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Should Women Train Differently Than Men?

6/28/2016

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Should women train differently than men? The answer to this question is far from black and white. 

There are some principles of strength and conditioning that remain constant whether training a male or female.  However, the biological makeup of women causes some factors to be different than a man.
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First I will address the YES, or why women should train differently.
  • Women tend to be more flexible, particularly while pregnant and post-partum.  While men may need to focus on mobilizing their tight hips or distracting their shoulders prior to exercise, this may not be warranted for some women.  If you know that you are hypermobile, or double jointed, you will not need the same mobility work for your joints.  Rather, your time would be better spent practicing motor control.  Controlling end range movement is always important, particularly when moving under weight. I’ve used the example before, avoid crashing into the bottom on a squat!  Dr. Danny broke this concept down very nicely in his previous blog post “How to Dramatically Improve Your Squat”. Check it out!​
  • “Core” work is important!  The core I am referring to is not just the six pack abs but the entire canister: diaphragm, pelvic floor, abdominals and posterior spinal muscles.  Women tend to have more pelvic health issues than men—this could be because they report it more but is more likely due to posterior chain weakness, poor motor control and post-partum effects.  Interestingly enough, the pelvic floor has been found to be weaker in athletes than non-active women! But don’t forget the other dimensions of the core. Here are a few suggestions for adjuncts to warm up and training schedules.
  • Diaphragmatic breathing- Many times athletes become upper chest breathers which is essentially using neck muscles to assist with breathing.  Ideally, we want to be belly breathers.  When inhaling deeply, the abdomen and lower thorax should expand before you see chest rise. Again I am going to point you to Dr. Danny’s last article because he explains a step-by-step approach to practicing this technique!
  • Posterior chain strength- Hamstring, hip and low back strength are essential for a balanced core.  Women may be prone to decreased posterior chain activation due to boney makeup of the pelvis, hips and knees.  Pregnant or post-partum women will also see a change in posterior chain strength due to the shift of the low back into increased lordosis, or sway back.  Different postures are assumed when the center of mass is moved due to the baby bump.
  • Unilateral training- This is a great way to engage the core, specifically the obliques and deep core (transversus abdominis) during training. Having a weight on one side of the body puts force on the torso making it want to rotate.  There are some specific “anti-rotation” exercises (Pallof press, for example) but this can be integrated into those posterior chain exercises! Reverse lunges with a front racked kettlebell is one of my favorites. If the kettlebell is in the front rack on the right, then the right leg lunges backward.  Unilateral training is also a great adjunct for upper body training. 
  • Pelvic Floor health- Training the external rotators of the hip has been shown to improve pelvic floor function.  So even though they are not a “pelvic floor muscle”, they are deep inside the hip and have a direct connection to the pelvic floor.  The monster walk is a great example and many people are familiar with the exercise. I like to warm up with some version of these before I squat or run.  You can walk sideways, forward or backward.  Also, for those weightlifters out there, you can set up in a split jerk stance and walk sideways as well!  This will give the deep hip external rotators some strengthening time while also getting fired up for lower extremity functional movement.
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  • Women are able to perform resistance training for more reps at the same percentage.  So when Jack hits reps at 80% of his max, Jill can hit more at the same percentage of her max! This may be due to muscular architecture or neuromuscular control but regardless, don’t be afraid to tweak training protocols or rep counts if it feels too easy!
  • Women have the ability to recover more quickly within training sessions and from day-to-day workouts.  Estrogen has anti-catabolic effects that allows improved muscle repair and reduces protein breakdown during exercise. It has also been shown to improve metabolic profiles effecting triglycerides and glucose levels.

NO- Reasons why women should not train differently than men
  • “Weight training will make women look like men.”  This statement is simply not true.  Our biology is different, so the amount of muscle that we can naturally put on is not in the same realm as men! Men produce 10x the amount of testosterone as women.  Testosterone is the hormone responsible for the anabolic effects of muscle and strength gains.
  • Don’t be afraid to add resistance training to your workouts.  As I mentioned before, it will not make you look “manly” but also it is a wonderful way to increase bone density and further improve lipid profiles.


