The Case of the Squat Part II

Technique, Myths and Problems.

 If it’s broken, fix it. If it isn’t, don’t.

If someone needs improving in their squat that would be me. Nevertheless the fact that this particular exercise has eluded me and caused me so much frustration has made me obsessed with it.

Now that we have gotten out the biomechanics part of the squat lets move onto squat technique, myths, and how to solve some common problems (if they can be fixed that is).

Technique

“Leave your ego at the locker room” and “your psychological baggage at the front desk”

If I had to say one thing about exercise technique and attitude you just read it. Most men that I see in the gym (especially in Greece) seem to think that the more weight they can lift the more macho they are. And that goes with the attitude also. You know what I mean and you’ve seen it for sure. I call it “hot eggs under the armpits” attitude. Dude relax (your arms, traps, shoulders), my girlfriend lifts (correctly) more than you. And its ok.

If there are 4 things that limit your progress in any exercise that would be mobility, technique, motor control and muscle imbalances. Wrong technique not only could result in injury but biomechanically places you in a less then optimal position to lift as much weight as humanly possible.

In a nutshell if you can’t perform an exercise with perfect technique you are doing yourself a disservice by loading it with extra weight. Especially weight you can’t handle. As Gray Cook would say “you are adding strength to dysfunction”.

Lets move on to squat technique. As just mentioned, you need to coach your athlete or client (this doesn’t apply to trainers only but to people who want to do it themselves) how to correctly squat without weight.

Before you start:

Foot placement should be about shoulder width. Too wide you’ll stretch your adductors too soon and that will probably prevent you from going too deep (that type of squat – the sumo squat, nevertheless is excellent at activating the adductors due to the light stretch/length tension relationship)

Whatever feels more natural is what I say. People differ widely here. Longer femurs will more probably require a wider stance. Long torso/short femur another possibility and you want to go much narrower.

Other things that can affect foot stance would be hip width, flexibility of hamstrings, adductors and calves to name a few. Also if your pelvic anatomy is not ideal (how your acetabulum is shaped and the way the femur fits in it) you’d probably want to go wider unless you want to suffer from acetabulofemoral impingement. More on that below.

Execution

Start the descent by bending at the knees and hips in an even motion. Your center of gravity should be in the middle of your foot. People that tend to break too much at the knees can be coached to descent thinking they are going to sit back in a chair and to shift their weight at the heels.

Go all the way to the bottom or as far as it is comfortable for you. Going in a deep squat is ideal as you activate more musculature especially the hamstrings, which are a biarticular muscle.

Even though I hate “sayings” I have to agree with “half squats = half muscle”. You can’t expect to activate your glutes and hamstrings properly when you stop at just parallel (femur relative to the floor). If you want to target only your quadriceps the ideal stopping point would be at 90 degrees.

Myth #1

You shouldn’t squat below parallel (deep squat)

Parallel squat

Its been haunting me since I can remember. Its time to put this one to rest. You should squat as low as you can and your mobility, and anthropometry will allow you. If you can go properly beyond parallel you should. A deep squat is when the pelvis has dropped below the level of the knee. Don’t pay attention to sayings like ass to the grass etc. In a full squat, the hamstrings are covering most of the calves. I know of few people that can demonstrate that correctly. Key word correctly.

Full Squat
Full Squat

The theory that deep squats pose an injury risk can be attributed to studies conducted by Karl Klein at the University of Texas. Klein noted that weightlifters that frequently performed deep squats displayed an increased incidence of laxity in the collateral and anterior cruciate ligaments compared to a control group that did not (8). Klein concluded that squatting below parallel had a detrimental effect on ligament stability and should therefore be discouraged. Soon thereafter, the AMA came out with a position statement cautioning against the performance of deep knee exercises because of their potential for severe injury to the internal and supporting structures of the knee joint.

Further research has disproved Klein’s findings, proving no correlation between deep squatting and injury risk (5,6,7). On the contary, there is some evidence that those who perform deep squats have increased stability of the knee joint. In a study, Chandler, et al. found that male powerlifters, many of them elite class, demonstrated significantly tighter joint capsules compared to controls (8).

“Provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity” (4)

So we can conclude that “contrary to commonly voiced concern, deep squats do not contribute increased risk of injury to passive tissues” (4).

Case closed.

Myth #2

Can’t let the knees go past your toes/bad for knees

No-Darth_Vader

That’s another one that doesn’t refuse to die. Toes for most people are going to be slightly or more in front of their toes and that is OK too! I know some of you are freaking out and think I’m full of it but bare with me.

What we need to understand is everyone has different anthropometry. What that means is that people have different femur: tibia ratio. People with longer femurs will probably extend their knees several inches past their toes.

The only potential problem with letting your knees go forward is not destroying them. It is that you most likely will not be able to drive with your hips out of the “hole” (bottom position of a deep squat), which means less glute and less hamstring activation.

