Though the traditional barbell squat is widely regarded as one of the best possible exercises in terms of lower body muscle recruitment and training, certain preexisting health conditions and injuries may be exacerbated due to the intense strain the squat places on the exerciser’s body.
With this in mind, a multitude of physical therapy patients, recovering athletes and gym-going individuals of advanced age will find themselves searching for an alternative exercise to the squat that spares them of these exacerbated injuries or conditions.
One of the most common types of injuries acquired from the barbell squat are those surrounding the patella (or knee) and its subsequent tendons, usually taking the form of a tissue sprain or, in more serious cases, may even present as patellofemoral pain disorder.
As such, individuals wishing to avoid or prevent the worsening of these knee related injuries may receive great benefit from alternating out or modifying the squat in their workout program.
Generally, squats are not in fact significantly detrimental to the physical integrity and function of the knees in most healthy individuals - save for the unfortunate situation of the exerciser performing said squats exercise with improper form or excessive amounts of weight beyond their physical strength capacity.
This is not to say that even just the unweighted movement of the squat will not place some form of pressure on the knees, however, as the bodyweight as well as any additional load is distributed evenly throughout the patellar plate and surrounding tissues, though generally not to any injurious extent in ordinary circumstances.
A distinctly common rumor found in many fitness and training circles is that the particular depth of the squat is directly proportional to the risk of knee injury, with the logic behind such a belief being that squats of lower elevation place more of the resistance on the knees as the exerciser’s positioning shifts their bodyweight parallel to the patellar joint.
Save for the use of improper form or the exerciser squatting on an uneven platform, there is no clinical evidence to suggest such a belief is true, and certain research articles have even detailed the opposite being true - with squats of low range of motion presenting the same tension on the knees as those of a deeper elevation.
Every individual performing the squats exercise is at some small risk of knee injuries, though exercisers with a history of knee injuries, arthritic conditions or those of novice resistance training experience will find themselves at a significantly higher risk of knee injuries from squats.
In the case of individuals with a history of knee injuries or histologically related health conditions such as arthritis, this is primarily because of the inherently weakened state of the cellular tissues that make up the knees of the individual - with no amount of proper form reducing the risk as the problem originates from the integrity of the knee joint itself.
In this particular circumstance, the best possible route for the individual (apart from proper medical consultation) is the substitution of the squat with an exercise of similar muscular activation pattern and intensity that does not possess the same characteristic tension on the knees.
For individuals of novice training experience, especially in regards to free weight compound exercises such as the traditional barbell squat, the matter is less related to the condition of the exerciser’s knees and more to the technique with which they perform the exercise.
When performed with improper form or excessive amounts of weight beyond the abilities of the exerciser, significant shear force, torsion and pressure can be placed on not only the tissues of the knee joint but also nearby musculature and other joints, resulting either in acute injuries or chronic disorders if done repeatedly over longer periods of time.
To remedy such a situation, the exerciser must first take some time to allow their knees to recover if they are already suffering from a knee injury - prior to seeking out the supervision of an athletic coach or physical trainer who will ensure that they are utilizing proper form with no risk of injury.
Yes, knee injuries from squats are entirely preventable for healthy exercisers so long as they utilize proper form and a reasonable amount of weight in accordance with their own level of physical strength.
In cases where the exerciser is unable or uncomfortable with both of these factors, it is entirely possible for them to instead make use of an alternative exercise that does not possess the same form or risk of injury as the squat exercise itself, sparing them from such requirements.
Each exerciser possesses their own unique biomechanics, bodily proportions and levels of joint flexibility - of which means that blanket advice on the modification of the squat exercise’s form may be ineffective or even worsen the problem itself.
However, certain tweaks to said form or related characteristics of the squat may result in a reduced risk of injury regardless of the exerciser’s biomechanics.
Keep in mind, there is a common misconception that a wider stance is more hip-dominant, where-as a narrow stance is more knee-dominant. There are no scientific studies to back-up these claims.
In fact a study by Escamilla, et al. (2001) showed that both a narrow and wide stance squat are knee-dominant and that wide stance squats were the most knee-dominant in all phases of the activity.
A narrow stance requires more anterior tracking of the knee which places greater stress on the patellofemoral joint. Assuming a wider stance will help lifters reach the same level of depth while maintaining the tibia in a vertical position - which puts less stress on the knee joint.
These are the usage of a smaller range of motion in accordance with the exerciser’s own lower body flexibility, the usage of footwear with an elevated heel such as in the case of specialized squat shoes, a reduction in the total amount of weight used as resistance and the usage of a proper warmup and stretching routine so as to improve the strength and function of the knees prior to squatting.
Not all injuries relating to squats are equal or are from the same cause - and as such, may not utilize the same alternative exercises, with such conditions like osteoarthritis requiring that little to no force be placed on the cartilage tissue between the patella and the shin bones or femur and as such preventing high volume alternative exercises from being used.
