6 Exercises to Improve Your Squat & Reduce Knee Pain

“I’ve been doing squats for a while now and suddenly my knees are starting to hurt. What am I doing wrong?”

Does this sound familiar?

You got serious about working out and started training consistently, making sure to do squats because everyone hails their importance and effectiveness. But perhaps you never got any personalized, professional help and tips on your squat form. Unfortunately, your body can only perform any exercise for so long with incorrect form before it starts to cry for help.

Now your body has gotten your attention, letting you know that something needs to change. But what? What is causing your knee pain, and will you have to stop squatting forever?

We went to the pros for you, and asked physical therapist and certified Pilates instructor, Wendy Grant, PT, DPT, “What can help prevent or reduce knee pain during squats?”

The good news is that you don’t necessarily have to stop squatting, and may be able to stop the pain. Grant says, “Knee pain can be addressed by focusing on proper squat form, and doing exercises that strengthen the lesser-used muscles in your glutes (buttocks) to do more of the work.”

 What is Good Squat Form?

Grant says that both in and out of the gym, proper alignment of your lower extremity (from hips to toes) is crucial for protecting your joints and allowing your thigh and gluteal muscles to work properly.  Without careful attention to your alignment, postural tendencies and muscle imbalances can cause unnecessary pressure on your knee joint and the surrounding soft tissues.

“It is also important to recognize that producing a certain position or movement is not simply a matter of brute strength, but involves retraining your brain and body to work together in a new way.  Be patient, concentrate, and enjoy the new challenge!”

Here are Grant’s tips for proper form:

Watch yourself in a mirror as you squat, and look for the following in your lower body:

• Your knee stays in a straight line with your hip (look/feel for the pointy part of your pelvis that sticks out at the sides of your abdomen), and with your second toe.  
• The knee should not drift inward as you squat, which is a tendency for most of us.  When the knee sags inward, it can put additional stress on the front and inner aspects of the knee joint, and the tendons and ligaments that surround it.  It may also impact the foot, ankle, hip, and low back.  
• Your heels stay on the floor. Think about keeping weight over your heels, as if you are reaching your buttocks back to sit in a chair.

“By focusing on these aspects of proper squatting technique, you will be able to save yourself some tissue damage and pain. You may want to take a break from using heavy weights and work on bodyweight squats only until you’ve perfected your form. Then you can slowly increase your squat weight,” adds Grant.

6 Exercises to Strengthen Your Glutes

The primary muscle that works to keep the knee aligned properly during a squat is called the gluteus medius, and is found from the middle of your buttocks to the side of your hip. Working this muscle selectively can train it to protect your knee and maximize your squats. 

Try these exercises to get your gluteus medius working, then make sure to feel it contracting as you hold your knee in alignment during your squats. Perform 3 times per week, or on leg-training days. A few reps right before squatting is recommended, so as not to get too fatigued before adding weight.

1.Clams

• Lie on your side, as if you were lying against a wall with your head, shoulders, buttocks, and feet all touching the wall.  Rest your head on the arm that is in contact with the floor to support your neck.  Place the other hand on the floor in front of you for support.
• Draw your knees up toward your body until they are bent about 90 degrees.  At this point your feet should still be in a line with the rest of your body, touching your imaginary wall.
• Make sure that your top hip is directly over your bottom hip, so that your pelvis is straight up and down, not open toward the ceiling.  The pelvis must stay in this position throughout the whole exercise in order to target the correct muscle.
• Make a space between your torso and the floor by tilting your top hip toward your feet, straightening your spine.  Draw your lower abdominals in without holding your breath.
• Keeping your feet together, use the muscles of your hip to slowly raise your top knee into the air so that the leg lifts like the opening of a clam shell.  Raise the knee as far as you can without your pelvis beginning to rock backward.
• Slowly lower the knee with control.  Continue to raise and lower, exhaling as you raise the leg, and inhaling as you lower.

• After a few repetitions, you should feel the work in the middle/side of your buttocks.  If you feel the work down your leg or in your knee, double check your pelvic alignment, and experiment with your knee position, either a little more, or a little less bent.
• Try 8-10 repetitions, or until you feel muscle fatigue, or lose control of your alignment.  Repeat on the other side.
• For added resistance:  Add a loop resistance band around both knees as pictured.  Be aware that the band will significantly limit your range of motion, so lift your knee slowly and carefully into the band, being careful to maintain proper form.

