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ExerciseImportant ConceptsKneeSit Like A Man

Do Not Do Squats!

 

I’m going to go ahead and post this blog. It’s going to make a lot of people mad. I posted it on my group’s blog (www.texasorthopedics.com) and we got more responses to it than any we’ve previously posted. And they were all negative! The exercise industry is highly invested in squatting. You just have to look at a health magazine to see that about every 10 pages has an ad or a column or a device incorporating the use of some variety of squat.

 

My physician assistant and I keep a running tally on the number of patients I see every day in my clinic who have knee disease related to the performance of squats. I put a little Post-It note on our work station and we make hatch marks when we see one. Every day there are at least 4, sometimes 5 and occasionally 6. I see patients 3 days a week. Subtract a few days here and there for vacation. Multiply by 24 years and it comes out to something around 15,000 patients. And that’s 15,000 patients who probably wouldn’t have knee disease or would have less of it if they hadn’t been doing squats. So despite the hate mail I continue to stand by my recommendation that you…

 

DO NOT DO SQUATS!  Let me emphasize the point.  DO NOT DO SQUATS! 

 

And learn to recognize deceptive forms of the squat; the deep knee bend, the lunge and its particularly egregious variations, the weighted lunge and especially the forward-moving-weighted-lunge.  I don’t know what it is called but I want to put a red circle with a cross hatch on those. 

 

A lot of people are going to hate me, including many trainers, coaches and promoters of video training programs. I’ve got to admit that squats are a good way and maybe the best, most efficient and cheapest way to build gluts and quads.  They utilize some of the biggest muscle groups in the body and so you can work up a good sweat and “feel the burn.” So doing them accomplishes a goal and maybe for football players, it’s the best way.  But it’s dangerous for their knees, their cartilages and particularly their knee caps as well.  There are some individuals who are biomechanically sound to do squats but they are rare and there’s really no way to identify those people and predict how long they can tolerate it.  So there are some people who tolerate smoking cigarettes just fine. But enough of us can’t and so in general we say, “Don’t smoke.” And in general I like to say, “Don’t do squats!”

 

More on this to come. I’ll get ready for the onslaught of negative comments. Bring it.

33 comments
  1. Sandra

    Perfect timing, my knee is killling me this week. Let me ask, does doing squats against a wall count? (are you laughing?)
    My trainer is big on squats of all kinds.

    1. Barbara

      Most trainers are “big on squats.” It’s a great way to get the burn. That being said, wall squats are better than traditional squats. It’s best to keep your ankle in front of your knee and a wall squat allows you to do that. But if you have pain or crunching and grinding under your knee cap, you must cease and desist! I said in my previous blog, that trying to teach a “good” way to do squats is kind of like trying to tell you a good way to eat sugar. It’s easiest and best to just say “no.” I hate to hear that your knee is killing you. Stop the squats and go walk instead. You won’t get the burn but you’ll spare your knees.

  2. Dee

    Okay, so I can’t do squats. What suggestions do you have to replace squats? I’m studying to become a personal trainer and I have the crunchiest knee you’ve ever heard. I avoid squats like the plague and would like to be able to give good advice to future clients with the same problem I have.

    1. Barbara

      Ugh! I’m so sorry you’re having this problem with your knee. Do lots of straight leg raises, strengthen the external rotators of your hips, and maybe try quarter wall squats (keeping your feet way out in front of you). That’s a tough problem for you. Use bungee chords attached to ankle straps in order to add resistance to the straight leg exercise. Get creative!

  3. Leticia

    Totally listen I wish I came across this blog five months ago.!! I started getting back into shape after my son and i had a knee injury from childhood. My workout was cardio aerobics with lots of squats and lunges. I loved it….but after my workouts I would have knee pain all night sometimes into the next day. Two months in I was running with my dog (in my house) and my knee dislocated! Excruciating pain ever! I did see Dr. Bergin and what she said made total sense. When I would lunge or squat there was always crunching so I pretty much set my self up for a dislocation. Well I’m 29 with 3 kids so its a bummer cause my weight loss is stalled while I’m still rehabbing a life long set up for dislocation let alone I’m limited at the moment to what I can do with my family. Dr. Bergin has been great she is the best doc I’ve ever been to. Seriously. She opened my eyes to a lot about my health….love her

    1. Barbara

      Thank you Leticia! I appreciate your kind words! I wish you didn’t have the problem you are now experiencing. It’s only through SLOW word of mouth that we get the “DO NOT DO SQUATS” message out there, because the exercise industry is so invested in the squat…especially for women!

