If your knees hurt when you squat, it’s often a sign of a specific underlying issue with the joint or surrounding muscles. Squatting is a common movement in everyday life—whether you’re exercising, picking something up, or just getting low to the ground—so when it becomes painful, it can disrupt your routine.
Common Causes of Knee Pain When Squatting
Knee pain during squatting is often linked to either mechanical problems within the joint or muscular imbalances that affect how the joint moves. Several common patterns show up when people experience this type of pain. These include ligament injuries, patellofemoral pain syndrome, and patella tracking issues. Each of these causes has its own set of features, and they may need different treatment strategies.
To identify the cause, clinicians usually consider where the pain occurs, whether there is swelling, and how the joint moves during the squat. In most cases:
- Pain without swelling and without a painful “click” usually points to a functional or muscular issue, such as patellofemoral pain syndrome.
- Pain with swelling or clicking often means there’s a ligament injury, such as a tear or strain.
Ligament Injuries: ACL, PCL, Meniscus, MCL, LCL
Ligament injuries are a common structural cause of pain when squatting. These include injuries to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial and lateral collateral ligaments (MCL and LCL), and the meniscus. These structures provide stability and support to your knee during movement. When one is injured, even slightly, pain during load-bearing movements like squats becomes noticeable.
The most telling signs of a ligament injury include:
- Swelling around the joint
- A painful “click” or snap with movement
- Inability to fully bear weight or extend the knee
- Sharp pain with rotation or bending
If you feel a sudden sharp pain with any of these symptoms, it’s worth getting checked. While home care may help mild sprains, a full or partial tear typically requires hands-on treatment or imaging for confirmation.
Patellofemoral Pain Syndrome (Runner’s Knee)
Patellofemoral pain syndrome, also called runner’s knee, often causes pain during squats. This condition happens when the kneecap (patella) doesn’t move smoothly in the groove at the end of the thigh bone. Pain usually appears when the knee is under load in a bent position—such as sitting for long periods, going downstairs, or squatting.
Runner’s knee symptoms include:
- Pain in the front of the knee
- Discomfort during prolonged sitting (often called the “moviegoer sign”)
- No swelling or clicking
- A strong urge to straighten the leg for relief
The condition responds well to physiotherapy that focuses on strengthening the vastus medialis—the inner part of the quadriceps muscle. Exercises are designed to improve control of the patella and reduce pressure during bending. If your pain doesn’t include swelling or clicking, there’s a good chance it stems from this issue rather than ligament damage.
Patella Tracking Issues During Movement
Poor patella tracking is often a cause or a contributing factor in knee pain when squatting. The patella is supposed to glide smoothly in a narrow groove on the femur. If it moves off-centre, either tilting or shifting laterally, this can create uneven stress on the cartilage underneath, causing pain and inflammation.
The issue tends to appear during activities that combine bending and load, like squatting, lunging, or climbing stairs. You might not notice any problems when the knee is straight or unloaded. When tracking is off, however, certain muscles around the knee—especially the outer quadriceps—pull harder than they should, disrupting the movement pattern.
This condition may not show visible signs like swelling but can be felt as a dull, achy discomfort deep in the knee. Corrective strengthening, especially of the vastus medialis, is usually the most effective treatment.
Functional Issues vs. Structural Damage
One of the most important distinctions in knee pain is whether the cause is structural (like a torn ligament) or functional (like a muscle imbalance or movement problem). Functional issues often mimic structural ones but require a completely different approach to treatment. Knowing the difference helps you avoid unnecessary scans or surgery.
Here’s how you can tell the difference:
- Structural issues typically present with swelling, locking, clicking, or instability
- Functional issues usually involve pain during movement but no swelling or sharp mechanical symptoms
Functional problems often respond well to strengthening and guided movement retraining. You might have pain because of how the muscles around the knee are activating—or not activating—during squats. Strengthening the right muscle groups can restore control and reduce pain.
If your symptoms change based on how you move, there’s a good chance your pain is functional. If the symptoms are constant regardless of motion or worsen over time, it may be more structural. Either way, knowing the category helps you get the right treatment sooner.
How Can You Treat Knee Pain When Squatting
Treatment depends on what’s causing the pain—structural damage, like a torn ligament, needs different care than muscular or movement-related problems. Many people can manage or improve their knee pain with targeted home strategies, while others may need professional help to fully resolve it.
When the cause is muscular imbalance or poor patella tracking, conservative care often works well. The focus shifts toward exercises that correct imbalances, reduce inflammation, and restore normal movement. Recognizing the cause early makes treatment faster and more effective.
Home Treatments
Home treatments for knee pain during squatting usually focus on strengthening weak muscles, reducing inflammation, and avoiding movements that aggravate the joint. Most muscular or functional issues improve with a structured and consistent approach.
Basic home treatment strategies include:
- Targeted muscle strengthening, especially the vastus medialis
- Heat or ice therapy, depending on whether inflammation is present
- Low-impact aerobic activity like cycling to maintain mobility
- Squat modifications to reduce strain while keeping muscles engaged
Each strategy supports the joint without pushing it into positions that make the pain worse.
