Intensity, or Position

Pain during squats often comes from doing too much, too soon—or squatting through poor positions.

Try adjusting:

  • Load

  • Frequency

  • Depth

  • Squat stance

  • Foot position

  • Type of squat variation (front squat, box squat, goblet squat, etc.)


Sometimes the fix is as simple as switching variations for the time being while addressing the ROOT CAUSE and then slowly adding back in the specific squat goal.



Knee pain physical therapy

Final Thoughts

Knee pain during squats doesn’t mean you have to stop squatting—it means you need to squat smarter. Most squat-related knee pain comes from a combination of mobility restrictions, strength imbalances, and technique issues, all of which are highly trainable.


If knee pain is holding you back or stopping you from squatting in the gym, the right individualized assessment can make a massive difference. At Redemption Physical Therapy, we help athletes identify the root cause of their pain so they can get back to training stronger than before.




If you want help figuring out your exact issue, schedule an assessment today!


Talk to you soon,

Redemption Physical Therapy

 
 
 

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