Remember: It’s a balanced act! Hopefully now you understand what I meant by the squat is possibly one of the MOST functional exercises ever.

Fry noted that “Although restricting forward movement of the knees may minimise stress on the knees, it is likely that forces are inappropriately transferred to the hips and low-back region. Thus, appropriate joint loading during this exercise may require the knees to move slightly past the toes.” (2)

As long as you don’t relax at the bottom position so the knee joint doesn’t open exposing the connective tissue to stress levels higher than their tensile strength you’ll be ok. Doesn’t mean you can’t pause at the bottom, just keep the tension.

On the previous article we mentioned that the front squat is actually easier and safer on the knees. The very same exercise that is going to force you to extend past your toes more than any other variation!

Try telling him: “huh excuse me kind sir but should you be letting your knees to go past your toes?” I’m not liable for the answer/outcome!!

Once you reach the bottom, there is only one way: UP. What you want to do at this point is to drive your hips up and forward and at the same time extend at the knees while keeping your chest up. Too much drive at the hips though will turn this into a deadlift, too much knee action and you shift shearing forces forward. It needs to be a coordinated affair.

So there you have it. This is all you have to do. It may look simple in paper, but in fact, there are a couple of things that can and WILL go wrong with people squatting that you definitely need to address in order to be safe, and effective. Here are the ones I think are most important:

Problems

 1. Butt Wink (gym lingo)

butt wink

Aka posterior pelvic tilt. Some people as they reach the low position of the squat, they will not be able to keep their spines in the desired neutral position and the lumbar spine will start to go into flexion.

This is important cause that is another reason why squats get a bad rep.

Myth #3

Squats will wreck your back

Letting the lumbar spine go into flexion can stretch the ligaments and ultimately cause a disk to bulge. Result? Anything from a slight pain that an ibuprofen can fix, all the way to bulging disks that may even require surgery.

 a. Cause

Possibilities: one belief is that it’s a flexibility issue. Mainly that your hamstrings are tight. They claim that as you descent in the squat the hamstrings (the part that attaches to your pelvis) compete for pelvic rotation with your lumbar extensors. So if you have weak extensors your tight hamstrings will pull your pelvis into a posterior pelvic tilt. I’m not totally convinced on this one. Hamstrings are actually SHORTENED at the knee in the descent so if you think about it there is no net stretch.

hamstrings

Second idea is that it is anatomical. Two things could be happening here. Your femur head and your acetabulum could be shaped in a way that when you flex your hips they imping early before adequate flexion can be achieved (Pic 1,2).

Pic 1. The femur and how it fits into the acetabulum of the hip

 

Pic 2. Two ways in which an anatomic deformity of the femoral head and the acetabular ridge can lead to impingement (10)
Pic 2. Two ways in which an anatomic deformity of the femoral head and the acetabular ridge can lead to impingement (10)

Also, it could be that your anterior superior iliac spine (ASIS) jams against your femur impinging your iliopsoas. Many people will complain of pain. They are not lying. (1,10).

b. Solution

A wider stance (as wide as you need according to anthropometry) will fix the femoral/acetabulum/ASIS possibility. Combine that with some good stretching of the hamstrings and you are on your way to greatness. The fastest way to mobility and flexibility is by manual work. I can’t stress how important it for people who exercise regularly to get a good massage. Preferably ART (Active Release Technique).

One quick footnote here: If it (the butt wink) happens close to parallel and its not so dramatic its ok, if its too much and you’re getting close to limit of lumbar flexion (ligaments, herniation) then no. Only experience can show that. Some people tend to overestimate their assessments. That will only hold an athlete back. Being safe is a priority but exaggerating can be a handicap.

2. Heels Raise from the floor

You will often notice that some people raise their heels when they descent low enough in a squat. Especially, if they are trying to keep their lumbar spine straight.

a. Cause

This is possibly a mobility issue in the ankle. Another possibility is tightness in the soleus muscle. Some people will say that the calves are tight. I’m not really convinced as the gastrocnemius is a bi articular muscle and during a squat descent it is actually shortened at the knee joint (same thing as the hamstrings). Another cause could be injury. One of my best clients and good friends has metal screws and plates in his tibia that prevent dorsiflexion in his left ankle.

The take-home message: if your tibia can’t travel enough forward due to any or a combination of the reasons mentioned above two things are going to happen. Either you will raise your heels or you will have to lean forward excessively. Why? Because you can’t expect to be able to balance (not fall on your ass) while your tibia stays close to vertical (relative to the floor). Unless you defy the laws of gravity. In that case I really want to meet you (feel free to contact me!).

b. Solution

Work on ankle mobility and stretch the soleus. In the meantime have your client wear weightlifting shoes or step on plates and/or a wooden platform. What this will do is it will shift the tibia forward to compensate for the lack of dorsiflexion.