2.Bridging

• Lie on your back with your head flat on the floor and your feet shoulder-distance apart.  Bend your knees so that your heels are about a hand’s distance from your buttocks.  
• Place a loop resistance band or Pilates ring around your knees, so that both knees are pushing out slightly to hold the band/ring in place, but still keeping the knees in alignment with the feet and hips.  This creates an isometric contraction in the gluteus medius, which helps to activate your muscles properly.
• Squeeze your sitting bones together.  Beginning with your tailbone, slowly peel your spine off the floor, lifting one vertebrae at a time until your weight is on your shoulder blades.  
• Your body should be a straight line from shoulders to knees.  DO NOT arch your back at the top of your bridge.

• Slowly lower from the bridge position by setting down one vertebrae at a time, starting with the neck, and progressing down the spine until the tailbone is the last thing to come to rest on the mat.
• Keep even pressure on the band/ring throughout the lift and lower, working the muscles on the sides of your buttocks/hips.
• Try 8-10 repetitions, or until you feel muscle fatigue, or lose control of your technique.  Exhale as you lift, and inhale as you lower.
• Alternative:  For weak inner thigh muscles, squeeze the Pilates ring and place it between your knees, keeping even pressure on the ring as you lift and lower.

3.Wall Slides

• Stand at a wall with one side of your body against the wall; lift the leg touching the wall and bend your knee about 90 degrees so that your foot is behind you. This knee should push lightly into the wall throughout the exercise.
• Prepare the other leg for a partial squat by making sure it is about 1 foot from the wall, with foot, knee and hip aligned. Bring your hands together in front of your body to keep your arms out of the way.
• Activate the muscles of your buttocks by lifting the inner border of your foot away from the floor, squeezing your sitting bones together, and using your gluteus medius to hold your knee in alignment as you slide your body down the wall into a squat no deeper than 90 degrees of knee bend. Picture sitting your body back as if reaching your buttocks for a chair. Keep your form as you slide back up.

• Try 8-10 repetitions, or until you feel muscle fatigue, or lose control of your technique.  Exhale as you squat, inhale as you return to standing. Repeat on the other side.  

4.Side Steps

• Stand facing a stretch of wall, or a mirror if possible, with your feet shoulder-width apart.
• Place a loop resistance band around your knees for beginners, ankles for more advanced users, then squat slightly.
• Check your squat alignment:  a straight line from your 2nd toe to your knee, and to your hip.  Your buttocks should be sitting back as if reaching for a chair so that your knee is not going forward over your toes.  Your back should be straight from the buttocks to the neck, not arched at the lower part.  Your hands can rest on your hips.
• Start by stepping your right leg gently out toward the right.  Do not work too hard against the resistance of the band or you will end up substituting with the incorrect muscles.  
• Keeping your squat position, step the left foot in toward the right foot.  Continue stepping out with the right foot, and then stepping the left foot in.
• After about 8-10 repetitions, switch directions by stepping out with the left foot toward the left, and following with the right foot.
• You should feel the work/fatigue in the gluteus medius muscle of each side.  Increase the difficulty of the exercise with more repetitions, using a band with greater resistance, or making your side steps bigger.

5.Knee Raises on All Fours

• This exercise is aimed at working your core and your gluteal muscles at the same time.  A strong core is always important for a proper squat!
• Step into a loop resistance band or Pilates ring and pull it up to rest just above your knees.
• Kneel on a mat and come to hands and knees; your hips should be aligned over your knees, and your hands should be just forward of your shoulders.
• Make your back a straight line from the crown of your head to your tailbone, and tuck your toes to prepare as you would for a push-up.
• Push out gently on the band or ring with your knees to hold it in place and activate your gluteals.
• Lift your knees off the mat, hold the position, and lower back to the floor.
• Try 8-10 repetitions.  Exhale as you lift, inhale as you hold, exhale as you lower.

6. Ball Squats

• Place your feet inside a loop resistance band and pull the band up so that it is wrapped around your knees (alternatively, you can use a Pilates ring around your knees).
• Stand with your back to a wall, and place a stability ball between your back and the wall, with your feet shoulder-width apart.
• With the ball supporting your mid and lower back, lean into it and walk your feet a few feet away from the wall; you want your feet far enough in front of you that you can slide down into a sitting position without your knees going forward over your toes.
• Squat and slide down the wall, with the ball rolling behind you, keeping slight outward pressure on the resistance band to help engage the gluteus medius.
• Stop at 90 degrees of knee bend, as if you are sitting in a chair, and then slowly push back up to standing.  Keep outward pressure on the band with your knees as you slide up.

• In the standing position, keep a slight bend in your knees to keep the muscles engaged.
• Try 8-10 repetitions, or until you feel fatigue or start to lose your form.  Exhale as you squat, inhale as you return to standing.

What do you think?