Common Signs of Dysfunction with Squatting: Part 1 – Knee/s Caving in

Have you ever wondered why you’re experiencing pain or struggling with your squat form? Well in this month’s blog series, I’ll be breaking down the three most common signs of dysfunction we often see with improper squat technique. Along the way, I’ll be sharing some practical tips to help you correct these issues and prevent them from leading to discomfort or injury.

Why is the Squat so Important?

One of the first things we assess in every patient is their squat pattern, and for good reason. This is because the squat is a fundamental movement that offers deep insight into overall body function. It’s not just a great exercise but a key indicator of how well your body is moving and performing.

The squat stands out due to its wide range of benefits, including:

Functional Strength: As it mimics everyday movements like sitting, standing, and lifting, making it essential for daily life.

Full-Body Activation: Engages the legs, core, and back, providing a complete workout.

Improved Mobility: Boosts joint flexibility and enhances muscle range of motion.

Strength and Power: Builds lower body and core strength/stability, increasing overall power.

Enhanced Bone Density: As a weight-bearing exercise (especially when adding resistance), squats can help increase bone density and reduce the risk of conditions like osteoporosis as you age.

Dysfunction 1: Knee/s caving in:

 

What is it?

Your knee caving in aka knee valgus during a squat simply means that the knee/s are moving inwards towards each other. Ideally, during a squat, the knees should track in line with the toes. So, when the bows in, it disrupts this alignment and can start to put excess load stress on the ankle, knees, hips, and lower back, thus increasing the risk of potential injury.

Some potential injuries that may result from this dysfunction include:

• ACL
• MCL
• Mencius
• Patellofemoral Pain Syndrome
• Tib Post dysfunction
• Plantar fasciitis
• Greater trochanter pain syndrome
• ITB syndrome
• Hip labral tears

 

There are several factors can contribute to your knee/knees caving in. These being:

1. Weak glutes and hip external rotators: These muscles help stabilize the hips and control the outward movement of the knee/s.
2. Weak knee stabilizers: as these muscles with work with the hip to stabilize the knee/s to prevent it caving in.
3. Stiff hips and tight groin muscles and stiff hips: A lack of hip mobility and tight inner thigh muscles may also contribute to pulling the knee/s inward.
4. Poor ankle mobility and control: Limited range of motion in the ankles and poor muscular control on our arch muscles can cause the feet to collapse, forcing the knee/s to move inward.
5. Improper form: Incorrect squatting technique, such as not engaging the core or keeping the feet too narrow, can also result in this dysfunction.

 

What can you do to help fix it?

To address knee/s caving in (knee valgus) during squats, it’s important to recognize that the issue can stem from several causes. Below I’ve provided 3 straightforward and effective strategies to help address the most common causes, to help you improve your squat form and prevent your knees from collapsing inward and potentially causing you pain.

1. Weak Glutes and knee stabilizers:

If your weak glute muscles are contributing to your knees caving in, strengthening them will help stabilize your lower body.

Solution: Place a resistance band just above your knees when squatting. The band will encourage you to push your knees outward, activating the gluteus medius and improving hip stability.

 

 

 

2. Poor Foot and Ankle Control (Flat Feet):

If you have flat feet or poor ankle control, this can affect your entire lower body’s alignment, including your knees.

Solution: Place a band around your ankles or feet to engage the foot and ankle muscles. This helps build stability and control from the ground up, improving knee positioning.

 

 

 

3. Correct Squat Technique:

Proper form is crucial to preventing knee valgus. Paying attention to your squat mechanics will help you move safely and efficiently.

Solution: Ensure your feet are shoulder-width apart, with toes slightly pointing outward. Focus on driving your knees outward in line with your toes as you descend and engage both your core and glutes as if you were sitting down into a chair to maintain stability throughout the movement.

 

 

Hopefully you have found part 1 of this blog series helpful. Stay tuned for part 2 where I’ll be diving into another common dysfunction we see called butt winking.

Chris Lamacchia

 

References:

1. Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501.
2. Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., & Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. Journal Of Strength And Conditioning Research / National Strength & Conditioning Association, 27(7), 1813-1823.
3. Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training, 47(5), 525
4. Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sport Rehabilitation, 2012, 21, Pg 144-150
5. Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., & Fonseca, S. T. (2010). Temporal couplings between rearfoot–shank complex and hip joint during walking. Clinical biomechanics, 25(7), 745-748.
6. Ramskov, D., Barton, C., Nielsen, R. O., & Rasmussen, S. (2015). High Eccentric Hip Abduction Strength Reduces the Risk of Developing Patellofemoral Pain Among Novice Runners Initiating a Self-Structured Running Program: A 1-Year Observational Study. journal of orthopaedic & sports physical therapy, 45(3), 153-161
7. Snyder, K. R., Earl, J. E., O’Connor, K. M., & Ebersole, K. T. (2009). Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clinical Biomechanics, 24(1), 26-34

8. Durran, B., et. al. (2015) Posterior Tibial Tendon Dysfunction: What does the single heel raise test mean in assessment?