So what do you do with this information?  For most of you, continue to train as you were.  However, it will behoove you to add some extra warm-up drills, “core” exercises and closely analyze your motor control.  However, do not cut yourself short on the intensity.  Remember, women can perform more reps at higher weight and yes you will maintain a feminine figure!  Keep the intensity high for greater metabolic impact and don’t skip the weights.
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Thanks for reading!
​

    -Dr. Jackie, PT, DPT, CSCS​


References:
Mata, John D et al. Sex Differences in Strength and Power Support the Use of a Mixed-Model Approach to Resistance Training Program. Strength and Conditioning Journal 38:2 April 2016.
Tuttle, Lori J et al. The Role of the Obturator Internus Muscle in Pelvic Floor Function. Journal of Women’s Health Physical Therapy. 40:1 2016.
Photos:    
http://onepercentchange.net/why-your-fitness-assessment-helps-with-weight-loss/
http://redefiningstrength.com/best-glute-exercises/
http://www.huffingtonpost.com/2015/01/13/running-effect-on-breasts_n_6460248.html
http://sites.psu.edu/amberwaresticker/2015/09/16/rhetoric-and-rosie-the-riveter/
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How To Dramatically Improve Your Squat

6/21/2016

1 Comment

 
The human body is an impressive and complex system. We are resilient, quick learners and infinitely adaptable. We also have had technological changes occur very quickly that have changed the day to day of many of us. This day to day currently involves large amounts of sitting and very little non-exercise based movement.

In our attempts to restore our movement patterns one of the first areas that is addressed is mobility. If you have issues squatting, we mobilize your ankles and your hips. If you can’t press overhead, we mobilize your shoulders and your upper back. But, what if that problem isn’t a mobility problem?

Here’s an example of a change we were able to get with one of our athletes in about 20 minutes with no mobility work at all!

                                      Before                                                                          After

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​I have had this scenario come into my clinic frequently: A 30-40 year old ex-athlete that is still very active doing CrossFit or training for a triathlon/marathon. They sit all day and have had a sedentary job for a very long time. They get into loaded squats because they have read in multiple publications that say squats are a great way to build strength (which is true). Their knees and lower back now both hurt them when they do loaded squats. They stumbled onto a video of Kelly Starrett talking about mobility for the hips to improve the squat. They start mobilizing their hip with a big green jump stretch band and do so daily for a few months. Very little change occurs and they get frustrated.

This person eventually ends up in my office seeking out a better mobility plan. What mobility techniques should they do and how much MORE per day do they need to do? What other ways can they smash their tissues into submission so they can finally have a normal squat again?
One of the first things I want to delve into when I see a case like this is what type of movement work have you been doing? Is there any prioritization of moving into the new range they are working on after mobilizing? Do they have any huge roadblocks that we need to address, i.e. surgery from 10 years ago to the knee that was never fully rehabbed.

Once those questions are answered, I want to assess their squat in an unloaded position. I will look at a few areas: The ability to get the hip into flexion; the knee into flexion (this is rarely an issue); and the ankle into enough dorsiflexion that we can achieve a parallel depth squat.
​

For hip flexion, you can use the supine test in the picture below. Leave one leg out straight and pull the other leg up to your chest. You can even use your hands to pull the knee to towards the chest. Once you feel like your butt is coming off the table, that's all the room you have in that hip. We’d like to see 125 degrees in this direction. In order to achieve a parallel squat, you really only need about 90-100 degrees.
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                                                                 Picture courtesy of MHHE

For the ankle, I’ll have my patient do a quick wall test. They can either do this standing or kneeling. With your foot in contact with the ground, drive your knee forward toward the wall. You want your knee to be able to touch the wall with the front of your foot 3-5 inches away. The farther away you get, the more mobility you have in the ankle.
Often, both of these correlation tests are passed showing enough movement availability to be able to perform the squat correctly. We’ll do one last test with them to see what the squat would look like unloaded in a hands and knees position.

In the picture below, the athlete is assuming what is called the quadruped rocking position. If you were to rotate the picture, this athlete would look like he was in a variation of a squat. This is an unloaded way to assess someone's ability to get their hip to parallel, or past, and see if they are able to maintain spinal neutral. His toes are up to mimic ankle dorsiflexion in the squat as well. Once I assess this and an athlete shows the capacity to get as far back in a quadruped position as the picture shows (hip crease farther back than the knee), we can move on to fixing this.
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                                               Picture courtesy of Foundry Sports Medicine

Here’s a list of all the information we’ve gathered so far:
​

    -They have sufficient hip flexion to achieve a squat.
    -They have sufficient ankle dorsiflexion to achieve a squat.
    -They have the capacity unloaded to maintain a neutral spine in a squat form (in quadruped).

At this point I can be pretty confident that this is not a problem that is going to be solved with crushing a lacrosse ball into their hip or band distracting their ankles. This is a control problem and it requires a completely different approach to restore the pattern.

