 Elbow pain can be one of the most irritating and inconvenient issues. I once had a patient say that the most painful part of his day was just cutting butter for his toast in the morning. Classically, we tend to blame the tissues at the joint—wrist extensors/flexors. Sure, the common insertion for these muscles becomes inflamed, but what causes that? I like to view the elbow similarly to the knee; it is a joint that is pushed and pulled on either side by very complex joints. The shoulders will largely influence the biomechanics of your elbow and the amount of torque that passes through the joint. Although somewhat simplified, we could group you as either tight and immobile or mobile and bendy. Each characteristic has its own pros and cons, but the cons are where pain manifests. With decreased shoulder mobility and/or control, the elbow will take the brunt of the force when lifting weights or swinging a racquet. Shoulder stabilization and control are important for correct biomechanics of the shoulder girdle and upper extremity. Lack of control upstream, allows more movement downstream at the elbow. The repetitive, small insults at the elbow joint will eventually result in elbow pain.  Hammering away at the soft tissue around the elbow is often where athletes start when self-treating. Don’t get me wrong, a little forearm smash with a lacrosse ball or barbell is great. But if it does not improve your problems, move on! In this case, we are going to check out the shoulder. Less mobile folks: To decrease the torque at the elbow, it would be ideal to improve both the external rotation (front rack) and flexion (overhead position) or your shoulder. Tight lats can often be the cause of the restrictions. Try these two mobility pieces:
  More mobile folks: Shoulder stabilization is going to be the key for you. A simple way to start on this is kettlebell carries, all variations! Here are two simple, yet effective stabilization drills:
  As always, do a movement screen/ form check first. Get a coach or super friend to watch you move and see if they notice any faults. Racquet sport athletes—if you constantly have elbow pain, check your grip size. Grips too small or too large can cause elbow issues as well. If you are a desk jockey, check out your work station and the ergonomics!
Try these mobility exercises and tips out. If you continue to have issues, come see us at Athletes’ Potential. We see elbow pain often and are able to effectively treat it with an evaluation! Keep devoting time to making your body work and feel better. Thanks, Dr. Jackie
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Guess what? Physical therapists sometimes have pain and dysfunction too! We are only human. Often times, people will see me wrapping a voodoo band here and there, or digging a lacrosse ball into my shoulder. It usually strikes up a conversation starting with, “What would you do if…..?” My ol’ volleyball knees tend to get creaky and achy sometimes, just as many athletes and patients often describe. So, what do I do if I have knee pain? These are my 5 favorite “quick fixes” for knee pain. Obviously, management of knee pain is more comprehensive than 5 quick tips. However, these are for when you are in the middle of weightlifting, running, playing your sport and you get that nagging knee thing. Ideally, you would consult a PT or watch a video of yourself moving to see what is causing the knee pain. But understandably, sometimes we just need it to feel better RIGHT NOW. #1 Modified Couch Stretch- This is a great stretch for the front of the hip! It is important that you stay tall and do not let the band pull your hips forward so that your back is banana shaped. Propping the foot up on a ball takes up more slack in the quad and intensifies the stretch. If you squeeze your booty, you will feel the stretch even more. Please kneel on something soft! Prolonged pressure on the front of your knee will only exacerbate the issue.  #2 VooDoo Band- Using a voodoo band, wrap your knee beginning below the knee and leaving a gap for your kneecap. Be sure it wrap it tightly! After it is wrapped, any knee movement will be beneficial. I like to do air squats and butt kicks to get deep knee flexion. You could also sit down and bend and straighten your knee. Leaving it on for up to 2 minutes will give you the best bang for your buck.  #3 Soft Tissue to quad- Often times, tension in the quad will cause knee pain right at the top of the knee cap or on either side. Pressure to the soft tissue in the thigh area can help the quad relax and allow more pain-free range. My favorite tool for this is the handle of a kettlebell. It allows more direct pressure than a foam roller and you can easily push down and then move it side-to-side for some release. Another option is a lacrosse ball. Just lie on your stomach, pin the ball on a sore spot on your quad, then bend and straighten your knee. Spend at least 2 minutes on this one.  #4 Knee Gapping- Everyone’s favorite! We like to use Yoga Tune Up Balls for this (as seen in the photo) but a double lacrosse ball or even a towel rolled up will work. Simply put the balls in the bend of your knee, then use overpressure form your arms to bring your heel towards your booty. This should feel good- like a stretch to your knee. Two minutes of oscillating between overpressure and releasing it will do the trick.  #5 Modify- Some days, the knees just aren’t on board. If you have completed a thorough warmup and tried some self-management but the knee still feels iffy--- modify, modify, modify. Don’t work through the pain! There are plenty of ways to change a workout that will still be beneficial but not aggravating to the knees. A great example is the box squat. If I have knee pain, it’s usually with heavy back squats- ol’ volleyball knees, remember? Box squats are a good option. I am still loading in the pattern I want, hitting the lumbopelvic muscle groups, but allowing my knees to stay back further so that the shear force is less.  To recap, if your knee hurts and you need it better now, then try some of these strategies. Keep in mind, there is a reason that your knee hurts. Maybe you have a funky movement pattern, less mobility on one side versus the other, or you didn’t warm up sufficiently. After you finish your workout, take the time to break it all down and find the cause. This will benefit you most in the long run!
