August 18, 2022
Your Guide To Returning To Squatting After A Knee Injury

Author: Dr. Colin Butler, DPT, ATC


If you’re going to be pushing the envelope on strength training and challenging your limits to produce force or handle a substantial amount of exercise involving a high amount of force, you’re not always going to be feeling great physically. 

Exercise is a stress on the body. Stress can be both a potential positive, and a potential negative, based on how the body responds to it. 

Everyone’s ability to take a physical stress from exercise and adapt to it is different based on a whole host of variables. This is why not everyone has the same response to the same exact fitness or training program. 

In the case of chasing improved ability to squat heavier weights, something that may arise is symptoms in and around the knee with increased loading or periods of intensity. This might commonly be called an “overuse injury” – which is just an over-accumulation of physical stress on an area of the body that is larger than it can buffer and have a positive reaction to. 

If your symptoms seem to improve with rest but come back as soon as your intensity (the amount of force you are having to produce) or volume (the total amount of pounds lifted), only resting will NOT help you continue to chase your ability to train intensely. Rest WILL give your body more time to recover and heal, but it will not help your knee learn to handle increasing amounts of force, or to be able to absorb and produce force in different ways. 

Here are some of my go-to methods, and my reasoning for why we are applying them, to help someone’s knee become more resilient when returning from a training related knee injury. 


1) Use cable assisted split squats to improve the ability for the knee to absorb force

Split squats are a useful way to train loading each leg with a bias towards the front leg. They aren’t true single leg loading because both feet are on the ground, but split squats bias loading towards the front leg. 

The front foot elevated version shifts some of the weight off of the front leg to make it more of a 55%, 45% distribution of weight between the front and back legs. 

The force of the cable helps to reduce your body weight slightly and allow you to load your knee in deeper ranges of motion than traditional bilateral squatting can sometimes allow, while assisting in helping to distribute the load between your hips and ankles. 

This is especially useful when we need to rebuild your confidence in being able to load your knee and is a very friendly variation when we are first reteaching your knee to absorb force, and to help the structures above and below the knee do their part so less focal stress gets put onto only your knee. 

2) Use regular split squats to load the knee more aggressively 

A split squat without the lead leg elevated will let the shin move more forward relative to the ankle, which will put more force into your knee. 

I’ll start programming regular split squats into client’s programs once they are performing front foot elevated variations without any pain or hesitation with an emphasis on having them being able to do sets of higher volumes (12 to 15 reps) with moderate load. 

3) Reintroduce bilateral squatting with an emphasis on absorbing force first 

The box squat is a great way to get back to a symmetrical stance squatting activity and can be tweaked in many ways to change how quickly the knee is loaded. 

Starting with a box squat, you can use moderately heavy loads mimicking your training weight and work on a complete rock back onto the box. 

A simple way to progress this is to use a progressively smaller box so you use greater ranges of motion over time as your body allows you to. 

Come to a complete stop on the box, then push the floor away and return to the starting position. 

4) Reintroduce training load of squatting without any constraints

Now that we’ve improved tolerance of the knee to loading in several different ways, we must reintroduce the actual movement without any constraints so that, using the principles of Physical Stress Theory, your knee can be exposed to and adapt to the specific forces it experiences when doing your desired squatting movement. 

The big takeaway from this article is that experiencing overuse injury type knee pain during a squat can be common. Rest has its place at times, but it is no substitution for making sure that your body is able to absorb and create force under many different situations to have a knee capable of doing many different physical tasks. 

Try some of the activities we talked about above, and reach out to your trusted coach or physical therapist if you need specific guidance customized to your unique situation!