Knee Pain: Keeping Your Knees Behind Your Toes, A Myth That Refuses To Die

“Don’t let your knees go in front of your toes when squatting and lunging” a common critique heard in the health and fitness industry for the past 30 years. Unfortunately, it is still being used by many health and fitness professionals to this day. The notion that this can cause knee pain is discussed here in this blog. Ethan Smith is going to attempt to debunk this common myth, discuss its potential origins and provide advice on simple ways to improve your squat technique.

The exact starting point of this myth is unknown. However, it is believed to have become popular in 1978 when a paper by Thomas McLaughlin was published. This paper investigated the kinetics of a parallel squat in a population of 12 powerlifting competitors. The study found that getting the tibia in a vertical position, when squatting, reduced the shear forces placed on the knee. Similar findings were made in 2003 in a study carried out by the University of Memphis. By keeping the knees behind the toes, it reduces the forces at the knee joint by 25%, reducing knee pain, compared to when the knees can track forward over the toes. Looking at these two studies it is easy to see how people can take this information and create the belief, that by keeping their knees back, is a better and safer squatting technique. However, if your read into the 2003 study in more depth, it goes on to state that by restricting the forward movement of the knees “ forces are inappropriately transferred to the hips and low-back region”, with hip forces increased by nearly 1000%. This begs the question, by keeping your knees behind your toes, you may be reducing knee loading but are you putting yourself at increased risk of hip and lower back injury from excessive load.

We also experience several activities in our day to day life that require our knees to go in front of out toes without an injury. Take walking downstairs. In order to make it to the next step our back leg must track over our toes whilst loaded.  Depending on your running style, your knees will travel in front of your toes as you go through the stance phase. How is it that we can manage these tasks and others daily without any major knee pain? People may argue that it is a matter of load, when squatting someone adds weight to the exercise which increases load at the knee. However, a counter argument to this is that up to eight times your body weight can go through your knee when running.

It is normal for the knees to move forwards in front of the toes especially at we squat lower. As someone squats, their centre of gravity will travel backwards with the bulk of their mass. In order to counter act this and keep the centre of gravity in the centre of their foot, the knees will move forward.

Tips for improving squat technique therefore decreasing you knee pain:

• Hips first: as discussed it is okay for the knees to track past the toes, but we want it to happen in the second part of the movement as we get low. Initially we want most of the movement to come from the hip. The cue to “sit back” or “pretend you are sitting in a chair” allows better hip movement and engages the stronger muscles involved in the movement.
• Keeping you knee inline with your toes: your knee can go past your toes but if it does, we want it going over the first or second toe. If the knee buckles in or outwards during squatting, it can cause abnormal loading of the knee and a loss of power thus causing knee pain.
• Improving ankle and hip mobility: to allow for increase depth in a squat it is not all about the knee. The joints above and below both also need to have a good range of motion in order to allow full movement.

If you are struggling with any lower back, hip or knee pain whilst squatting, it is best to get this checked out by one of experienced physiotherapists at Cairnhill Physiotherapy. They will be able to assess your squatting technique, any areas you are tight or have a decrease in mobility and then formulate a plan to help counter these. Don’t put up with niggly pain or not being able to squat painfree, contact us today for an appointment.