Knee Pain When Squatting? How To Diagnose It Based On Location + Feel

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Knee pain when squatting is a common but preventable issue; it can vary in frequency and intensity depending on what is causing it.

Squatting is an essential movement, and we will regularly recreate some variation of a squat multiple times per day. You may squat down to sit on a chair or pick something up off the floor; it’s a movement that cannot be avoided.

The first step to stopping knee pain when squatting is to identify the specific cause in order to be able to address it effectively.

We’re going to look at the most common causes of knee pain when squatting based on location and feel.

If you experience persistent or severe knee pain when squatting, it’s crucial to seek advice from a qualified healthcare professional or a physical therapist with experience in injury prevention and rehabilitation.

In this article, we will look at:

  • How To Diagnose Knee Pain Based On Location And Feel
  • Knee Pain When Squatting – Final Thoughts

Let’s get into it!

A person holding their knee, squatting.

How to diagnose Knee Pain Based On Location and feel

So, if your knee hurts when squatting, we may have your answer as to why. Let’s take a general look at which pathologies are most likely based on the symptom of experiencing knee pain when squatting.

It is important to note that there can be a lot of crossovers when deciphering knee pain when squatting. Therefore, as mentioned above, consult with a qualified professional who can accurately assess your own unique situation.

However, before we assess what areas of the knee correspond to certain injuries, we will look at other important aspects that we should first consider.

  • How long have you had your symptoms?
  • How severe is the pain?
  • What was the onset of pain like? Did it come on suddenly or gradually?
  • Have you had any previous injuries or medical conditions related to the knee?
  • Have you recently increased your activity level?

Knee pain when squatting can mean many different things. Considering these questions will start to give you an idea of what may be going on.

A person holding their knee in pain.

Now let’s break it down into location and feel:

Lateral Knee Pain When Squatting

Lateral knee pain when squatting or outside knee pain when squatting can be caused by several conditions.

These are likely, but not restricted to:

#1: Iliotibial Band Syndrome (ITBS):

Iliotibial Band Syndrome (ITBS) can have a significant impact on your training and may cause knee pain after squats or during squatting. You may also notice that your knee pops when squatting.

The symptoms include pain on the outer side of the knee, tenderness when touching the affected area, sharp pain on the outer side of the knee, pain radiating to the thigh or calf muscle, and increased pain when going downstairs or running downhill.

ITBS is commonly an overuse injury caused by compression of localized innervated adipose tissue.

It occurs during the footstrike and early stance phase of running when the knee is at approximately 30 degrees of flexion, leading to compression of the ITB. It will likely cause outside knee pain when squatting.

Treating ITBS involves modifying activities to avoid further aggravation and engaging in active rest.

A therapist holding a patient's knee.

Cross-training is recommended to maintain conditioning while avoiding activities that worsen symptoms.

Deep friction massage or foam rolling can be beneficial, and strength training might be necessary if muscle weakness is present.

#2: Lateral Collateral Ligament (LCL) Sprain or Injury:

The LCL is a ligament located on the outer side of the knee joint. You’ll likely notice if you have damaged your LCL. LCL damage will usually occur with direct force or sudden twisting.

A sprain or injury to the LCL can cause pain and instability during activities like squatting.

#3: Lateral Meniscus Tear:

The menisci are C-shaped pieces of cartilage that cushion and stabilize the knee joint.

A tear within the lateral meniscus will likely cause pain on the outside of the knee, especially during activities like squats.

That said, many people with meniscus tears do not report any symptoms!

A physical therapist with a patient.

Inner Knee Pain When Squatting

Inner knee pain when squatting can be attributed to various factors.

Such as:

#1: Medial Meniscus Tear

A tear in the medial meniscus, located on the inner side of the knee, can cause pain during squatting or twisting movements.

#2: Medial Collateral Ligament (MCL) Sprain or Injury

The medial cruciate ligament stabilizes the inner portion of the knee.