  4. Nina

    Hi!
    Thank you for getting this message out. I always knew my knees didn’t like squats but it was never a definite thought in my head that squats are bad for my knees.. Before my knee problems I did some martial arts, which involved a lot of “horse stance” ( a 45 degree stationary squat as if sitting on a horse). The back was required to be straight and the butt “tucked in”, the ankles in line with knees. I was wondering if that form is okay to do. That is the base of Kung fu and I will not be able to go back to studying it if I can’t perform it.
    Thank you!

    1. Barbara

      Nina,
      I’m glad you can appreciate the issue I have with squats, but sorry that you have a conflict. Look, it’s a free country and you can do squats and modified squats. When patients ask me if they can do certain modified squats, I tell them that for me to tell them how they can do certain squats, would be like me telling them under what circumstances is it okay to eat sugar. It’s just easier to say “don’t do squats and don’t eat sugar.”
      That being said, I think it’s important for you simply to have a heightened state of awareness. I want you to recognize a problem with your knee cap on the first day you have the problem. Don’t keep doing squats in the face of pain.
      I ride horses competitively. It could be said that I am often doing a modified squat. But I have a heightened sense of awareness of my knee cap’s position in the world, and if it starts hurting, I’m prepared to make adjustments.
      So that’s all I can ask of you. Just be aware. And chose your poison. Don’t do the “horse stance” in a Kung Fu workout and then go down to your local gym and do a bunch of squats. Don’t work out on the stair stepping machine. Use a bench when you’re gardening. Catch my drift?
      Thanks for checking out my blog. Sorry for the delayed response.

  5. Gail

    Agree! I exactly did squats and hurt my knee. I was naive, but not likely to forget the pain and have become cautious in how I move.

    1. Barbara

      Gail,
      Ha! You’re not so naive. When I first came to Austin and started my practice, I also started running stairs between cases while I was waiting for the operating room to turn over for my next case. I just didn’t want to sit around twiddling my thumbs. Within about a week my knees were crunching, swollen and I was in pain. What a doofus! And here I was already an orthopod, so I should have known better.
      Anyway, I’m glad you listened to your body! We have to do that. Don’t work through pain! I can’t tell you how many women come in who continue to do squats and run stairs despite being in agony and being able to hear their knees as they exercise!

  6. Lorraine

    So what is your take on standing leg raises (knees bent) . A slow standing in place march …..no problem because it’s not weight bearing? 🙂

    1. Barbara

      Lorraine,
      It’s not uncommon for patients to ask me about alternative forms of squats. Just like they ask me what forms of sugar are okay. I can tell you it’s okay to eat a little sugar, or it’s okay to put a teaspoon of sugar in your coffee, or it’s okay to eat chocolate. But it’s just easier for me to tell you not to eat sugar, and I would be right in doing so. Same goes for squats. Is it okay to do little squats, quarter squats or Smith machine squats? I can say “everything in moderation.” But then I have some patients who have pain doing everything in moderation! So you have to make the decision based on what works for you. If you have pain doing something, you just shouldn’t do it. You have to evaluate any modification to see how it affects you and your knees. I would have to write a ten page blog to describe every variation on the squat, and how often and how much to do it. And the majority of you are not my patients, so I can’t evaluate how they affect YOU. So it’s easier to say “no squats.”

      Marching in place is just like any repetitive exercise. There is potential for repetitive strain and stress reactions if you do it too much. everything in moderation. Remember, walking is what humans are put together to do. We do it well. If you can march, surely you can walk. Go walk!

    1. Barbara

      I have been known to do leg extensions, but I call them my crunch-free-leg extensions. I literally put my hand on the front of my knee and find the range in which I can do the exercise without feeling any crunching underneath my knee cap. I don’t use heavy weights, and I do them slowly. I never use momentum to help hoist the weight into the air. Same with leg press. I do a limited arch of range of motion. I keep my feet high on the platform, so that my ankles never get behind my knees, in other words, there is never greater than a 90 degree angle of my knee. If there is any pain during or after (24 hours) that series of exercises, I cease and desist! Telling my patients and readers how they can do a gentle form of a squat, is kind of like the diabetic’s doctor trying to tell them how to just eat a little sugar. Easier to just say no sugar. Same for squats.

