Severe Knee Pain When Squatting Slowly: Causes and Treatment Options

Experiencing severe pain in the knee during a half-squat?

Hello doctor, I have been troubled by a problem for a while.
I can squat down and stand up quickly with both legs normally, but if I squat slowly, I experience severe pain and weakness when I reach halfway.
The pain is located on the inner upper part of both knees.
I usually play basketball, but I don't recall any knee injuries.
The only time my knees were impacted was a year ago when I fell off my bike and hit my knee, but at that time, it only felt like a superficial pain.
After applying medication, the wound healed, and I thought everything was fine.
I'm wondering if you have encountered similar cases where a person can squat normally but cannot slowly squat to a half-squat position.
What could be the possible reasons, and how should it be treated?

Jason, 30~39 year old female. Ask Date: 2021/08/24

Dr. Wang Shouji reply Orthopedics

Hello, based on your symptoms, it seems to be an issue with the hip joint or the medial head of the quadriceps.
This area can bear more than eight times the body weight when squatting or going up and down stairs, which may lead to your symptoms.
If you are experiencing discomfort, it is advisable to consult an orthopedic clinic to confirm your condition.
Changhua Hospital cares about your health.
Sincerely, Dr.
Wang Shou-ji.

Reply Date: 2021/08/24

More Info

Severe knee pain during slow squatting can be a frustrating and debilitating issue, particularly for someone active in sports like basketball. Based on your description, it sounds like the pain is localized to the inner upper part of your knees, which could indicate a few potential underlying causes.
One common reason for pain in this area, especially when squatting slowly, is patellofemoral pain syndrome (PFPS), often referred to as "runner's knee." This condition arises when the kneecap (patella) does not move smoothly along the groove in the thigh bone (femur), leading to pain, particularly during activities that involve bending the knee, such as squatting or climbing stairs. Factors contributing to PFPS include muscle imbalances, overuse, and improper biomechanics during activities.

Another possibility is a meniscal tear. The meniscus is a C-shaped cartilage in the knee that acts as a cushion between the femur and tibia. While you mentioned not recalling any specific injury, the previous incident of falling off your bike could have caused a minor tear that has since worsened with activity. Meniscal tears can lead to pain, swelling, and a sensation of the knee "catching" or locking during movement.

Additionally, your symptoms could be related to ligamentous issues, such as a sprain of the medial collateral ligament (MCL), which is located on the inner side of the knee. This type of injury can occur from a direct blow to the knee or from twisting motions, which might not have been immediately apparent after your fall.

To address your knee pain, it is essential to first consult with a healthcare professional, such as an orthopedic specialist, who can perform a thorough examination and possibly recommend imaging studies like X-rays or an MRI to assess the condition of your knee structures.

In the meantime, here are some general treatment options that may help alleviate your symptoms:
1. Rest and Activity Modification: Avoid activities that exacerbate the pain, particularly slow squatting or any movements that cause discomfort. Allow your knee time to heal.

2. Ice Therapy: Applying ice to the affected area can help reduce swelling and numb the pain. Aim for 15-20 minutes of ice therapy several times a day, especially after activities.

3. Compression and Elevation: Using a knee brace or wrap can provide support and reduce swelling. Elevating your knee when resting can also help minimize swelling.

4. Physical Therapy: A physical therapist can develop a tailored exercise program to strengthen the muscles around your knee, improve flexibility, and correct any biomechanical issues contributing to your pain. Focus on strengthening the quadriceps, hamstrings, and hip muscles.

5. Pain Management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation. However, consult with a healthcare provider before starting any medication.

6. Gradual Return to Activity: Once your pain subsides, gradually reintroduce activities, starting with low-impact exercises and slowly increasing intensity. Pay attention to your body’s signals and avoid pushing through pain.

7. Biomechanical Assessment: If you continue to experience issues, consider a biomechanical assessment to evaluate your movement patterns during sports and daily activities. This can help identify any abnormalities that may contribute to your knee pain.

In conclusion, while your ability to squat quickly without pain is a positive sign, the severe pain during slow squatting indicates an underlying issue that should be addressed. By seeking professional evaluation and following a structured treatment plan, you can work towards alleviating your knee pain and returning to your regular activities, including basketball.

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