The Controversial Squat for Knee Pain

On a wet Tuesday night at a packed physiotherapy clinic, the waiting area resembles a queue for a gig nobody wanted to attend. Patients hold ice packs, elastic supports and those small plastic pouches of scans that seem to crinkle at exactly the wrong volume. A middle-aged runner rubs his kneecap through his trousers; an office worker in heels looks at her phone while pressing the outer side of her knee; by the window, a woman in leggings performs a subtle stretch with her gaze fixed on the ground.

When the physiotherapist eventually calls her through, he does not recommend swimming or Pilates. He gestures towards a low bench and says a single word that seems to stop the room: “Squats.”

But these are not the squats you are used to.

Why one simple squat is now dividing doctors

For years, guidance for knee pain played on repeat: “Go swimming, try Pilates, avoid impact.” Everything was low-load, low-risk and low-intensity. It felt reassuring, yet for many people it achieved very little. Their knees still hurt, and their everyday lives remained restricted.

A growing group of specialists is now advocating something that can sound almost reckless: specific, deep and often slow squats, including for people who already have pain. These are not gym-bro “leg day” squats. They are clinical, carefully coached squats that intentionally load the joint rather than treating it as though it were made of fragile glass.

Some doctors see that as brilliant. Others regard it as irresponsible.

Consider Julia, a 47-year-old office manager, former runner and self-described expert at abandoning hobbies. After three years of patellofemoral pain and a dispiriting round of “just rest it” advice, she found a sports medicine clinic using a disputed protocol. No more swimming pool. No more “avoid stairs.” In its place was a 12-week plan based almost entirely on a progressively developed squat.

In week 1, she could scarcely bend to 30 degrees without grimacing. By week 8, she was lowering herself to almost chair height while holding a light kettlebell. At week 12, her pain score had fallen by more than half. One day, she climbed two flights of stairs before noticing that she had not thought about her knees even once.

Her GP was delighted by the outcome, yet still muttered, “I hate that they made you squat.”

The thinking behind these squats is starkly straightforward, and unsettling for anyone brought up with the “rest and protect” approach. Joints require more than rest: they also need load. The muscles around the knee must become strong and coordinated against the forces of real life, rather than only when you are lying on a treatment table and squeezing a foam roller. Cartilage benefits from movement, circulation and variation.

Rather than avoiding the movement that causes pain, some therapists therefore teach it slowly and with purpose. A controlled squat works the quadriceps, glutes and hamstrings in a way that may steady the knee and recalibrate pain signals. Critics see an obvious danger: progress too hard or too quickly and everything can flare up. Supporters believe the greater danger is consigning millions of people to permanently tiptoeing around stairs, chairs and pavements.

The “controversial squat” protocol appearing in rehabilitation rooms

The squat being debated by experts is not a quick, ego-led gym movement. It is more like a slow, supervised ritual. Stand with your feet roughly hip-width apart and your toes turned slightly outwards, facing a wall or gripping the back of a chair. Next, bend at the hips and knees as though you are sitting down on a low stool behind you, allowing the knees to travel over the toes without letting them cave inwards.

Descend only as far as you can manage without sharp pain, pause for two or three seconds, then stand back up at the same unhurried pace. Certain protocols place a small wedge beneath the heels or use a slant board to alter the angles, moving load away from the hips and more towards the quadriceps. The aim is not depth or heroics, but precision under load.

When knees have been deconditioned for years, ten repetitions can feel like an entire training session.

This is also the point at which people commonly go wrong when trying it alone. They move too fast, pursue the “burn”, or imitate a TikTok demonstration made by a 22-year-old with perfect cartilage and no medical context. Pain then flares, and the conclusion becomes: “Squats ruined my knees.”

In reality, the explanation is generally less dramatic and more mundane. The load increased too rapidly, rest days disappeared, or technique fell apart as soon as fatigue set in. Honestly, almost nobody manages this every day with the patience of a monk. That does not mean you are weak; it means you are human.

Effective therapists now allow for “wiggle room” weeks and lighter sessions, and have candid discussions about what patients can truly maintain alongside work, children and a leaking kitchen sink.

“The squat itself isn’t the villain,” says Dr. Léa Marceau, a French sports physician who co‑designed a knee rehab program based on progressive squats. “The real problem is dosage and supervision. A well‑coached squat can be medicine. A rushed, copied‑from‑YouTube squat can be a disaster for a sensitive joint.”