Strengthening the Vastus Medialis
Strengthening the vastus medialis, the inner portion of the quadriceps, is the primary treatment for patellofemoral pain syndrome and related tracking problems. When this muscle is weak, the kneecap tends to drift laterally, creating uneven joint stress and pain during bending.
Specific exercises target this muscle more than others:
- Leg extensions with the foot rotated slightly outward
- Squats with feet turned outward to activate the inner quad
- Step-down exercises to build control during single-leg loading
These exercises help stabilize the patella during movement, reducing pain over time. Progress is typically seen within a few weeks when done consistently.
Using Heat or Ice Based on Inflammation
Choosing between heat and ice depends on whether inflammation is present. Bursitis or recent swelling responds better to ice, which calms inflammation and numbs the area. In contrast, heat is better suited to muscular tightness or chronic soreness where inflammation isn’t active.
Use this guideline:
- Ice for conditions involving swelling, redness, or bursitis
- Heat for tight muscles, stiffness, or chronic non-inflammatory pain
Ice should be used for 10–15 minutes, especially after activity. Heat can be applied before movement to loosen up muscles or improve flexibility.
Stationary Biking and Modified Squats
Low-impact movement helps maintain knee health without aggravating pain. Stationary biking keeps the joint moving in a controlled way and strengthens muscles around the knee without sharp loading. It’s often one of the first exercises recommended for people recovering from joint issues or early arthritis.
For squats, modification is necessary when pain is present. Strategies include:
- Shallow squats that reduce knee flexion
- Wall-supported squats to reduce load
- Feet-turned-out stance to better engage the vastus medialis
- Slower tempo to focus on muscle control rather than depth
These changes allow you to keep training movement patterns while avoiding further irritation. They also help build strength where it’s needed most.
Seeing a Professional
When knee pain during squatting doesn’t improve with home care, worsens over time, or includes symptoms like swelling, instability, or clicking, it’s time to seek professional help. A trained clinician can determine whether the issue is muscular, mechanical, or structural by taking a detailed history and performing a physical exam. This step is essential if the source of pain is unclear or if activity modifications and exercises haven’t helped.
A professional will assess movement patterns, palpate the joint, and may test for structural issues like ligament tears or meniscal damage. The exam may also rule out conditions such as patellofemoral pain syndrome, which mimics ligament problems but requires a different treatment strategy.
When Should You Seek Professional Treatment?
Some symptoms suggest a more serious problem and should prompt a clinical evaluation. These include:
- Pain that does not improve after several weeks of targeted exercise
- A clicking or locking sensation in the joint
- Swelling that appears after activity or persists at rest
- A feeling of instability, like the knee might give out
- Pain that interferes with daily movement or sleep
You should also consult a clinician if your knee pain began after trauma, like a twist or impact during sport or work. Early assessment can shorten recovery time and prevent further joint damage.
What Treatments Can You Get?
Professionals offer a range of treatments depending on the cause of your pain. For functional issues like patella tracking or muscular imbalance, therapy focuses on restoring movement patterns and muscle control. For structural issues, rehabilitation may need to be more protective or involve medical imaging.
Treatment options may include:
- Physiotherapy, focused on strengthening the quadriceps—particularly the vastus medialis
- Hands-on therapy, including muscle release, joint mobilization, and guided stretches
- Electrotherapy modalities, like ultrasound, laser, or interferential current to reduce inflammation and support tissue healing
- Shockwave therapy for persistent cases or those with chronic tendon issues
- Exercise prescription tailored to your movement needs and deficits
Care is adjusted based on how your symptoms respond. In most cases, you’ll be given a structured plan to follow at home between visits.
How Long Does it Take to Heal?
Recovery time depends on the cause and how long the pain has been present. If treatment begins early—within the first week of symptoms—many people feel better within two to three weeks. Functional issues typically improve faster than structural ones, especially when the right muscles are targeted.
Estimated healing timelines:
- Recent-onset pain: noticeable improvement in 2–4 weeks with guided care
- Chronic cases (3+ months): a minimum of 3 weeks of consistent therapy, followed by reassessment
- If there’s at least 50% improvement after 3 weeks, recovery may be complete in another 3–4 weeks
- If progress is limited (10% or less), treatment may extend up to 20 weeks or longer
A slower timeline doesn’t mean the condition is untreatable—it may just require more consistent reinforcement, especially if pain is tied to long-term movement habits or repeated strain.
PinPoint Health Can Help
If you’re struggling with knee pain when squatting and don’t know where to start, PinPoint Health offers comprehensive assessment and treatment services to help you move without pain.
Our clinics provide physiotherapy, chiropractic care, and advanced modalities like shockwave or laser therapy to treat both functional and structural issues.
We have locations in:
- Toronto
- Etobicoke
- Brampton
- Markham
- Maple
- Mississauga
- Newmarket
- Woodbridge
- Oakville
- Vaughan