When squatting, the MCL will provide help to stabilize the force going through the knee, which could lead to pain.

#3: Pes Anserine Bursitis

Pes Anserine bursitis is the inflammation of a fluid-filled sac (bursa) inside the knee. Pain commonly occurs on the inner side of the knee below the joint.

The inflammation is usually triggered by increasing mileage or intensity too quickly, irritating the bursa and causing swelling.

Treatment focuses on symptom relief with rest, ice, heat, and anti-inflammatories for pain. Once the swelling subsides, running can be resumed. However, if pain and swelling persist, seeking the help of a healthcare professional is recommended.

Strengthening the knee can help prevent long-term injuries.

A therapist helping a patient squat.

#4: Genu Valgum (Knock Knees)

Some runners will have a genetic disposition where their natural knee alignment is closer together than their ankles when standing.

This is known as genu valgum or knock knees.

Squatting with this alignment can increase stress on the inner knee and lead to pain.

Pain Above/Below Knee When Squatting

Pain experienced at the front of the knee or pain above knee when squatting can be down to a number of primary causes.


#1: Patellofemoral Pain Syndrome (PFPS) – Runner’s Knee

So, your knees hurt when squatting? Look no further.

Runner’s knee is characterized by pain at the front or side of the kneecap. It can also cause pain behind the knee after running, during activities like squatting, walking up and down stairs, kneeling, or sitting for a prolonged period.

The condition is caused by factors such as weak quadriceps muscles, overpronation while running, or increasing mileage too quickly.

Weak quadriceps can lead to excessive movement of the patella, causing deviation in its tracking in the trochlear groove of the femur. Overpronation causes internal rotation of the tibia, leading to knee joint inflammation.

To address runner’s knee, it’s essential to avoid activities that worsen the symptoms and gradually reintroduce movements that don’t cause excessive pain.

Long-term strengthening of the quadriceps, hamstrings, and glutes is crucial for preventing future injuries. Ice, heat, and the use of a runner’s knee brace can provide temporary relief.

A therapist helping a patient with their knee.

#2: Patellar Tendonitis (Jumper’s Knee)

Patellar tendonitis is characterized by pain below the knee, where the patellar tendon connects the kneecap and shin, affecting the knee’s full extension.

The main cause of patellar tendonitis is increasing training mileage and intensity too quickly, leading to inflammation and pain due to excessive stress on the patellar tendon. Weak or tight quadriceps and hamstrings can also contribute to the condition.

To treat patellar tendonitis, avoid activities that worsen the pain and engage in active rest.

Gradually reintroduce low-load activities, progressively increasing volume and load. Ice and heat can be used to alleviate symptoms, and wearing a patella brace can help reduce stress on the patellar tendon.

#3: Quadriceps Tendonitis/Muscle Strain:

A muscle strain in the quadriceps can lead to knee pain when squatting.

The quadriceps muscles, located on the front of the thigh, play a crucial role in knee extension and overall leg strength.

A strain in these muscles can occur due to sudden overstretching or repetitive stress.

Why do my knees hurt when I squat? When squatting, the quadriceps are engaged, putting strain on the injured area, resulting in pain, swelling, and difficulty performing the movement.

Rest, ice, compression, and elevation (RICE) can aid in the initial treatment, followed by gradual rehabilitation exercises to strengthen and heal the affected muscles.

A person kneeling down pointing at their knee that hurts.

#4: Anterior Cruciate Ligament (ACL) Sprain or Injury

The anterior cruciate ligament (ACL) is a critical knee ligament that stabilizes the joint.

Likely causes of damage are sudden twisting or hyperextension of the knee, which leads to pain and instability.

Does your knee hurt when squatting? Squatting puts stress on the ACL, resulting in discomfort, swelling, and limited range of motion.