Another thing to try here is front loading the client. Goblet squats are a great squat variation that fix heel lift and forward leaning most of the time. The name goblet comes from the fact that you hold a dumbbell to your chest as a goblet. The neat thing is that the dumbbell needs to make contact in two places: Chest and abs. Talk about killing two birds with one stone. Holding the dumbbell in front, someone with bad ankle mobility can keep his/her heels on the floor because the weight acts as a balance. At the same time, if they lean too much forward inevitably they would loose point of contact in the abs so they have a point of reference. Some people (example my friend) will ALWAYS have to do that. Nevertheless with a couple of modifications he clearly demonstrates a perfect squat that I am envy of (video).

 3. Knee Valgus

Many people’s knees will “collapse” during a squat, especially on the way up. Keeping your knees out during a squat is essential for 2 reasons.

If the knees track medially to the feet during the squat it increases the q angle. This refers to the angle that your femur forms in relation to your hips and to be more specific your anterior superior iliac spine (ASIS). Anything less that 165 degrees and you have a condition called knee valgus.

Femur_Q_Angle

In women naturally this angle is narrower because of the fact that women have wider hips than men.

When this occurs, chances of encountering chronic knee injury – such as patellofemoral pain syndrome (PFPS), knee osteoarthritis, medial collateral ligament sprains, and damage to the knee cartilage and meniscus – all increase. Just a 10 degree shift in Q angle increased patellofemoral contact forces by 45% (9).

a. Cause

The main stabilisers of your femur as it relates to your knee joint are your gluteus medius and your VMO (vastus medialis obliqus). Unless the problem is anatomical these two players are weak. More that probably, your adductors are tight as well, as your TFL, lateral gastrocnemius and bicep femoris.

b. Solution

The key to the squat is glute and external rotators activation. Some people have a hard time activating their glutes to say the least.

Actively voicing to the client to keep their knees out (after you have demonstrated how of course) and using your hands to point which way the knees should be facing, will usually work.

If it doesn’t, a nice little trick is placing a piece of theraband just bellow the knee of the client. To prevent valgus the client has to engage the glutes to perform external rotation at the hips.

There are other ways like placing blocks on the outside of the clients foot that he/she has to touch with their knees but not knock over etc.

Assistant exercises to work the gluteus medius (all kinds of hip abductions) and variations of the squat to target the VMO like the infamous 1 and ¼ cyclist squat are a must. Stretching the adductors, gastrocnemius and TFL completes the package.

Pic 7. Knee Valgus αριστερά και "γόνατα έξω" δεξιά.

I want to close this (lengthy) article by stressing two things. As I mentioned earlier, anthropometry will play a huge role in squat performance. Certainly not everyone will be able to perform a deep squat, even more so a full squat, with perfect form. Don’t sacrifice quality. If someone can’t execute perfectly don’t load him or her until they can. There are many alternatives that produce identical if not comparable results. My favorites are unilateral movement (lunges, step ups, split squats etc). Don’t let ego get in the way of safety and performance.

The second is that the lists of problems is by no means exclusive nor are the solutions. As you progress in your training (if you are a lifter) or in your career (as a trainer) you’ll come across different scenarios that are going to challenge you and broaden your knowledge.

So between all this “tricks” or “solutions” you could possibly get a perfect squat out of most the first time around!

 References
  1. Rippetoe, Mark and Stef Bradford. Starting Strength Basic Barbell Training 3rd Edition. Wichita Falls, Texas: The Aasgaard Company, 2011. Kindle.
  2. Fry AC, Smith CJ, and Schilling BK. Effect of knee position on hip and knee torques during the barbell squat. J Strength Cond Res 17: 629-633, 2003.
  3. Hirth CJ. Clinical movement analysis to identify muscle imbalances and guide exercise. Athl Ther Today 12: 10-14, 2007.
  4. Hartmann H, Wirth K, Klusemann M. Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Med. 2013 Oct;43(10):993-1008
  5. Meyers E. Effect of selected exercise variables on ligament stability and flexibility of the knee. Research Quarterly. 42(4):411 – 422. 1971.
  6. Panariello R, Backus S, Parker J. The effect of the squat exercise on anterior-posterior knee translation in professional football players. AmericanJournal of Sports Medicine. 22(6):768 – 773. 1994.
  7. Steiner M, Grana W, Chilag K, and Schelberg-Karnes E. The effect of exercise on anterior-posterior knee laxity. American Journal of Sports Medicine.14(1):24 – 29. 1986.
  8. Chandler T, Wilson G, and Stone M. The effect of the squat exercise on knee stability. Medicine and Science in Sports and Exercise. 21(3):299 –303. 1989.
  9. Mizuno Y, Kumagai M, Mattessich et al. Q-angle influeces tibiofemoral and patellofemoral kinematics. J of Orthop Res 2001; 19:834-40.
  10. Norkin, Cynthia and Pamela Levangie. Joint Structure and Function: A Comprehensive Analysis. Philadelphia: F.A. Davis Company, 1983. Print.

 

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