Is Squatting Bad for Your Knees?

The short answerIs squatting bad for your knees? For most people with healthy knees, usually not. Squatting is part of everyday life, from using a squat toilet to rising from a low stool. What matters is how deep you go, where your knees travel, how long you stay down and how you get back up. If squats feel uncomfortable, small changes may make them easier. See a doctor if knee pain comes with swelling, locking, giving way or a knee you can't put weight on.

Think about how often you squat in a normal week. Using a squat toilet at a highway rest stop on the way back to your kampung. Crouching at the wet market to pick out fresh kangkung. Weeding the chilli pots, scrubbing clothes in a basin, or scooping up a grandchild who runs over for a hug. For many Malaysians, getting down near the floor is routine.

So you may wonder whether all that bending is hard on your knees, especially once they start to ache. Sore knees are common. In a survey of 5,056 adults in urban and rural Selangor, published in 2016, roughly 1 in 5 (21.1%) reported knee pain in the previous six months. They were parents and carers of secondary-school pupils, with an average age of 38.5, and knee pain became more common with age. The survey didn't ask about squatting, but it shows how many people live with knee pain. Here's what the research says about squatting, and when squatting knee pain is worth a check.

1. What the research says about squatting and your knees

Squatting is one of the body's basic movements. A 2024 expert commentary by physical therapy researchers calls it essential for daily living, for things like using the toilet and getting in and out of a chair. But a quick dip to pick up your keys is very different from crouching for half an hour to clean fish. This article is about everyday squats like these, not gym training.

For people who already have a knee condition, knee pain when squatting (蹲下膝盖痛) is a familiar complaint. In a small 2018 Malaysian study, researchers interviewed 12 people with knee osteoarthritis who were attending physiotherapy at a university hospital (average age 67). Most of them named squatting as a movement that made their knee pain worse in daily life.

So is squatting bad for your knees? For most people with healthy knees, an everyday squat isn't a problem in itself. The 2024 commentary treats the squat as a movement you can adjust to suit different knees, by changing how deep you go, where your knees travel and how upright you stay, rather than one to avoid. How you squat, how long you stay down and how your knees feel afterwards tell you much more.

2. Is squatting bad for your knees? It depends on how you squat

Four things can change how a squat feels on your knees.

• How deep you go. A 2002 lab study of 19 people with healthy knees found that bending the knee well past a right angle asked more of the knee and thigh muscles than walking or climbing stairs. The study measured forces in a lab, not long-term effects, so it can't tell us whether deep squats harm a healthy knee. But it helps explain why depth matters if your knees are sore.
• Where your knees travel. The 2024 commentary explains that when your knees travel far forward as you go down, the knee and the muscles at the front of your thigh work harder. Tipping your upper body slightly forward, with a straight back, shares more of the effort with your hips, though your back muscles work harder too. Neither way is right or wrong; it's a trade-off. For people with pain around the kneecap or with knee osteoarthritis, the authors suggest shallower squats rather than deep ones. (If your knees also click on the stairs, see Why Do My Knees Click on the Stairs?)
• How long you stay down. A 2004 study of Beijing residents aged 60 and over looked at a community where squatting was an ordinary daily posture. About 4 in 10 men and 2 in 3 women recalled squatting for an hour or more a day at age 25. Those who recalled squatting for two hours or more a day were more likely to show knee osteoarthritis on X-rays. The study relied on memory and shows a link, not proof of cause, and a long daily habit like that is very different from quick everyday squats. If a long squatting job leaves your knees sore, standing up for a short break may simply feel more comfortable.
• How you get back up. Rising from a low squat can feel like the hardest part. Coming up slowly, with something sturdy to hold, may feel easier than springing up in one go.

3. Everyday squats in Malaysian life

Here in Malaysia, asking "is squatting bad for your knees?" is a very practical question. A 2021 Malaysian expert consensus on managing knee osteoarthritis notes that squatting and kneeling are commonly seen in daily life here. Familiar examples include:

• Squat toilets in older homes, kampung houses and highway rest stops.
• The wet market: bending low over baskets of vegetables, then sorting them at home on a low stool.
• Gardening, from weeding to trimming pandan that grows close to the ground.
• Grandchildren: lifting a toddler, or sitting on the floor to share a picture book.
• Chores like washing clothes in a basin, wiping the floor or preparing food for a big family gathering.
• Kneeling at a place of worship. If getting down and up again is uncomfortable, a doctor or physiotherapist can suggest knee-friendly ways to get up and down.

For most healthy knees, these squats are simply part of life. If your knees are sore, long, deep or repeated squats during chores may bother you most.

