Why knees hurt during squats

• Load exceeds tissue capacity: Pain often reflects a spike in volume/intensity rather than a single “bad rep.”
• Mobility bottlenecks: Limited ankle dorsiflexion or hip rotation can push the knee or trunk into stressful positions.
• Technique drift: Valgus collapse, heels lifting, or losing core brace increases joint stress.
• Strength imbalances: Undertrained quads, calves (soleus), and lateral hip stabilizers can overload the knee.

Good news: Most squat-related knee pain improves by adjusting load, dialing in technique, and strengthening key areas.

Quick self-checks

1) The 2-out-of-10 pain rule

During and after training, aim to keep pain at or below 2/10 and not worse the next day. If pain rises or lingers, reduce range of motion, volume, or load.

2) Knee-to-wall ankle mobility test

1. Stand facing a wall, foot flat, big toe 3–5 inches (8–12 cm) from the wall.
2. Drive the knee forward to touch the wall without the heel lifting.

Target: About 4 inches (10 cm) or more pain-free. Less than this can make squats feel “pinchy” at the knee or force your heels up.

3) Step-down control

1. Stand on a 6–8 inch step on one leg; slowly tap the opposite heel to the floor and return.
2. Keep knee tracking over the 2nd–3rd toe without collapsing inward; control descent for 2–3 seconds.

If the knee caves or wobbles, train single-leg strength and lateral hip control.

A smart warm-up (8–10 minutes)

1. 2–4 minutes light cyclical work (bike/row/skip) to raise temperature.
2. Ankle and hip prep:

   • Knee-to-wall ankle rocks: 2 sets of 10–12 reps per side
   • 90/90 hip rotations: 2 sets of 5 slow reps per side

3. Activation:

   • Band terminal knee extensions (TKE): 2 sets of 15 per side
   • Mini-band lateral walks: 2 sets of 12–15 steps each direction
   • Bent-knee calf raises (soleus): 2 sets of 12–15

4. Groove the pattern:

   • Heel-elevated goblet squat, 3–4 second descent, 1–2 second pause: 2 sets of 6–8 light reps

Mobility that matters

Ankles (dorsiflexion)

• Knee-to-wall rocks: 2–3 sets of 10–15 reps, daily or pre-squat
• Loaded calf/soleus raises (focus on slow lowering): 3 sets of 10–15, 3–4 days/week
• Heeled wedge or weight plates under heels during squats as a short-term aid while you build capacity

Hips

• 90/90 rotations or shin boxes: 2–3 sets of 5–8 slow reps
• Half-kneeling hip flexor with posterior pelvic tilt: 2 sets of 30–45 seconds per side
• Adductor rock-backs: 2 sets of 8–10 per side

Thoracic spine (helps with upright torso)

• Open book rotations or wall slides: 2 sets of 8–10 per side

Keep mobility gentle and consistent. Gains stick when you follow with strength in that new range.

Squat technique cues that protect your knees

• Stance: Start hip-width to shoulder-width; toes slightly out (5–20 degrees). Adjust to your hips and ankles.
• Tripod foot: Big toe, little toe, heel evenly loaded; grip the floor.
• Brace 360 degrees: Inhale, expand ribs and belly into your belt or hands, maintain through the rep.
• Knees and hips together: Let knees travel forward in line with toes while hips sit between your heels.
• Depth: Use the deepest pain-free range with control; build deeper over time.
• Tempo: Slow 2–4 second eccentric to groove control; pause 1 second at the bottom if pain-free.
• Heels lifting? Use a heel wedge or reduce depth while you improve ankle range.
• Knees caving? Think “push the floor apart” and “track over 2nd–3rd toe.”

Strength progressions for durable knees

Pick the starting level that is pain-free or ≤2/10 and progress weekly.

