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  • Danyell Russell, PT, DPT

Foundation Work: Squats

I wanted to take some time and talk about one of the most important foundational movements that we do: squatting. There seems to be a lot of information about squats going around, some that is good information and some not so much. So we’re going to talk about what a squat should look like, some myths about squatting, and finally we’ll talk about some things we can do to correct our squat mechanics.


First let’s talk about what a squat should look like, or the Points of Performance of a squat:


Stance About Shoulder Width: While the specific stance width varies person to person, shoulder width is a good place to start. You can always change this as you go.

Neutral Spine Position: We want to keep your spine in a nice straight line during your squat. This means that we don’t want your back to over arch nor do we want your hips to tilt under into what we call a “butt wink”.


Knees in Line with Toes: Knees should be driven out in line with your toes. This means that your knees may translate over your toes and will go out away from each other, not towards each other.


Hip Crease Below Knee: Yes, hip crease BELOW knee. We will talk more about this when we get to the squat myths section, but a full depth squat ends with your hip crease below your knee.

Hips Release Back, Knees Break Forward: Hips and knees move simultaneously here. Hips begin moving backwards, while knees begin moving forward. Chest should remain upright during a squat. Think of it as if you were in front of a mirror, you would want to be able to read the writing on your shirt.

Weight Through Midfoot: We want your full body weight distributed over the midfoot, not through your heel nor through your toes.

Neutral Head Position: Just like we want your back to stay in a straight line, we want you to keep your head upright, not looking down towards the floor nor looking up towards the ceiling.


In the picture above, we can see that all of the points of performance of a squat are maintained, despite it not being a perfect squat (I’m human too, y’all! I still have things I’m working on).



This video is where I took the still shot from and you can see that I do not necessarily maintain all of the points of performance throughout each squat, but again, it is a work in progress. :) Now that we know what a squat should look like, let’s talk about some myths surrounding squats.


 

Squat Myth #1: Squatting below parallel is bad for your knees.


This is a myth that we all have likely heard, and I remember being taught this when I was in physical therapy school. In fact, I spent the first few years of my career teaching my patients this exact thing and never having people squat below parallel, because this myth was so engrained in me throughout my time as an athlete, during my undergraduate studies, and throughout physical therapy school. The thing is, though, it simply is not true.


According to research performed by Hartmann et al, full depth squats do not increase the risk of injury to the knee and actually appear to be protective against injury to the menisci and ligaments of the knee. The compressive forces at the patellofemoral joint are greatest at 90 degrees of flexion, and actually decrease below 90 degrees due to a wrapping effect that occurs. So all of the times that we have had people stop their squat at parallel, we have actually been having them stop and change directions when the patellofemoral joint is at its most compressed. Which means that by having people stop their squat at parallel, we may actually be doing them a disservice and a detriment.


In addition to deep squats not being the cause of degenerative changes, it actually appears that loading into a deep squat can be protective against degeneration of the meniscus and cartilage of the knee joint as well as making the ligaments of the knee more robust and able to withstand forces at the knee.


As if the above were not enough to convince us that loading into a full depth squat were not enough, the research by Bloomquist et al and Hartmann et al gives yet more reasons to squat to full depth: performance. Bloomquist et al found that loading squats through a full range makes people stronger throughout the full range (no surprise here) and that jumping performance improves more with full depth squats than partial range squats. Hartmann et al had similar findings that performance of jumping improves with full depth loaded squatting, but not with partial depth squatting. Want to get stronger? Squat to full depth. Want to be able to improve jumping performance? Squat to full depth.


Squat Myth #2: You should never let your knees go past your toes.


Here’s another myth that I would be willing to bet most people have heard. Again, this is a myth that was engrained in me from the time I was in middle school athletics all the way through my physical therapy school education. The assumption here is that if you let your knees go past your toes, you are increasing the forces at the knee to a detrimental level and can cause injury.


So here’s what the research says about restricting anterior knee translation: it does, in fact, reduce the amount of forces through your knee by about 22%. HOWEVER, by restricting the anterior translation of your knees over your toes, it INCREASES the forces through your hips and lumbar spine by 1070%. Read that again. Yes, it reduces the forces through your knees by a small amount, but it transfers the forces over a 1000% to your lumbar spine and hips. This can increase the amount of shear forces your lumbar discs and ligaments have to withstand, and obviously set you up for a potential injury to your lumbar spine and/or hips. (Fry et al)


In addition to increasing your risk for a lumbar spine or hip injury, it can also greatly affect your ability to be able to perform a full depth squat by restricting your knee translation over your toes. If you restrict your knee mobility over your toes, then you are having to find that mobility elsewhere, and likely you are going to have trouble attaining a full range of motion through your squat.


In the Fry et al article, they made a very direct, specific argument that recommendations to restrict knee translation over the toes should be strictly avoided and that these recommendations should be removed from future literature and coursework given to movement professionals. If you are unfamiliar with clinical research, this is a very bold claim to make. Typically in research, you will see phrases such as, “additional research is required,” or “there is not enough evidence to conclude.” So the fact that Fry et al made the argument to remove these recommendations should be taken very seriously.


Where does Strong Foundation Physical Therapy stand with the myths presented above? In short: Squat to full depth. Squat with unrestricted knee translation. Squat with load. Squat often.


 

That’s all well and good, however, sometimes people have trouble squatting to full depth OR have trouble with allowing their knees to translate over their toes. So how do we address that? Below you will find a few drills to help with improving squat depth and unrestricted knee translation.


Deep Squats with Lateral Weight Shifts Using a squat rack or door frame for support, squat down into your full depth squat. Once there, shift your body weight to the right and pause, then to the left and pause. Concentrate on pushing your knee outwards and forwards over your toe.


Bottom Up Squats Begin with sitting on a box or wall ball with your feet in your normal squat stance. Lift your buttocks off of the box and pause for 3-5 seconds. Lower yourself back to the box. As you’re able, lower the box height until you are able to maintain good mechanics in the bottom of your squat.


Squat to Target Using a box or wall ball, slowly reach your buttocks down and back to the target. Tap the target with your buttocks and then slowly return to the start position. I like to perform this as a tempo squat with a 3 second descent, 3 second pause, and 3 second ascent.


Squat with Knee Translation Squat to a depth that you are comfortable with holding, then using a dumbbell or kettlebell push one knee forward and out over your toe and hold for a couple of seconds, then switch sides. Make sure that you keep your heel down while you’re doing this.


If you’re having trouble with getting to the bottom of a squat or allowing your knees to translate over your toes, give these drills a try. And if you would like some additional help with improving your squat (or any other movement for that matter) please reach out to me at danyell@strongfoundationpttx.com or 940-268-4365 to schedule a Wellness Session where we can assess your movement and develop a plan to improve your movement.


Squatting is a crucial movement for our everyday lives, and it is important that we are able to perform them well. Squat deep. Squat with unrestricted knee translation. Squat often. Squat well.

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