Pain Behind The Knee

#1: Hamstring Tendonitis

Hamstring strains can occur due to overuse or direct trauma, resulting in microtrauma or tears in the hamstring muscles. The severity of the strain can range from mild discomfort to a complete tear, impacting the ability to run.

The hamstring muscle group comprises the biceps femoris, semitendinosus, and semimembranosus. Different classifications of hamstring strains are based on the extent of the damage, ranging from Grade I (minor) to Grade III (severe).

Overuse, direct trauma, and running gait issues can cause hamstring strains. Runners are advised to rest and gradually reintroduce activity while seeking professional guidance if necessary.

The recovery process includes specific phases of rehabilitation, such as rest, ice, compression, and elevation in the initial phase.

As recovery progresses, exercises to rebuild strength and muscular proprioception are introduced. Runners should monitor their bodies and adjust the running intensity accordingly to prevent exacerbation of the injury.

A therapist helping a patient with their knee.

#2: Popliteal Cyst (Baker’s Cyst)

A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled swelling that develops at the back of the knee.

Its severity can range from a small lump to a large swelling extending down the calf muscle.

Symptoms include posterior knee pain, swelling or mass in the popliteal fossa, limited range of motion, and stiffness exacerbated by activity.

Baker’s cysts usually result from underlying knee problems like osteoarthritis, rheumatoid arthritis, or meniscus tears, causing excess synovial fluid to accumulate in the knee joint and form a cyst.

Treatment for an asymptomatic Baker’s cyst may involve self-resolution over time. However, if symptoms are present, short-term options include rest, non-steroidal anti-inflammatory drugs (NSAIDs), and applying ice to manage discomfort and inflammation.

An exercise program, guided by a physiotherapist, can be implemented after a period of rest to reduce symptoms and the risk of reoccurrence. Stretching and strengthening exercises are typically targeted.

In severe and symptomatic cases, the cyst can be drained or removed through surgical methods. Always consult a medical professional before taking NSAIDs or pursuing any treatment options.

A person with their knee in pain.

#3: Popliteus Tendinitis

Popliteal tendonitis is a condition characterized by acute pain behind the knee joint.

It is most commonly caused by overuse, where the popliteus muscle is subjected to excessive physical load, leading to inflammation and micro-tears.

Treatment for popliteal tendonitis involves an initial period of rest to avoid aggravating the affected tendon.

During this time, engaging in cross-training activities that do not worsen the symptoms is recommended to maintain muscle strength and conditioning.

After the rest period, a progressive strengthening regime should be implemented to effectively treat the tendonitis.

A person holding their knee.

Other Conditions

There are a number of conditions that we haven’t covered, as pain is too general to pinpoint to one location.

#1: Osteoarthritis

Osteoarthritis of the knee causes pain, swelling, and stiffness in and around the knee joint.

It occurs when the hyaline cartilage that separates the bones wears away, leading to bone-on-bone grinding. The severity of osteoarthritis can vary, and it is often considered a normal part of aging. However, there are ways to improve symptoms.

To address osteoarthritis, movement is essential to keep the joints healthy and mobile, which can reduce pain over time.

Running on softer surfaces and avoiding sudden movements can help.

Muscle weakness, especially in the quadriceps, is common in people with osteoarthritis, and strengthening the muscles around the joint can have a positive impact on most individuals.

This is another possible cause as to why your knees hurt when squatting or you are experiencing knee pain after squats.

A person holding their knee.

Knee Pain When Squatting – Final Thoughts

If you are experiencing knee pain when squatting, taking note of where you experience the pain can help you diagnose what the problem might be.

However, if you made it this far, you will realize that there are plenty of possible causes.

If your pain has persisted for a while, get it checked out by a professional!

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Ben is a qualified Personal Trainer and Sports Massage Therapist with a particular interest in running performance and injury. He has spent the last 9 years working with runners at his clinic in Brighton. Ben is a keen runner and avid cyclist. Evenly splitting his time between trail running, road biking, and MTB.

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