Phase 1: Calm symptoms, build confidence

• Isometric options (great for soothing knee pain):

  • Wall sit or “Spanish squat” hold: 4–5 sets of 30–45 seconds, 1–2 days/day when irritable

• Goblet box squat (high box): 3–4 sets of 6–8, 2–3 times/week, slow lowering
• Split squat (vertical shin initially): 3 sets of 8–10 per side
• Soleus raises (seated or bent knee): 3 sets of 12–15
• Hip hinge (RDL): 3 sets of 6–8 to share load with hips

Phase 2: Restore range, strengthen quads and stabilizers

• Heel-elevated goblet squat (deeper ROM): 3–4 sets of 6–10
• Front-foot elevated split squat: 3 sets of 6–8 per side, allow knee to travel forward
• Step-downs or Petersen step-ups: 3 sets of 8–12 per side
• Romanian deadlift or hip thrust: 3 sets of 6–10
• Mini-band lateral walks or side planks: 2–3 sets of 12–15 steps or 20–30 seconds
• Calf raises (straight and bent knee): 3 sets of 10–15 each

Phase 3: Performance and resilience

• Back squat or front squat (progressively heavier): 3–5 sets of 3–6, leave 1–3 reps in reserve
• Bulgarians (rear-foot elevated): 3 sets of 6–8 per side
• Cyclist squat or sissy-squat variation (if pain-free): 3 sets of 8–12
• Single-leg RDL or step-up (higher box): 3 sets of 6–8 per side
• Optional low-level plyometrics (once pain-free): pogo hops or snap downs, 2–3 sets of 10–15 contacts

Notes:

• For tendon-type pain that “warms up,” emphasize slow, heavy strength and consider isometrics on high-pain days.
• For pain deep in knee flexion, reduce depth temporarily and build tolerance gradually.

Programming blueprint

Weekly template (2–3 lower-body days)

• Day A (quad emphasis): Squat pattern + split squat + soleus raises + lateral hip
• Day B (hip hinge emphasis): RDL/hip thrust + step-downs + calf raises
• Optional Day C (single-leg/control): Bulgarian split squat + single-leg RDL + isometric wall sit

Example session (45–60 minutes)

1. Warm-up: 8–10 minutes (see section above)
2. Primary lift: Heel-elevated goblet squat, 4 sets of 6–8 at a 3–0–1 tempo, 1–2 reps in reserve
3. Accessory 1: Front-foot elevated split squat, 3 sets of 8 per side
4. Accessory 2: RDL, 3 sets of 6–8
5. Accessory 3: Step-downs, 3 sets of 10 per side
6. Calves: Bent-knee calf raises, 3 sets of 12–15
7. Finisher (optional): Wall sit, 3 sets of 30–45 seconds

Progression rules

• Increase load 2–5% or add 1–2 reps per set when all sets feel like 2–3 reps in reserve and pain ≤2/10.
• Every 4th week, deload by reducing volume by ~30–40% or using lighter loads.
• If pain spikes, reduce depth, use a wedge, or swap to isometrics for 1–2 weeks while maintaining training frequency.

Recovery and load management

• Sleep 7–9 hours and meet protein needs (~1.6–2.2 g/kg/day).
• Spread lower-body work across the week; avoid large jumps in sets or intensity.
• Easy options for symptom relief: short walks, heat before training, ice after if it feels good (comfort, not cure).
• Track: pain during squats, next-day stiffness, and ankle/knee ROM. Adjust if trends worsen.

When to get medical guidance

• Acute pop with swelling, instability, or inability to bear weight
• Locking/catching, or knee repeatedly giving way
• Night pain, fever, unexplained weight loss, or persistent swelling
• Pain that worsens for weeks despite reducing load

FAQ

Are knees over toes safe? Yes. Letting knees travel over toes is normal and often necessary for full-depth squats. The key is control and appropriate load.

Should I avoid deep squats? Not necessarily. Use the deepest range you can control without flaring symptoms. Depth can progress as tolerance and strength improve.

Is a heel wedge cheating? No. It’s a tool that increases ankle range and torso uprightness, often reducing discomfort while you build mobility and strength.

What if only one knee hurts? Train both legs, but bias single-leg work and isometrics to the sensitive side within the 2/10 rule. Seek assessment if it persists.

Sources

• Willy RW, Hoglund LT. Patellofemoral pain. J Orthop Sports Phys Ther. 2020.
• Escamilla RF. Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc. 2001.
• Hartmann H et al. Analysis of squat-related kinematics and kinetics. Sports Med. 2013.
• Malliaras P et al. Patellar tendinopathy and load management. Br J Sports Med. 2013.
• Barton CJ et al. Best practice for patellofemoral pain. Br J Sports Med. 2015.
• Rabin A et al. The ankle dorsiflexion–knee valgus relationship. J Orthop Sports Phys Ther. Multiple studies.