how to fix knee pain with squatting the prehab guys

How To Fix Knee Pain With Squatting

Do you have knee pain? Have you tried changing your movement mechanics when performing a squat? Did you know there are different ways to squat by using a knee strategy versus a hip strategy? A knee strategy has been shown to increase the risk of tibiofemoral joint injuries, patellofemoral joint pain, patella tendinopathy, ACL sprains, as well as IT band syndrome. Utilizing a hip strategy with movements such as squatting, stair climbing, and jumping will reduce demand on your knees, which may reduce your knee pain or help prevent you from having knee pain in the future! Read more to understand the difference between a knee vs. a hip strategy, and how to fix knee pain with squatting!


Why Newton’s Laws Matter With Changing Your Mechanics

Letโ€™s bring it back to Newtonโ€™s Third Law: For every action (force) there is always an equal and opposite reaction โ€œGround Reaction Forceโ€, which is the force equal to and opposite to the force which we impose on the ground. Based on this ground reaction force we will be able to distinguish the lever/moment arm of each joint. What is a lever arm? It is the perpendicular distance from the line of force to the axis of rotation. The larger the lever arm the greater the external moment/torque on a given joint.

Basically the larger the moment arm -> the larger the external moment is, which induces a larger internal moment arm, thus creating a larger demand on the muscles at that joint to work!


Improve The Mobility Of Your Squats!


Fix Knee Pain with Squatting: Understanding Knee vs. Hip Strategy

Here Arash is performing the squat with a hip and a knee strategy: A HIP STRATEGY is used during the first two repetitions, where the work is primarily being done by the hip extensors. This has been shown that this movement is roughly controlled 50% by the hip extensors, and only 25% by the ankle plantar flexors and 25% by the knee extensors During the last 2 repetitions he performs with a KNEE STRATEGY (knees forward), which will put a LARGE demand on the knee extensors AKA quadriceps. It has been shown this movement is controlled by approximately 50% by the knee extensors (20% hip extensors and 30% plantarflexors). Unfortunately, we live in a knee dominant world, we are here to tell YOU to start sitting a little bit deeper into your squat (by using a hip strategy) whether you are plopping on to your chair/couch/toilet or squatting at the gym.


Knee Pain Due To Squatting? Overcome Those Obstacles With Our Program!

knee program fix pain with squatting the prehab guys

It is common for individuals to experience knee pain with squatting; however, our program can help optimize your knee function so that you do not run into this issue any longer! The Knee [P]Rehab Program is a physical therapist developed, step-by-step program that teaches you how to optimize your knee health. This 3-phase program will expose you to various knee and lower body strengthening and stabilization exercises supported by science. This program will bulletproof your knees for anything life throws at you! Learn more HERE!ย 


Lunging with a Knee Vs. Hip Strategy

There are three primary things to consider when looking to bias either the GLUTES or the QUADS in the lunge.

1๏ธโƒฃ Tibia Angle: A tibia that is forward = more forward knee migration. This translates to a greater degree of knee flexion and thus a longer lever arm on the quadriceps. Essentially, the more forward the knee travels past the toes, the greater the demand on the quadriceps while decreasing demand on the glutes.

2๏ธโƒฃ Trunk Angle: A forward trunk = longer lever arm for the glutes. In the same fashion in which a forward knee increases the quad lever arm, the trunk does the same thing for the glutes.

3๏ธโƒฃ Hip extension vs Knee Extension: This is one of the harder ones to see. Even if the biomechanical set up in the is correct to hit either the glutes or quads, if your control over which muscles you are firing isn’t right, it does’t make a difference at all. In the ascent phase of the exercise, you ideally will be using your quad to drive knee extension and glutes to drive hip extension. They should both be occurring.

However, many times people tend to focus on just one – many times knee extension – and miss out on hitting the glutes.ย Notice how my knee “snaps back”, that’s a tell tale sign that I’m initiating my lunge movement primarily with knee extension. Stay on the lookout for the knee snap back if targeting the glutes!


prehab guys lunging variations


Fix Knee Pain When Squatting: Master The Hip Hinge

The first step in mastering a hip strategy is understanding how to appropriately hip hinge. The video below will help improve your ability to hip hinge! Understanding how to hip hinge is a pre-requisite in understanding how to change your mechanics to improve knee pain.


Hip Hinge – Dowel

Sample Knee [P]Rehab Program Exercise Video

  • HOW: Begin in a standing position with your feet about hip-width apart. Place a dowel behind your back with one end making contact with your head and on your tailbone with the other end, the middle of the dowel should also be in contact with your mid-back. Make sure you keep contact with these three points for the entirety of the movement. Next focus on hinging primarily at the hips. This is achieved by bringing your torso forward and pushing your butt back. Lower yourself as far as you feel comfortable while maintaining all three points of contact, then pull yourself upright by using the muscles in the back of the legs. Squeeze your butt once you are upright to ensure that you stand fully erect.


  • FEEL: You will feel the muscles in the back of the legs work with this exercise. As you hinge over you will feel a pull in the hamstrings, the back upper thigh muscles.


  • COMPENSATION: Avoid rounding the back as you lean your torso forward. Movement should primarily be at the hips. Donโ€™t allow the knees to go forward past your toes with this exercise. Maintain the 3 points of contact during this exercise, (tail bone, mid-back, and back of the head).


Hip Hinge – Hand Behind Back

Get set up standing with your hand resting behind your back in a comfortable position. Begin the exercise by performing a hip hinge followed by standing tall and reaching out and back behind you with the other arm. This exercise is a 2 for 1 movement, in which you are also improving the functional internal rotation of the shoulder by having the shoulder in a static position and moving from a differing joint in the body! It could be a good way to start acclimating yourself to IR movements if you have more symptoms with this movement.



How To Progress Lower Body Exercises The Prehab Guys


Closing Thoughts

The Big takeaway from this article is that learning how to perform hip dominant squats can help fix your knee pain with squatting! With that being said, it is NOT bad to squat with more knee dominant form, and there are many times where are knees must go past our toes with activities of daily living. However, if you are trying to work on your squatting mechanics and are having a difficult time with this activity, starting with more hip dominant movements may allow you to continue this form of movement while avoiding knee pain! Eventually, when your body and your knees can handle it, you want to work into a strategy where the hips and knees hinge at the same time and it is an equal strategy and contribution from both areas!


Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

  • Anna
    Posted at 20:20h, 15 October Reply

    Thank you guys, enjoyed the smiles in this one as well as the amazing content, thank you! Could you do some info on meniscus prehap/rehap please?

    • Michael Lau
      Posted at 11:27h, 23 October Reply

      We have a whole section on our exercise library devoted to meniscus prehab and rehab, check it out!

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