FPF Show Episode 9: Are Deep Squats Bad For Your Knees? (Part 1)

By dpope2020

November 26, 2021

In today's episode we take a look at the literature to try and answer the question, "are deep squats bad for the knees?"  We go over:

  • Why the buzz about deep squats?
  • What happens within the knee joint during a deep squat?
  • Are deeper squats more stressful than a more shallow squat?
  • Does habitual squatting lead to increased risk of arthritis and joint replacement?
  • What populations that squat are at risk for long term knee problems?

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Show Notes / Relevant Articles:

  1. The Ultimate Guide to Getting Out of Knee Pain and Back to Squatting, Olympic Lifts and Other Lower Body Exercises
  2. The Complete Guide to Patellar Tendinopathy
  3. The Complete Guide to Patellofemoral Pain Syndrome
  4. Does Knee Cave-in During the Squat Matter?

References:

  1. Willy RW, Meira EP. CURRENT CONCEPTS IN BIOMECHANICAL INTERVENTIONS FOR PATELLOFEMORAL PAIN. Int J Sports Phys Ther. 2016 Dec;11(6):877-890. PMID: 27904791; PMCID: PMC5095941.

  2. Loudon JK. BIOMECHANICS AND PATHOMECHANICS OF THE PATELLOFEMORAL JOINT. Int J Sports Phys Ther. 2016;11(6):820-830.

  3. Wallace DA, Salem GJ, Salinas R, Powers CM. Patellofemoral joint kinetics while squatting with and without an external load. J Orthop Sports Phys Ther. 2002 Apr;32(4):141-8. doi: 10.2519/jospt.2002.32.4.141. PMID: 11949662.

  4. Kujala UM, Kaprio J, Sarna S. Osteoarthritis of weight bearing joints of lower limbs in former élite male athletes [published correction appears in BMJ 1994 Mar 26;308(6932):819]. BMJ. 1994;308(6923):231‐234. doi:10.1136/bmj.308.6923.231

  5. Kujala UM, Kettunen J, Paananen H, et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum. 1995;38(4):539‐546. doi:10.1002/art.1780380413

  6. Amin S, Goggins J, Niu J, et al. Occupation-related squatting, kneeling, and heavy lifting and the knee joint: a magnetic resonance imaging-based study in men. J Rheumatol. 2008;35(8):1645‐1649.

  7. Zhang Y, Hunter DJ, Nevitt MC, et al. Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: the Beijing Osteoarthritis Study. Arthritis Rheum. 2004;50(4):1187‐1192. doi:10.1002/art.20127

  8. McAlindon TE, Wilson PW, Aliabadi P, Weissman B, Felson DT. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999;106(2):151‐157. doi:10.1016/s0002-9343(98)00413-6

  9. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2(2):205‐212.

  10. Nagura T, Matsumoto H, Kiriyama Y, Chaudhari A, Andriacchi TP. Tibiofemoral joint contact force in deep knee flexion and its consideration in knee osteoarthritis and joint replacement. J Appl Biomech. 2006;22(4):305‐313. doi:10.1123/jab.22.4.305

  11. van Rossom S, Smith CR, Thelen DG, Vanwanseele B, Van Assche D, Jonkers I. Knee Joint Loading in Healthy Adults During Functional Exercises: Implications for Rehabilitation Guidelines. J Orthop Sports Phys Ther. 2018;48(3):162‐173. doi:10.2519/jospt.2018.7459

  12. Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T, Lane KA. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Rheum. 2006;55(5):690‐699. doi:10.1002/art.22245

  13. Hartmann H, Wirth K, Klusemann M. Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Med. 2013 Oct;43(10):993-1008. doi: 10.1007/s40279-013-0073-6. PMID: 23821469.

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Thank you!

Dan Pope DPT, OCS, CSCS