Knee Pain in Pistol Squats: What I Did

I developed aching in my left knee around the month mark of pistol squat training. Here's what I identified and how I addressed it.

The most common cause of knee pain in pistol squats is excessive inward caving (valgus collapse) at the knee, especially during the descent. Weak hip abductors allow the knee to track medially, which loads the patella unevenly. Clamshell exercises and hip abductor strengthening resolved this for me within three weeks.

The second most common cause is excessive forward lean of the torso combined with the knee tracking too far past the toes without the supporting tissue being conditioned for it. The fix here is temporary regression — using a box or counterweight until the tissue adapts.

A physio visit is worth it if pain doesn't improve in two weeks with the above. Knee pain that persists during training should not be trained through.