If you continue to have trouble with knee pain, come see us at Athletes’ Potential. We see athletes from all different backgrounds- high school athletes, tennis players, runners, CrossFitters, Pure Barre-ers- and help them move more efficiently and pain free. We would love to help! Thanks for reading! Dr. Jackie  Last week I outlined some mobility restrictions that are likely the culprit if you have pain or trouble with squat pattern. Hopefully you have tried those mobility exercises out, even if you think you are flexible. There is sometimes a lingering asymmetry here and there from past injuries and such. So, you checked your mobility and you have the ideal mobility for a squat. What else could it be? The “butt wink” is a pelvic reversal or loss of the lumbar curve at the bottom of the squat. A few things can cause this—bony architecture and tibia to femur ratios, lack of mobility usually in hip flexion or internal rotation, and/or poor motor control throughout the squat pattern. I will not get into the debate of the first possibility. Yes, we are all unique snowflakes, but let’s make sure our mobility and control are up to par before we blame our parents. To be sure you are setting yourself up for success, check and see if your foot placement is ideal for your bony make-up and mobility. This is best done on your hands and knees with a partner watching and preferably filming. Make sure that your hands are below your shoulders. Rock forward and backwards the finally settle at the center—ask your partner to confirm that you are actually centered. From here, slowly push your hips back as if moving to child’s pose.  Watch your pelvis; when you notice that is starts to rock backwards, this is where your butt wink starts when you are standing with this foot distance. Now widen your knees out a few more inches and repeat. Did the pelvic reversal look the same, better or worse? If better, a wider stance in the squat would work better for you. If worse, stay narrow. If the pelvic position was the same, check in with how your hips felt during each of the two foot positions. Say in the wider squat you felt a bit of pinching, then stay narrow. Top picture: no butt wink, so a good foot position. Bottom picture: butt wink, so I will likely have a pelvic reversal with a squat to this depth or deeper.   Going a step further, you can move to your forearms to mimic the forward inclination of the torso during a squat. Perform the same steps. In the picture below, this is right before I start to have a pelvic reversal, so this is my target depth with loaded squats.  After finding the correct foot placement, stand up and try a few more squats. Is the butt wink still there? Yes: if you are in the correct foot position and have ideal mobility, keep reading! Many of the athletes that I treat fall into these categories: Very flexible and can squat with their booty to their ankles Report feeling tightness in their hamstrings, even though they can bend forward and put their palms on the floor Have back pain with squats that increases at the bottom of the squat, often one-sided but not always Always sore in the quads after squats, rarely glutes or hammies Does this sound like you? Here are two of my favorite exercises to start working on motor control of the lumbar spine, hip and pelvis under load as well as posterior chain strengthening. The tempo goblet squat: This exercise forces anterior stabilization by adding a weight at the chest. The deep core must fire to offset the kettlebell. With a 3 second count lowering to the box, motor control of the lumbopelvic area is even more challenged. Additionally, squatting to a target allows the athlete to sit back more in the squat, engaging the glutes and hammies. This is often a new input for these athletes who are quad dominant. Check it out here: Goblet Box Squat The banded bird dog: Practicing moving your extremities while under the load of a small band is important before you try to move big weight. The bird dog requires hip and midline control with movement, made a bit harder by adding a band. Again, having a partner for a form check or performing this by a mirror is ideal. Many people will have a movement fault and not even realize! The goal is to keep the back and torso in the neutral position throughout. As soon as your form falters, take a break. Check it out here: Banded Bird Dog Add these exercises to your strength days and/or warm up a few times each week. Maintaining your core and pelvic control throughout the range of motion is the first step to easing back pain and improving your strength in the squat!  If you try to self-manage for a few weeks and still see no change, let us know. We would love to help you here at Athletes’ Potential!