    2. Barbara

      Curls are fine. Extensions have to be done with caution. When, and if I do them, I do them within my “crunch-free” zone. I put my hand on my knee cap, and do them in the range where I don’t feel any crunching. If you are young or have no crunching, they might be okay, but do them with caution, a lot of control, and limit the heavy weight.

  7. Peter

    I had a meniscectomy at age 19 after a football injury. Had most of outside meniscus removed and was told it was macerated, I had tried to keep playing on it for months after first having it misdiagnosed as a ligament strain. I was told to never squat again and largely followed that advice for the last twenty years and lived with constant aches and pain in that knee. Recently I had an acute tear in the other knee and had another meniscectomy. I rehabbed it for months following a very strict no squat program. But still could not hike on that knee for longer than ten minutes without serious pain.

    Over the last several months I have started squatting again after having tried all alternatives. After the first couple days of squatting my knees hurt a lot, I almost gave up squatting. I am glad I didn’t, both my knees feel better than at any point after the surgeries. The one knee feels the best it has felt in twenty years. I only go to parallel (research shows that beyond that forces ramp up on the meniscus) and I only go to eight reps, and I don’t go to failure (probably about two reps from failure). I can squat 300 pounds pain free.

    I can physically feel a strengthening of the joint and its ligaments, there is way less slop in it. You will never get that ligament development from walking, but you will still be putting miles on that knee.

    There is some evidence that weight lifters have stronger cartilage.

    1. Barbara

      Peter,
      For every thousand patients who tear up their knee doing squats…there is the ONE who gets better! For every 100,000 people who can’t make it through the training for the Boston Marathon, there is the one 80-year-old who does, and my patients bring me the article in Fit Magazine about him, and bemoan the fact that they can’t. I’m happy you are doing well. There are many potential reasons why, and they might not be because you are doing squats. But, I’ll concede that you are doing well because of them. I make part of my living off the injuries sustained by people doing squats. So I will stand by 37 years of experience…always. But I’m glad you’re better. And stop doing squats…lol!

    1. Barbara

      Just regular exercise: walking, cycling, swimming, straight leg raises. My parents are both in their mid-eighties. They dance, golf, walk, travel, and live a really good life, and neither of them ever did squats for exercise, other than a brief few years that my mom did yoga squats…and it caused her meniscus to tear, so she stopped doing them, and the pain went away.

  8. Chris

    I am soooo glad I found your site. I am 68 years old and tore my meniscus 10 years ago. At that point it took forever to find a doctor that would not push me to get a knee replacement. The sales pitches were unreal. So I finally found a UPenn doctor who got an MRI and saw the tear (only when I asked him to show me where my meniscus was on the MRI). The report read that it was just arthritis.

    All was great until this year when my lab puppies reached the age where they weigh over 80 pounds and like playing keep away in between my legs. So, back to the doctor who of course wants to replace the knee. He told me that if I could not do squats it was because my knee was worn down and needed to be replaced.

    Thank you for your advice. Walking sounds good. Low impact exercise sounds good. I have a more positive outlook thanks to you!!!

    1. Barbara

      I’m glad I was able to help you in some way. Let me tell you, you will not be able to squat following a total knee replacement. But it’s best just not to squat, and to figure out a way to modify your activities to diminish the stresses to your knees. When the pain is so bad, that it forces you into submission, and affects the quality of your life in a significant way, then it’s time for total knee replacement.

  9. Charlotte

    Just came from a butti yoga class where you squat all the way down to the ground…hold and then bounce up and down. I was thinking this can’t be good for my knees. I thought squatting that low was bad and yes my knee seem to be sore. Will this kind of routine ruin my knees?

    1. Barbara

      Most likely. Women are just susceptible to having problems with their knee caps. The problem is that by the time you realize that it’s harming you, it’s often too late, and you’ve already done damage to your knee caps. Do not do squats…in any shape or form.

  10. Thomas

    Very interesting information. After my first two scopes on my left knee, I was encouraged by the surgeon and especially PT to pound away on my knee with squats and lunges. My left knee still hurts, badly at times. I recently had a menisectomy on my right knee. The new surgeon said no squats or lunges or running-ever! Problem is that PT is pushing me to do them saying they are part of everyday life. I don’t know who to believe anymore. I’m 41 and I just want to be able to backpack. Looks like that’s just a pipe dream.

