I can't tell you how many times over the years I have heard something to this effect, "I would like to do squats and lunges but I have bad knees and should avoid those exercises." It is true that if you squat with stiff knees and haven't warmed up properly, you will likely feel pain in the front part of the knee. Does this mean that squats cause knee pain and even arthritis? Does this mean that you should avoid squats if you feel pain or have been diagnosed with arthritis?
Let's back up and define arthritis and look at the aging knee pathology. There are several forms of arthritis but let's just focus today on the type of degeneration that comes from the degradation of the padding or cartilage that covers the bones. Osteoarthritis is the most common form of arthritis with aging and it is associated with pain, stiffness, aching, and swelling. The surrounding area may also change in appearance with chronic swelling.
The good news is most people notice that gentle motion and activity decreases pain. They typically feel better after they have moved the joint through full motion.
It is well known that knee arthritis is more prevalent in the United States than other developed countries and exponentially more than 3rd world countries. My assessment after treating patients for over 10 years now is that people don't move their knees enough. The average adult does not do deep knee bends or squats regularly. Most Americans go from squatting down and playing on our knees in childhood and grade school to sitting in a chair and playing upright sports from middle school into sedentary adult lives.
Even the most active adults tend to stay off the floor and avoid deep squatting motions unless they deliberately work into full range of motion with yoga, pilates, functional fitness training, olympic lifting and CrossFit, and emerging forms of animal flow exercise (look it up, it's pretty interesting).
For years, people were told to avoid squatting below parallel and stick to low impact sports such as cycling and hiking. This has not helped the situation as all of the above limit the motion at the knee joint.
I'll explain it with an analogy. If you live in Colorado, you are very familiar with the ruts that form on I-70 over Vail pass and along the route to the mountains. Think of a lane on the highway as the surface of your knee joint. If all the traffic is forced to stay in one area of the lane, ruts will form; grooves will wear into the pavement; cracks and weakened areas of the road will start to break away. However, if the lanes are widened, cars and trucks can then drive off the main ruts slightly, and the pavement is smooth and safe.
Now, apply that to the knee joint. Most surgeons who perform total knee replacements will tell you that most knees are "bone on bone" in just one small aspect of the joint. The rest of the cartilage and joint surfaces are nice and smooth. What if the "lanes of the joint" were widened and the surfaces were allowed to move through new ranges of motion unimpeded? Would it be possible to spare the joint and decrease the pain?
The answer is a resounding YES! We need to use the entire range of a joint to offload the areas that get more compression and breakdown.
When we look at the health of the knee joint, we should be going into deep knee flexion (bending) and full straightening on a daily basis. Does the cyclist do that in their sport? Does walking and hiking require full motion at he knee joints? No. So the answer to the question is ... squats CAN help prevent arthritis and treat arthritis.
Now, there is a lot to be said for proper form with squats, the right type of warmup, to load or not to load with weight, and frequency of exercise, etc etc.
So, if I have convinced you to avoid avoiding squats but you aren't sure where to start and have to work through some issues, we can help! It can take a few weeks of exercise, manual therapy, and other strategies to "widen the lane" of your joint. Schedule an in-person PT session with us. There are many strategies and treatments that we can do to avoid pain, avoid surgery, and improve your motion.