This is where motor control work comes into the equation. Motor control simply put is technique. Here’s a more specific definition of motor control as well.

Motor control is the process by which we use our nervous system (brain, spinal cord, nerves) to activate and control the muscles/limbs involved in the performance of a skill.

So how do we get better at motor control? The answer is practice, in particular, blocked practice when we are trying to master a skill.

If you’ve played a sport, you’ve done blocked practice. Blocked practice is fundamental work. If you were a basketball player, you could improve your skills by just playing a bunch of pick up games. If you wanted to be a really good basketball player, you wouldn’t just do that. You would spend time working on dribbling with your non-dominant hand. You’d practice shooting free throws for hours. You’d practice the subtle nuances of a bounce pass vs a chest pass vs a lob pass. These are individual components of the overall game and you practice them individually so you can master the fundamentals. This is the most effective way for beginners to learn a new skill, but it’s also very effective for advanced athletes to maintain their mastery of the skill.

For the purposes of this article we will assume we are all beginners because the reality is many of us NEED to relearn this skill. Sadly, we were all probably much more efficient squatters when we were 5 years old and now we need to relearn that skill.

We’re going to start with breathing because it’s one of the most underrated portions of the squat and it has a dramatic effect on hip/spine positioning.

To start with, we will have athletes assume what is called the 90/90 position. This is essentially an unloaded squat pattern. We want our athletes to adopt a position similar to what they are trying to improve. We’ll try and get 10 reps through on this exercise prior to any other squat practice. It’s a great way to feel what we want our rib cage to feel like when we are squatting. It’s an easy way to also get a little prep work in for the diaphragm which is also a major stabilizer of the spine. Watch the video below for a more detailed explanation of this drill.

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Step two is we want our athletes to understand how we want them to organize their spine during the actual squat movement. Here’s the general explanation I use:
​

First, I like to cue thinking about creating a steel tank and then pressurizing it with air. Think of a propane tank as an example. Our torso should be the steel tank and the air you breath in should pressurize it.

Here are the steps:

-Squeeze your butt.
-Screw your feet into the ground.
-Take a big breath in and blow all the air out until you feel like your ribs are pulled down flat with your abdominal muscles.
-Maintain tension and breath into it.

The amount of tension you need is dictated by the task. For example, if you’re squatting something really heavy, you want to have a lot of tension. If you’re doing a bodyweight squat, you do not want or need a ton of tension. You want just enough to be able to complete the movement safely and effectively.

Now that we have breathing down and we have an understanding of how to brace our spine, it’s time to move. We’ll start with something unloaded and then move to a somewhat loaded exercise. Also, just to be clear, this is not your workout, this is practice. Treat this as practice, take it seriously and your squat will improve dramatically.

The wall squat, “squat therapy”: For this drill I’ve picked a video that Rich Froning himself put together. I think this video does a good job of demonstrating a commonly used squat drill. As an added bonus, Rich is not wearing a shirt - you’re welcome!
One subtle change I like to make to this drill, is to have my athletes pause half way down. They will pause, take a big breath in, both the air out and then breath back into the tension they create. This is essentially making them go through the torso bracing sequence twice during the squat. If you feel your spine shift significantly when you do this, chances are you are over extending your lower back. We want your spine in neutral, not in a extremely arched lower back position. Your lower back should not look like a banana!
​

Also, make sure to pause in the bottom and control that position. Imagine you are hovering over the grossest toilet in the world! This should be a very active position in the bottom of the squat.
Start by performing 10 of these squats a comfortable distance away from the wall. It should take you 3-5 seconds to descend, pause for 3-5 seconds and stand up in 1-2 seconds. Next, move a little closer to the wall so it’s moderately challenging for you to hold the position. Perform 10 more repetitions with the same tempo as the first 10. Lastly, move a little closer to the wall so it’s difficult for you to maintain the squat position. Again, use the same tempo. Don’t rush this, the struggle is where progress is made!

For the next drill we’ll throw in some real nervous system trickery! We’re going to use a band to help  create something called Reactive Neuromuscular Stabilization. It’s a big term for exaggerating the problem.

Ever wonder why your coach or PT has you squat with a band around your knees? Well, it’s because if we force you into a bad position, the body naturally tried to correct it by firing in the opposite direction. So if we pull your knees in with a band, your body with activate the hips to engage the knee outward into the pressure.

We’ll do the same thing with your torso to help correct excessive forward leaning. In the video below, I explain how I use this with my patients. I show this with one arm at a time but you could absolutely do it with both arms at the same time.

