Why Getting Off the Toilet Shouldn't Be the Hardest Part of Your Day
Struggling to stand up from the toilet because of knee pain? A Doctor of Physical Therapy explains why this happens, what your body is actually doing, and how to start fixing it.
By: Dr. Shari Miller, PT, DPT, OCS
Nobody talks about this one.
Not your doctor. Not your spouse. Definitely not your friends at dinner.
But if your knee has been bothering you for a while, there’s a good chance the toilet has quietly become one of the hardest parts of your day.
The lowering down. The standing back up. That moment where you’re not sure your knee is going to hold, and you reach for the wall or the counter or whatever’s close enough to grab.
You probably don’t tell anyone about it. But you think about it. And you’re not alone. I hear some version of this from almost every new client I work with. It’s one of those things people are quietly embarrassed about, and honestly? That breaks my heart a little because it’s so fixable once you understand what’s actually going on.
Let's Talk About What's Happening
Getting up from the toilet is essentially a single-leg squat from a very low position. Your knee has to bend past 90 degrees, and the muscles around it, especially your quads, have to generate enough force to push your full body weight up from that low point.
Side note: this is why squatting is one of the 6 foundational movements I talk about constantly. Squat, bend, lift, reach, balance, propel forward. If you can do all six, you can do life. And the toilet? That’s a squat. Every single time. Multiple times a day. It’s the squat nobody thinks of as a squat until it becomes a problem.
When those muscles aren’t strong enough to do the job, your body compensates. You might lean forward more than you should. You might shift your weight to the other leg. You might push off your thighs with your hands. You might hold your breath and brace through it.
And here’s the thing, your body is smart. When something hurts, it finds a workaround. But after a while those workarounds become habits. And those habits create new problems. The other knee starts to ache. Your lower back gets tight. Your hip on the “good” side starts doing more work than it was designed for.
I wrote a whole article on why your knee caves inward during a squat and what that means about your hip and ankle and it applies here too. If you want to understand the mechanics behind this, that’s worth a read:
Why Your Knee Tracks Inward When You Squat
It’s not your knee that’s broken
This is one of the most important things I tell my clients: your body is not broken. It’s compensating. And when we understand the compensation, we can start to undo it.
The sit-to-stand struggle usually comes down to three things working together:
Quad weakness. Your quadriceps are the primary muscle group responsible for straightening your knee under load. If they’ve been underworked because you’ve been resting, avoiding activity, or favoring the other leg then they lose the strength to handle this demand. I go deeper on this in my quad strengthening article if you want the full picture.
The Quad Strengthening Program for Pain-Free Squats
Glute underperformance. Your glutes should be doing a significant amount of the lifting when you stand. You have likely heard "glutes aren't firing" or "dead glutes" or the term "lazy butt." All of these terms and ideas are not really what's happening. If you have the physical ability to stand up from the toilet or a chair...your glutes are working fine. It is not an issue of the nerve synapse firing to the muscle to activate it. However, strength and endurance of the muscle should be talked about. It's a pattern I see often, weak hips cause a loud knee. To save going off on a tangent, you can read the article below to get the full scoop.
Confidence. This one is real, and I don’t think it gets talked about enough. When you’ve had enough bad experiences with pain, your brain starts guarding. You hesitate. You brace. You hold back. That hesitation actually changes your mechanics and makes the movement harder. It’s not “in your head” it’s your nervous system doing exactly what it’s designed to do. And that's ok. It's normal. We just need to give your nervous system a reason to trust the knee again.
What you can start noticing right now
Before we talk about exercises and I know, that’s what everyone wants to jump to...I want you to pay attention to something the next time you stand up from a seated position:
Which leg are you loading? Are you shifting your weight to one side to avoid the painful knee? Are you using your arms to push off? Are you holding your breath?
These aren’t bad things. They’re survival strategies your body figured out. But noticing them is the first step toward changing them.
If you want to go a step further, I built a free knee function self-test that walks you through six movement tests including a sit-to-stand assessment so you can see exactly where your knee stands right now. It takes about 10 minutes and gives you a baseline you can track over time.
The path forward
This is fixable. Not with rest. Not with waiting it out. And not with a single magic exercise you found on Google at midnight. (I know that rabbit hole. We’ve all been there.)
It starts with rebuilding the strength your knee needs, in the right order, without pushing past what your body is ready for. That’s what progressive loading means: start where you are, not where you want to be.
Things to watch for as you start to improve: How much do you rely on your arms to stand? How long can you sit before your knee stiffens up? Can you lower yourself down slowly, or do you kind of just drop?
Those little changes are how you’ll know it’s working.
If you’re also noticing pain when you squat during exercise, not just the toilet, but in workouts, picking things up, that kind of thing I recommend the next thing you read be my article on what’s actually causing knee pain when you squat. It covers the three cheat patterns your body uses and how to identify which one is yours.
Knee Pain When Squatting: The Cheat Pattern Fix That Actually Works
If this sounds like your daily reality and you’re tired of working around it, I walk through understanding your knee better, step by step, inside my newsletter, 3 Steps Forward. One email a week. No overwhelm. Just the next right move for your knee.
3 Steps Forward newsletter signup
Want to know exactly where your knee is right now? Start with my free Knee Function Self-Test. It takes 10 minutes and tells you what your knee can and can’t handle today.