Make squats easier on your knees

NEW YORK – Most exercise scientists today say the squat is one of the most beneficial exercises you can do as you age. Just think about all the ways you squat throughout the day: grabbing dish soap from under the sink, crouching to hug your children and even sitting down on the toilet.

“We probably do hundreds of squats a day,” said Dr Christopher M. Powers, a professor of physical therapy at the University of Southern California. Some say it is fundamental to how you move.

But what if you suffer from chronic knee pain and the thought of squatting makes you wince? Can you still do the exercise safely?

As it turns out, most people can effectively squat while navigating all sorts of issues, such as kneecap pain, arthritis, meniscus tears, ligament and tendon strains, and post-operative recovery, said Mr Jarlo Ilano, a physical therapist in Seattle.

The key, he said, is to find ways to adjust your form that take stress off the knees, then to gradually get stronger and rely on those adjustments less. A recent research review, for example, found several adjustments that can decrease knee pain for people struggling with arthritis and recent anterior cruciate ligament (ACL) damage.

Finding the right adjustments may take some trial and error.

For one person, simply squatting with a wider stance may provide relief. Others might want a wider stance and an outward toe rotation. Try one adjustment at a time first, then see if some combination provides more relief.

Here are four form adjustments for the most common knee woes that experts recommend for comfier body-weight squats.

Forward torso lean

Recommended for: patellofemoral pain (kneecap pain), osteoarthritis, post-ACL reconstruction surgery

In a typical squat, with the top half of your body in an upright position, your knees and quads take the brunt of your body weight. But in this version, you lean your torso and arms forward, and sit your butt back, which lessens the strain on the knees.

One caveat: This is not recommended for people who have lower back pain, because it can create strain on the lumbar spine and cause injury, said Dr Powers.

Shallow(er) squat

Recommended for: patellofemoral pain (kneecap pain), osteoarthritis, post-ACL reconstruction surgery

The lower you sit into a squat, the more stress you put on the knees, Dr Powers said. So, to reduce strain, do not squat as low.

To find the right depth for you, stand in front of a mirror and squat until your knees start to hurt. Take note of where that is, then practise squatting only to the level right before your knees get cranky, Mr Ilano said.

It could be helpful to have an object to sit towards, like a chair, to give you an idea of how low you are going, said Dr Howard Luks, an orthopaedic sports medicine surgeon in New York and author of Longevity... Simplified.

Outward toe rotation

Recommended for: patellofemoral pain (kneecap pain), post-ACL reconstruction surgery

Turning the toes outwards by about 30 degrees can prevent the knees from buckling towards each other, and will minimise unwanted pressure on the inner side of the joints. Pointing your feet out more than 45 degrees may cause you to lose your balance, so find an angle that feels stable for you.

However, if you have arthritis, an outward toe rotation can be particularly uncomfortable. Talk to your physical therapist or surgeon for advice.

Wide stance

Recommended for: patellofemoral pain (kneecap pain)

Physical therapists often recommend strengthening the butt muscles to help support the knees in the squat. One way to do this is to widen your stance.

Step your feet shoulder width (or more) apart, which will activate your gluteal muscles more. For more of a challenge, put a resistance band around your thighs. Avoid stepping out more than 1½ times your shoulder width, though, which can cause your knees to collapse in and trigger more joint pain.

What comes next

As your quads, hips and knees get stronger through practice, you may find over time that you can squat deeper and with less knee pain. Check in with yourself every four weeks to see how far you have come.

Once you start to feel confident with these adjustments, you can try other ways of squatting that may previously have irritated your knees. However, be patient and do not force any range of motion that feels too painful, said Mr Ilano.

Some minor knee soreness may be normal when training, Dr Luks said. You might even add some lightweight dumbbells. But if at any point you feel pain that causes you to place most of your weight on one leg, or is accompanied by swelling, locking (when you are unable to bend or straighten the knee) or limping, it is time to see a medical professional, he added. NYTIMES