Keep the same tempo as the squats above for this one. That would be 3-5 second decent, pause 3-5 seconds, and then stand up in 1-2 seconds.

It is also very important that you maintain control of your torso/spine while you do this. We are not trying to reinforce a bad pattern of firing too much into spinal extension. Video yourself from the side just to make sure you don’t instantly start the movement by overextending your lower back.
Perform 2 rounds of 5 reps on each side.
Lastly, let’s get some weight in your hands. We’ll use a dumbbell or kettlebell as we do a squat variation called a goblet squat.

The goblet squat is one of my favorite squat training drills. I’ve heard some coaches say they hate the goblet squat and that’s mainly because you are semi-limited on how much weight you can load with. For the purpose of building pure strength, there are definitely better squat options. For learning/improving the loaded squat pattern, I think the goblet squat is the best squat variation.

A few things happen with the goblet squat that are interesting. First, we add weight to the body in front of the torso. This creates a really unique counterbalance that allows us to be more upright and sit down a little bit deeper into the squat. It also creates some inherent need for “anterior stability” or tightness in the abdominal region. Loss of control in the abdomen is one of the biggest faults I see in loaded squatting. It creates countless issues in the hips/back/knees and can be retrained well with the goblet squat.

Pick a semi-light weight but something heavy enough to counterbalance you. 10 pounds will probably not be enough for most people but grabbing the 100 pound meatball kettlebell isn’t the best idea either.

Once you pick the up the kettlebell go through the same bracing sequence we talked about earlier:

-Squeeze your butt.
-Screw your feet into the ground.
-Take a big breath in and blow all the air out until you feel like your ribs are pulled down flat with your abdominal muscles.
-Maintain tension and breath into it.

Perform 10 reps at a faster tempo than our unloaded squats. Try 2 seconds on the decent, pause 2 seconds and then stand up. We’ll go through this two rounds as well.

Here’s the prescription:

3x per week perform this practice session:

1 round not for time

-90/90 breathing 10 reps, 5 seconds in, pause 5 seconds, exhale 5 seconds
-30 reps wall pause squat to a target, getting closer to the wall after each sequence of 10 reps
-Overhead RNT banded pause squats 2 rounds 5 reps each side
-Goblet pause squat light to moderate weight 10 reps

So, when can you plug this into your training? You have a few options, but in my opinion it’s best to do this prior to a training session. Think about incorporating this into part of your warm up on squat days. If we go back to the basketball reference, it would be like practicing shooting from different spots around the 3 point line prior to a game. There is a carry over effect in that motor pattern to the actual game where you have less than ideal conditions(people trying to stop you from shooting).

Practice the skill and then use the skill. Your workout is the game but your practice is what makes you dramatically better.

Step one is to help tease out if you have a mobility problem or not using the tests we described in the beginning of the article. If you don’t have a mobility restriction, then it’s time to practice the movement. Give it a solid 4-6 weeks of practice and see how much more comfortable it feels to squat.

Don’t spin your wheels thinking you have a mobility problem. It’s not always the case and movement really is medicine!
​


-Dr. Danny, PT, DPT, OCS, CSCS​

Still have questions? Contact us at info@athletespotential.com to see how we can better help you.
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Is Squatting Bad for My Knees? Part II

6/7/2016

3 Comments

 
Let’s recap from last week:

​Your ankles drive the squat bus and your knees are along for the ride.  Unfortunately, the hip is often overlooked when pain or dysfunction with squats occurs.  Strengthening targeted to the hip will improve knee position during the squat.  If it hurts your knees to squat, it is likely a faulty movement pattern causing the issue.

When there is pain, do not push through.  Jane Fonda might have said “no pain, no gain” during her abs, buns & thighs workout but this does not apply.  The feeling of an ice pick jabbed in your knee cap is not normal.  Pain with a back squat does not mean you can’t squat at all!  Try these first:

  • Use different rack positions.  Front squats will be more difficult for those with poor ankle mobility to achieve. High bar and low bar back squats each have their own advantages. I dig into this deeper later!
  • Lower the weight and work on form.  It is not about hitting a PR every time you walk in the gym.  For longevity of your body and long-term strength goals, work with a light weight until you have the ankle mobility, posterior chain strength and appropriate movement patterns.  To continue to build strength with these lighter weights, work eccentric movements.  That is, slowly lower into the bottom of a squat (count of 3-5) and then drive out of the bottom with power. Initiate the movement with a hip hinge and no crashing into the bottom!
  • Looking to deload the knees?  Try squatting to a box.  This allows the tibia, the lower leg, to remain more vertical.  So if you have ankle mobility issues, these are your friend.  Box squats are also a fantastic exercise to target the posterior chain!  More about this below!