Across this newer protocol, several shared principles recur in both research and clinical settings. Most programmes quietly rely on the same basic rules:

• Begin higher and with less range than your ego might prefer: a shallow movement, slow tempo and no extra weight initially.
• Work with a pain scale: mild discomfort (3–4/10) is acceptable, while sharp or persistent pain is a warning sign.
• Exercise two to three times each week rather than daily, giving tissues time to adapt.
• Combine squats with hip and ankle mobility work, so the knee does not have to do all the work.
• Review progress after 6–8 weeks, rather than after 3 painful sessions.

Caught between two approaches: protect the knee or train it?

The divide in medicine can leave patients trapped between entirely opposing directions. One doctor says never kneel again; another asks you to sit deeply with a kettlebell. One physiotherapist is committed to reformer Pilates, while another matter-of-factly hands you a barbell. For someone who simply wants to use the stairs without negotiating with the universe, it is maddening.

People consequently begin testing things in private: a few cautious squats in the kitchen as the pasta cooks, or a half-depth bend beside the office printer. Pain is worse one day and improved the next, while the story they tell themselves about their knees shifts wildly. Are the joints worn out, or merely undertrained? Are they rehabilitating them, or damaging them?

Traditionalists in the debate argue that a degenerative joint ought to be protected from compressive force. They point to X-rays, age, weight and surgical history. They worry that encouraging squats will drive vulnerable patients towards overuse, particularly where there is no medical follow-up. Progressive clinicians, meanwhile, cite evidence that appropriately loaded exercise can ease pain, improve function and, for some people, postpone or even prevent surgery.

They also highlight a difficult reality: instructing people to “avoid” bending their knees often results in less movement overall. Less walking, less social life and less confidence. The knee becomes both an excuse and a prison. That emotional decline may not appear on MRI scans, but it appears everywhere else.

A quieter reality lies somewhere between the two positions: both sides are simultaneously right and wrong. Not every knee can, or should, be pushed into deep squats, particularly during a flare-up or after a recent injury. Equally, not every knee that looks alarming on an MRI is a ticking time bomb. Context is decisive.

For some people, the controversial squat offers a way to renegotiate how they live in their own body, one deliberate repetition at a time. For others, it is simply too dangerous, too painful or too triggering after years of unsuccessful therapies. Both reactions are valid. The important question is not “Are squats good or bad for knees?” but “What kind of squat, at what stage, for whom, and under whose guidance?” That is where the discussion becomes real and personal.

Key point	Detail	Value for the reader
Load can heal, not just harm	Carefully designed squats build muscle strength and settle pain instead of “wearing out” the joint	Provides hope beyond rest and passive treatment for persistent knee pain
Progression beats perfection	Beginning with shallow, slow and supported movement lowers risk while building confidence	Makes squats seem achievable even if bending your knees feels frightening
Personalisation matters	Age, injury history, weight and levels of fear all affect what a programme should involve	Encourages readers to get individual advice rather than copy random online workouts

FAQ:

• Are squats always safe if I have knee pain? Not always. Progressive squats work very well for some people, while others experience a severe flare-up. Safety depends on your diagnosis, your squat technique, the load and the speed of progression. Before attempting greater depth or adding weight, it is worthwhile having at least one in-person assessment.

• What kind of squat is usually recommended for painful knees? Therapists commonly begin with a supported squat to a chair or box: feet hip-width apart, a slow descent, limited range and a short pause at the bottom. A heel lift or slant board is sometimes added. The priority is control and comfort, not the depth you can achieve.

• Can I replace my physio exercises with squats only? That is probably not a good idea. Squats can form a central part of the plan, but most robust programmes also include hip strength, core stability and some form of balance or walking work. Think of squats as a leading actor, rather than the whole cast.

• How much knee pain is “normal” during rehab squats? Many clinicians use a 0–10 pain scale and consider up to about 3–4/10 acceptable during exercise, provided the discomfort settles within a couple of hours and does not leave you worse the following day. Sharp, catching or increasing pain is the signal to stop and make adjustments.

• What if I’m too scared to try squats again? That fear makes sense, especially if you have spent years being told that bending will destroy your knees. You can start smaller still: mini “sit-to-stand” movements from a high chair, partial weight-bearing with your hands on a worktop, or simply controlled knee bends while holding on. A good physiotherapist will acknowledge your fear and progress gradually with you.