When a new member walks into our gym for their first training session, we spend a few minutes discussing their previous training and athletic experience, as well as any injuries, and general aches & pains they might have. Knee pain is often mentioned. I, myself, am not a physical therapist or an orthopedist so I never attempt to diagnose the knee damage. However, nine times out of ten, a simple movement screening test shows me right away what the cause is. Our first movement screen for knee pain is the Air Squat. This is the test recommended to us by our friend Dr. Kelly Starrett for one simple reason; excluding a catastrophic injury, a person who squats well will never experience the usual “knee-itis” pain that so many people are troubled by.
What we see in that first squat is predictable; incorrect hip motion, knees driving forward, and heels lifting off the ground. This quad dominant position creates a lot of shearing force on the patellar tendons, and inevitable knee pain. If you have ever been told not to squat because of your knee pain, this would be why. Your body is a remarkable machine and has an amazing ability to tolerate bad positions, but all tissue has a point of failure. So lets fix the position and, in turn, your knees.
An example of knees forward quad dominant squat. This is NOT how you want to squat.
One of our go-to tools for teaching this is by squatting to a box or chair (not to be confused with the box squat, a technique used by power lifters). As we discuss in our instructional video on the Air Squat, the proper position begins in a stance with your heels shoulder width apart. For many people this position feels much too wide. In my experience, finding your squat stance will take several months of work to consistently dial it in.
By placing the box just behind you, you will have a target to “reach” for.
Start with your feet turned out slightly, 5 to 10 degrees, from parallel, and twist your feet into the ground, as if you are trying to turn your toes out, to create hip torque. Notice how your knees turn out slightly when you do this. Next, you must make sure your midline is stable. You can do this by contracting your abdomen and taking a short pressurizing breath. It is important to stand a step or two in front of the box. This will make it necessary to “reach” back with your hips and engage your glutes and hamstrings.
Firmly place your feet on the ground and provide torque by “twisting” your feet into the ground. DON’T let them move!
As you begin this backward hip reach, make sure to keep your spine neutral while leaning forward enough to maintain your balance . Although your knees should not move forward, your knees must bend to allow your hips to flex properly. Just before you feel like you are going to fall backwards, allow your knees to track forward slightly until you are seated on the box . Your shins should slightly forward and your spine neutral.
Now that you are seated, you can take time to organize yourself in preparation to stand. While maintaining your neutral spine, lean forward and begin to put pressure on your heels – without lifting your toes – and begin to stand upright. Throughout the movement continue to provide stability for you knees by twisting your feet into the ground. This process should look like the reverse of your downward squat with your shins remaining nearly vertical. If you are still experiencing some discomfort, this may be due to the fact that you are still driving the knees forward or in, either on the way down or on the way back up. As you progress, stop sitting fully on the box. Instead, only gently touch, maintaining tension at the bottom before driving up.
Yes, this is not yet a full depth squat. However, if this allows you to squat pain free, this is a big step forward. You have begun to retrain your hip muscles. Not only are you helping to alleviate pain, you are also learning the proper movement pattern and sequencing in a squat while allowing yourself to reset before you stand again. After some practice you will be able to perform this same squat to a lower and lower target, until you are able to squat fully, freely and without pain.
Movement done correctly does not cause chronic pain!
One More Thing
If your quads are chronically tight, this may hinder your progress. Foam rolling is a fantastic way to treat chronically tight tissue. If you don’t have a foam roller, it is time to buy one.