Separated into three distinct types of ligament injuries referred to as the posterior cruciate ligament injury, medial collateral ligament injury and the lateral collateral ligament injury, these types of squat related knee issues are generally due to an improper angle of resistance or a proper one that is stressed beyond the breaking point due to excessive resistance.
In order to avoid exacerbating or causing these types of knee injuries, it is important for the exerciser to maintain a proper flexibility routine as well as to alternate out the squat with an exercise that prevents the legs from moving at an awkward or injurious angle, such as glute bridges or hip thrusts.
More related to the effects of aging and genetic predisposition rather than improper form or the rigors of the squatting exercise, osteoarthritis and similar forms of arthritis are nonetheless a major risk factor related to the squat and the knees of any individual that performs squat exercises.
Unlike acute injuries sustained from the squat or those relating to the squat exercise, arthritis will generally not heal over time, and represents a chronic weakening of the structural integrity of the exerciser’s tissues.
As such, no single alternate exercise to the squat is considered suitable for exercisers with arthritis, with the total amount of resistance and volume instead being of a primary concern - though individuals with such a condition can doubtless receive some benefit from reduced stress being placed on their bones and connective tissues.
Generally referring to injuries or inflammation of the two meniscus pads that cushion the outside and inside of the patellar joint, meniscus injuries are less commonly sustained from a single incident and more from chronic overuse or repetitive movement with excessive amounts of pressure, such as would be the case in high volume squat sets.
As such, when choosing to alternate the squats for such a type of knee injury, it is best for the exerciser to utilize isolation exercises with a low range of motion that does not directly involve the knees bearing a significant amount of strain or pressure.
Also a form of chronic connective tissue injury relating to overuse or improper angle of resistance during squats, tendonitis is one of the most common forms of bad knee injuries relating to the squat exercise, and is best left to recover on its own as opposed to utilizing any form of alternative exercise.
However, after the tendons of the knee have sufficiently recovered, it is best for the exerciser to either correct the circumstance that lead to such an injury in the first place, or to choose one that utilizes a lesser amount of volume in relation to said knee tendons, such as is the case in glute bridges or lateral lunges.
If the exerciser has decided to forego modifying their squat exercise and instead wishes to utilize an alternative that recreates the intensity or muscle group activation pattern of the squat, several candidate exercises may be used - either in combination so as to achieve a better training substitution or on their own.
As always, however, it is important for the exerciser to temper their expectations, as the majority of alternative exercises to the squat will irritate bad knees and similar injuries, and as such the few alternative exercises that do not do so are somewhat less similar in terms of muscular activation and equipment used.
This can result in slower or less effective training stimulus occurring, or the need to perform more than a single alternative exercise so as to train all the same muscles as the ones normally involved in a compound squat movement.
As can be inferred from its name, glute bridges primarily utilize the gluteus maximus and minimus muscles as the primary movers of the exercise, a muscle group that is also utilized to a great extent during the squat.
In addition to this, glute bridges also activate the lower back, core muscles, and hamstrings throughout the entirety of the movement, with only the quadriceps being left out of the muscle activation pattern when compared to that of the squat.
As such, glute bridges are an excellent alternative to the squat for individuals wishing to entirely avoid aggravating their bad knees, but must be combined with a quadriceps isolation exercise of a similar nature so as to fully recreate the training stimulus of the squat - even if glute bridges are generally less intense.
Making use of a leg curl machine, the leg curl exercise activates the majority of the lower body posterior chain in a movement quite similar to that of the squat - though with the drawback of removing the quadriceps, core and hip flexors from the equation, thereby leaving primarily the glutes and the hamstring muscles as the main focus of the exercise.
A benefit to using the leg curl as an alternative to the squat is in the fact that it induces a minimal amount of tension to the knees and other joints of the exerciser, even with its comparably large range of motion and usage of time under tension to impart training stimulus.
Much like glute bridges, leg curls are best combined with another exercise that activates the quadriceps femoris and core stabilizers so as to best recreate the sort of activation pattern and training benefits of the squat exercise - alongside the higher amount of volume needed for the leg curl itself.
Popularized by many social media fitness influencers, cable donkey kicks are an intermediate alternative to the squat that place the leg in such a position that tension on the knees is collectively reduced throughout the exercise.
Much like the previously mentioned exercises, however, cable donkey kicks primarily activate the posterior chain of the lower body and as such must also summarily be combined with a quadriceps isolation exercise in order to completely recreate the muscle group activation found in the squat.
When alternating the squat with cable donkey kicks, the exerciser may utilize significantly more volume due to the greatly reduced impact on the joints characterized by the cable donkey kick - though this is not applicable in cases of repeated overuse strain injuries such as patellar tendonitis.
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