    1. Barbara

      Thomas,
      I face this dilemma EVERY day in my office: therapists and trainers telling patients that squats are part of every day life. I haven’t had to do a squat in over 30 years, except once…when I got down on my knees to do CPR on my own son! Just FYI…it worked. And trust me, I was able to do it, and get back up…no problem. If something drops down on the ground, I actually try not to squat to pick it up. If I have to say, get under my bed to pick up my glasses, because they dropped to the floor and somehow rolled under there, then I use the bed to help me down there, and use it to push myself back up. But repeatedly doing squats? Up and down, up and down? When would you EVER have to do that? DO NOT DO SQUATS. And frankly, do not seek out stairs as a source of exercise. These things hurt your knees. They put exponential amounts of pressure on your knees. As you age, you will be able to seek living situations in which you avoid stairs. It’s the right thing to do. As I’ve said in my blog posts…squats have paid for my children’s college education. They’re bad for you. There are other ways to promote strength of your quads without doing them: walking, riding a bike or stationary bike, straight leg raises, swimming, etc.

  11. peter klee

    Hi Barbara, is inclined walking on a road O.K? Early morning before the traffic begins. Should I zig zag my way back down the road? the circuit I use doesn’t have a more gentle decline to take.
    Also I feel discomfort in different parts of my medial right knee with M.R.I diagnosed intrasubstance degeneration involving the posterior horn and posterior horn-body junction of the medial meniscus Could this be a roaming effusion? or is it the damaged meniscus affecting areas around it?

    1. Barbara

      Use your pain to guide you. If you notice pain while or after you walk up that hill, then find a flat place to walk or yes, consider traversing. I had a hill like that in a place where I used to walk, and it was so steep that I just traversed it. I looked very stupid, but no pain. Who’s the stupider…haha.

    2. Barbara

      Oh, and regarding the meniscus. Almost anyone over forty would have these findings on an MRI. The natural result of aging of that cartilage and the knee. It will usually not cause an effusion, in and of itself. But once the meniscus no longer cushions the surface cartilage, that cartilage will start to wear out, and that is the beginning of arthritis, which can cause swelling. Hope that answers your questions.

  12. peter klee

    I would like to have seen you moving back and forth on that hill, it conjures a relaxing image, crazy woman! Ha, no seriously Barbara the service you are providing here is really impressive, you are a wonderful Doctor.
    Concerning my knee, I assume you mean cartilage on the surface of the meniscus wearing out. It sounds right, unfortunately.
    From now on I will traverse at will during decline. Thanks.

    1. Barbara

      Haha. It is a funny thing. I will go to extremes to protect my knees!
      No, I mean the surface cartilage, like on the end of a chicken bone. We have two types of cartilage in the knee; the meniscus and the surface cartilage. That is different from all the other joints, and kinda special…until it gets screwed up. The meniscus protects the surface cartilage. Neither has a blood supply, so when they are torn or disrupted, they cannot heal. All you can do is protect them from getting worse, and from natural…and progressive deterioration.

      1. Isaac

        This is fundamentally incorrect. Studies looking at people with no pain in their knees over relatively long periods of time show that these “degenerative changes” are completely normal and do not correlate well with pain at all. Also there is no data even suggesting that doing squats leads to faster or “worse” degeneration, in fact some show the opposite. Same with meniscus. It is so common and poorly correlated with pain that it is now adviced against doing meniscectomy except in certain cases like mechanical locking-especially in older adults. Why? Because conservative management has better long term outcomes even without “fixing” the meniscus. Please stop the fear mongering- you are doing more harm than good.

        1. Barbara

          What are your credentials? I guess you haven’t read my treatise on Meniscus Tears After Forty. I absolutely agree with conservative management of these conditions, but it doesn’t always work, and you would have to be an orthopedic surgeon to understand that. Are you an orthopedic surgeon? Squats are one of the biggest causes of damage to knees, especially in women. Do you see a lot of women in your practice? Do you just tell them to suck it up and keep doing more squats, like so many of my colleagues do? Or do you just tell them they’re fat, and to go away? Or are you a trainer, because they’re the ones who are usually so vocal about squats. But they don’t see all the clients they lose because of pain. They just assume they went away because they’re lazy.
          Thank you for your input. It just reminds me of where my business comes from: trainers who encourage women to do more squats or other orthopedic surgeons who pooh pooh their pain. Other than that, my patients come from other patients who get better from my recommendations!

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