u/CartoonistMost3601

I’ve assessed hundreds of lifters over the years, and knee pain from squatting follows a
remarkably predictable pattern. It’s almost never the knee itself that’s the problem.
Here’s what I consistently find:
The actual causes, from most common:
Restricted ankle dorsiflexion. When the ankle can’t dorsiflex adequately, the knee
compensates by collapsing inward. The fix isn’t knee work — it’s ankle mobility and calf soft
tissue release. I’ve had some ankle-issues myself as a soccer/football player (injuries, stepped on, rolling my ankle, etc) - and everytime my ankle is affected, there’s pain in my knee or hip in some way or form.

Weak glute medius. The glute medius controls hip abduction and internal rotation. When
it’s underactive, the femur internally rotates under load, driving the knee into valgus. Lateral
band walks and single-leg work fix this faster than most people expect. I love these as a part of my warm up routine - it makes it way easier to engage my hips/glutes on more technical lifts (clean/jerk, other explosive movements I do for football)

Anterior pelvic tilt under load. When the pelvis tilts forward at the bottom of the squat, it
changes the tracking of the patella. This is a hip flexor and core stability issue, not a knee
issue. I believe combining soft tissue work, loaded stretches and proper warmup is the key here - especially if my clients have work that makes them sit for longer hours (office jobs, truck drivers, excavator drivers are some of the clients I’ve worked with who have these issues etc)

VMO inhibition. The VMO (the teardrop-shaped quad muscle) is the primary stabiliser of
the patella. It’s often inhibited in lifters with knee pain, creating a feedback loop where pain
causes inhibition causes more pain. I also see issues here with people who’ve had ACL-repairs if they are scared of using their knee, issues with loading etc.

The protocol I use:
Before every lower body session: 5 minutes of calf and hip flexor soft tissue work, 10 ankle
circles per side, 15 lateral band walks, 15 TKEs (terminal knee extensions) per side. Then load.
Most lifters see a meaningful improvement within 2–3 weeks of consistent application.
Happy to answer questions — this is what I do for a living (From Norway BTW 😊)

First things first - I tried posting this in a separate forum but for some reason they flaggednit as medical advice - not sure why it was deemed as such, as its what I do for a living, so therefore I am not allowed to speak on forums?😅 I assume with the same logic, a mechanic can’t speak about car engines either? Anyways, I’ve assessed hundreds of lifters over the years, and knee pain from squatting follows a
remarkably predictable pattern. It’s almost never the knee itself that’s the problem.
Here’s what I consistently find:
The actual causes, from most common:
Restricted ankle dorsiflexion. When the ankle can’t dorsiflex adequately, the knee
compensates by collapsing inward. The fix isn’t knee work — it’s ankle mobility and calf soft
tissue release. I’ve had some ankle-issues myself as a soccer/football player (injuries, stepped on, rolling my ankle, etc) - and everytime my ankle is affected, there’s pain in my knee or hip in some way or form.

Weak glute medius. The glute medius controls hip abduction and internal rotation. When
it’s underactive, the femur internally rotates under load, driving the knee into valgus. Lateral
band walks and single-leg work fix this faster than most people expect. I love these as a part of my warm up routine - it makes it way easier to engage my hips/glutes on more technical lifts (clean/jerk, other explosive movements I do for football)

Anterior pelvic tilt under load. When the pelvis tilts forward at the bottom of the squat, it
changes the tracking of the patella. This is a hip flexor and core stability issue, not a knee
issue. I have had good success with clients when combining soft tissue work, loaded stretches and proper warmup is the key here - especially if my clients have work that makes them sit for longer hours (office jobs, truck drivers, excavator drivers are some of the clients I’ve worked with who have these issues etc)

VMO inhibition. The VMO (the teardrop-shaped quad muscle) is the primary stabiliser of
the patella. It’s often inhibited in lifters with knee pain, creating a feedback loop where pain
causes inhibition causes more pain. I also see issues here with people who’ve had ACL-repairs if they are scared of using their knee, issues with loading etc.

The protocol I use:
Before every lower body session: 5 minutes of calf and hip flexor soft tissue work, 10 ankle
circles per side, 15 lateral band walks, 15 terminal knee extensions, (use a band or set an extension machine to end of range of motion) per side. Then load.
Most clients see a meaningful improvement within 2–3 weeks of consistent application, however like I always say: If you don’t use it, there’s no point in having a program.
Happy to answer questions — this is what I do for a living (From Norway BTW 😊)