Many of our patients are in shock when we tell them that driving their knees out is what is causing their pain. They then state that “they have always been told to squat this way”. Before we dive into why this is let's cover where this cue even came about. Most people when they are first learning to squat will collapse their knees during the ascent of the squat due to weakness. Therefore, who ever their coach or trainer is will tell them to drive their knees out to keep this from happening. At this point in their training that would be the correct cue to give because letting the knees collapse poses its own risk for injury. However, once this person is strong enough to maintain proper positioning at the knees they still have this cue of “push the knees out” in their head. This cue is now causing more harm than good because they are now push their knees out past “neutral”.
So why is this positioning potentially causing your knee pain? Because whenever the knees get pushed out past the feet so far that the big toes loose contact with ground, the quads get overactivated and you will lose activation of the glutes and hamstrings (or posterior chain). In addition, if you are leading the descent of your squat with pushing the knees out that is where your body will start to build tension which in turn is where most of your force will come from when ascending. This will again cause overactivation of the quads and actually decrease the amount of force you can produce. Whenever there is an increased activation of the quads it will cause increased tension at the knee which can lead to that irritating knee pain that you are experiencing.
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