4. Small changes that may make squatting feel easier

You don't have to give up the chores and hobbies you enjoy. These adjustments aren't treatments, but they may make squats feel easier.

• Sit low instead of squatting low. Keep a sturdy low stool nearby for jobs near the floor, so your knees don't have to hold a deep bend.
• Bring the job up to you. Rest the laundry basin on a low bench, move plants into raised pots, or sit on the sofa and let your grandchild climb onto your lap.
• Don't go all the way down. A half squat, bending at your hips as well as your knees, may feel more comfortable.
• Hold on to something sturdy. Push up from a heavy table, a kitchen counter or a firmly fixed wall rail, and rise slowly. If a parent uses a squat toilet at home, a fixed rail beside it gives them something to hold.
• Shift your weight and take breaks. During a long job, rock gently from foot to foot, and stand up to walk around every so often.

If an adjustment doesn't help, or a movement keeps hurting, ask a doctor or physiotherapist rather than pushing through.

5. Stronger hips and thighs, with a physio's guidance

The muscles at the front of your thighs and around your hips do much of the work when you lower yourself and stand up again. Staying active in ways you enjoy, such as regular walks, keeps them working.

For people with knee osteoarthritis, a 2020 review of 8 trials found that adding hip-strengthening exercises to thigh exercises improved walking more than thigh exercises alone. The extra hip work made no clear overall difference to pain, though a smaller analysis suggested hip exercises done against resistance may ease pain more than functional, balance-type hip exercises.

A registered physiotherapist can watch how you squat and stand, and suggest exercises that suit your knees. If you have a heart or other health condition, check with your doctor first, and stop if pain sharply increases.

6. Squatting knee pain: when to get it checked

Maybe the question on your mind is less "is squatting bad for your knees?" and more "why do mine hurt every time I squat?" Then it's worth getting checked. A doctor, a registered physiotherapist or your nearest government klinik kesihatan is a good place to start.

They will ask about your symptoms and watch how your knee moves. If they find a condition such as knee osteoarthritis, the 2021 Malaysian consensus puts four things at the core of care: education, exercise, weight loss for people who are overweight, and less load on the knee in daily life. Physiotherapy, medicines, joint injections or, for some people, surgery may be added. You and your doctor decide together what fits you.

Reading this for a parent? Offer to go along, and note which everyday movements bring the pain on.

The bottom line

So, is squatting bad for your knees? For most healthy knees, an everyday squat is a normal part of life. Depth, knee position, time spent down and how you get up all matter. If squats feel uncomfortable, a low stool, a sturdy handhold and regular breaks may make daily life easier. Building hip and thigh strength with a physiotherapist's guidance, staying active and keeping to a healthy weight in a way that suits you are all part of knee care. This week, notice which daily squats feel fine and which don't. If pain keeps coming back, see a doctor or physiotherapist and look together at the full range of options, from exercise and physiotherapy to medicines, injections or surgery where needed.

This article is general information, not medical advice. Please see a doctor or physiotherapist about your own symptoms.

If you're in your 50s or older, or caring for a parent who is, regular check-ups with a healthcare professional are a good habit, even when nothing hurts.

References

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2. Straub RK, Powers CM. A biomechanical review of the squat exercise: implications for clinical practice. Int J Sports Phys Ther. 2024;19(4):490-501.
3. Ahmad MA, Ajit Singh DK, Chua WQ, Ab Rahman NNA, Mohd Padzil F, Muhammad Hendri EN. Knee osteoarthritis and its related issues: patients' perspective. Jurnal Sains Kesihatan Malaysia (Malaysian Journal of Health Sciences). 2018;16(si):171-177.
4. Nagura T, Dyrby CO, Alexander EJ, Andriacchi TP. Mechanical loads at the knee joint during deep flexion. J Orthop Res. 2002;20(4):881-6.
5. Zhang Y, Hunter DJ, Nevitt MC, Xu L, Niu J, Lui LY, Yu W, Aliabadi P, Felson DT. Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: the Beijing Osteoarthritis Study. Arthritis Rheum. 2004;50(4):1187-92.
6. Yeap SS, Abu Amin SR, Baharuddin H, et al. A Malaysian Delphi consensus on managing knee osteoarthritis. BMC Musculoskelet Disord. 2021;22(1):514.
7. Hislop AC, Collins NJ, Tucker K, Deasy M, Semciw AI. Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med. 2020;54(5):263-271.

Source consulted: a Harvard Health Publishing article on everyday activities and knee pain (October 2023).