I eluded to different flavors of squats in the last post. Is high bar back squat bothering the knees today? Try a low bar position, front rack or squat to a box.  There are so many options!   It is nearly as exciting as picking a flavor of ice cream.

Check out Noel showing us some variations of squats!  Pay attention to her ankle and shin positions.

High Bar Back Squat a.k.a Traditional Back Squat

The bar rests across the top of the upper trap, on the shoulders.  Throughout the movement, the torso remains upright.  With this set up, the knees tend to move more forward than in other squat variations so adequate ankle mobility is essential! 
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Remember, those with significant ankle mobility issues will have trouble maintaining the upright torso and may try to sidestep the issue by turning the toes out wide.  Another squat flavor will allow you to move in less compromising patterns while still gaining strength.  Don’t forget to work on ankle mobility every day!
 
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Front Squat

The bar rests across the front of your shoulder, elbows are high and in front. The torso is the most upright in this squat flavor to keep the barbell over the midfoot.  Again, ankle mobility is key here!
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For those who do not have glaring mobility restrictions, the front squat is a great exercise to carry over for the clean.
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Low Bar Back Squat

The feet are in a wider stance than for the traditional squat. The bar rests lower across your shoulders, elbows are back and high to help create a shelf for the barbell.  The torso maintains more of a forward inclination to keep the barbell over the midfoot.  
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This flavor of squat decreases the torque at the knees by allowing the tibia, or the shin, to remain more vertical. (Go back and look at her shin-to-foot angle in the traditional squat and compare!) More torque is placed at the hip, so the hammies and glutes are targeted.  If you feel a pinching at the front of the hip, vary your squat width and work on that hip flexion mobility! 
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Box Squat​

The feet are in a wider stance, similar to the low bar set up. The bar rests across your back in either high bar or low bar position.  A sturdy box is behind the lower legs.  The hips are allowed to travel further posteriorly during this movement which allows the tibia to remain vertical.  
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The box squat is great for all athletes to include in their workouts.  It is helpful when just learning how to squat or trying different foot positions.  After a knee or ankle injury, it is a good way to decrease torque at the knee and demand on the ankle joint.  Box squats are also used for power athletes as it has been shown to increase the rate of force development, or explosive strength, more than other squat flavors. ​
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Each of the squat flavors has something different to offer for your health and athletic development. If you are recovering from an injury or lack mobility in the hips or ankles, there is still a flavor for you!  Grab an empty barbell and try each of the variations. Don’t be afraid to vary your stance width.  Start with a taller box and gradually work your way down as you get comfortable.
Taking a video of yourself moving is the cheapest and quickest way to find faults and underlying mobility issues.  Once you work through each squat flavor, you will have a better idea of which mobility drills to introduce daily. Get your squat moving correctly and cut out that knee pain! After all, it’s not your knees’ fault!

Thanks for reading!

-Dr. Jackie, PT, DPT, CSCS​


References:
Swinton P, Lloyd R, Koegh J, Agouris I, Stewart A. The biomechanical comparison of the traditional squat, powerlifting squat, and box squat Journal of Strength and Conditioning Research. 2012;26(7):1805-1816.
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Is Squatting Bad for My Knees? Part I

6/2/2016

5 Comments

 
Simply put, no. Squatting, specifically deep squatting, is actually beneficial for your muscles and tendons.  If you simply wanted to know the answer to the question, that is the abridged version. But those “why” people (it’s ok, I am one too!) should continue reading.
Research tells us:
  • The compressive forces at the knee are greatest at 90 degrees (at parallel).  So the fans of squatting TO parallel rather than past parallel are still hitting the most stressful range. 
  • The body responds to the imposed stresses from deep squatting (with appropriate progression and form) by increasing the thickness of the tendons, ligaments and cartilage of the knee. 
  • The greatest glute activation is in the deepest part of the squat.

​The Knee, the Middle Child

In my experience, the knee joint seems to be the most baffling to folks.  So much emphasis is put on knee position during workouts that other (more important, in my opinion) joints are virtually ignored. It may be more beneficial to understand this joint if you view it as the middle child. 
The ankle is like the oldest child.  It sets the scene for how the other joints are allowed to act.  If the older child is rebellious and does not behave as expected, the middle and youngest child will imitate the older sibling. Without the proper ankle mobility and foot strength, who cares what your knee and hip joints can do?  The foundation for these multijoint movements is already the weakest link.

The hip joint is the youngest child.  By this point, the parents are exhausted from the rebellious older child who influenced the middle child into its rebellious ways.  The youngest child can get away with anything.  Our hip joint is a large, strong joint complex that should be the prime mover during squats.  Unfortunately we get so focused on the knees and ankles that we overlook the hips and allow them to “run free”.  This presents in the form of decreased pelvic control during large movements like the squat.

Finally, the knee joint is the middle child of the family. It gets pushed and pulled by its siblings but never has a moment when it’s all about the knees.  During foundational weightlifting movements, the knees never work alone.  They are guided by their neighbors.
​

So what does this mean?  The ankles are the steering wheel.  If you do not have sufficient mobility in your ankle joint, your knees are predisposed to faulty movement patterns.  But it’s not your knees' fault!!  ​
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Sad stick man on the right does not have great ankle mobility which causes his femur, the thigh, to be pushed backward.  From this position the torso has nowhere to go but forward if he wants to remain standing. Throw a barbell in the front rack and the stress in concentrated on the knees, low back and upper body. With a barbell on the back rack, it will be harder to maintain spinal alignment, particularly in the bottom of the squat. This is often the position athletes attain when their hips raise well before their knees begin to straighten in a squat.
I don’t know what to do with my knees!

“Knees out!” is one of the most over-coached cues.  Sure, it is a quick and easy fix in the middle of the workout but it is important that athletes understand what this means. If your knees are crashing in during a workout, the weakness is at your hip.  A weak gluteus medius is often the culprit but it has an accomplice!  If your hammies and glutes are weak and you attempt a heavy squat, your adductors are going to kick in to assist with hip extension.  But the primary motion of these muscles is hip adduction, or knees together. Thus, crashing ensues. So strengthen your hip muscles and your knee position will improve. ​
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If squatting is not bad for my knees, why do they hurt?

Undoubtedly, this will be the next question. There are several reasons that your knees may hurt during a squat.  Some irreversible arthritis or previous injuries may be contributing but even these populations should be able to return to pain-free squatting. They just may need to try a different flavor than the traditional back squat.

Essentially, squatting is not bad for the knees but it is how you are squatting!
  • Video yourself during a squat.  Focus on your hips and knees, which moves first?  A squat should be initiated with a hip hinge- hips back and then knees begin to bend.  Athletes who initiate squatting with a knee bend are leaving their posterior chain out of the exercise.  This can also be assessed by soreness after a heavy squat day.  Are your quads sore? Your adductors?  Ideally, you would feel the work was done by the glutes and hammies along with the quads.
  • Is your posterior chain strong?  Quad dominant athletes can experience greater occurrence of knee pain due to the strong and unopposed pull of the quadriceps tendon at the knee cap.  Warming up with good mornings or RDLs can help get the posterior chain firing.
  • Remember sad face stick man?  I bet his knees hurt (and probably his back).  Lacking mobility, particularly at the ankles, can cause athletes to assume less than ideal positions for the knee.  If an athlete is squatting with their toes pointed outward well beyond normal they are able to mask the lack of ankle mobility by still achieving a squat below parallel.  However, their knees are now in compromising positions and under load.  Remember, the ankles drive the bus and the knees are just along for the ride.

Do I squat through the pain?

No!  Our body is very good at letting us know when something is not right.  Now, I am not referring to muscle fatigue pain but true pain.  If the back squat is causing knee pain today, try another variation.  There are plenty of flavors of squats that can be used for training while you work on mobility or strength deficits.  Be sure to look out for my next article about finding the best squat flavor to suit you!
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Moral of the story: squatting, even below parallel, is not bad for your knees.  The squat is a fundamental movement pattern that all humans should be able to attain.  If pain arises from this movement, remember it is how you are moving.  Decrease the weight, video yourself performing a squat and pay attention to which muscle groups are doing the work. If you continue to have pain, contact us at Athletes’ Potential so we can watch you move and delve deeper into your individual movement patterns!  Most importantly,
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Thanks for reading,

    -Dr. Jackie, PT, DPT, CSCS​
​
  1. 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;43(10):993-1008.
  2. Swinton P, Lloyd R, Koegh J, Agouris I, Stewart A. The biomechanical comparison of the traditional squat, powerlifting squat, and box squat Journal of Strength and Conditioning Research. 2012;26(7):1805-1816.
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