Dr. Jackie  Appropriate shoulder rotation is essential for overhead athletes; I want to discuss this in the context of volleyball. My bread and butter. Think of a volleyball player hitting a cut shot or winding up to swing away at a set. You will see a great amount of external rotation during the cocking phase (the middle frame in the photo above). The greatest demand for internal rotation range of motion would be the follow through for a cut shot or “thumb down” (as in the photo below).  The amount of shoulder rotation range of motion for a volleyball player is that of a normal individual but you need a balance of range of motion, strength and control. A quick side note worth mentioning: as an overhead athlete, you are likely to have greater range of motion in external rotation and less internal rotation. This is normal due to the demands of your sport. The baseline that we look for is that total range of motion side-to-side is the same. So you may look like the guy on the right in the picture below. It is also common for volleyball players to demonstrate greater internal rotation rather than external rotation strength, which may lead to injury down the road if the ratio becomes too skewed.  Let’s go through the steps of an arm swing and see where a weakness may be and how to address it:
Check your external rotation by laying on your back, arm out to the side and elbow bent. See how far you can drop the back of your hand down to the floor. Lacking here? Try this out: Subscap Smash 
The shoulder joint is one of the most complex in the body due to its high mobility demands that compromises the stability. For volleyball players, shoulder maintenance is key for longevity, pain-free function, power and control. I broke the attack down very simply to highlight a few major areas of weakness that is often found in volleyball players. Give these mobility and strengthening exercises a try and see what works best for you. At Athletes’ Potential, we believe that self-maintenance should be the first step toward managing pain and recovering properly. But if you have a nagging volleyball shoulder and cannot seem to find that silver bullet, give us a call! Thanks for reading, Dr. Jackie  Since “retiring” from volleyball, my fitness regimen now consists of weightlifting, rowing, body weight movements, running (let’s call it casual jogging), and so on. What are all of these movements missing? Rotation! I have become very strong in the sagittal plane—cleans, jerks, rowing, squatting, pull-ups. No wonder when I play a pick-up game, I am sore as all get out! This one goes out to those athletes who continue to be competitive in overhead rotational sports. Tennis players, softball-baseball-volleyballers, I’m looking at you! You guys hang out in the transverse plane a lot so this is where you need strength and control. This is why shoulder and spinal rotation is so vital for power and longevity in your sport and how to begin to maximize your performance. The Anatomy of Rotation Rotation in the thoracic spine is normally about 35 degrees but can be difficult to differentiate from lumbar rotation. However, the bony structure of the lumbar vertebra allow much less rotation than thoracic vertebra so we will focus there. The two major anterior rotators are the external and internal obliques. The external oblique (EO) attaches to the last 6-7 ribs, to the upper fibers of the serratus anterior and lateral fibers of the latissimus dorsi (on the right in picture). Due to these connections, you see how rotation strength would also affect shoulder stability. It acts to cause contralateral rotation; so the left EO turns your trunk to the right. The internal oblique (IO) acts to rotate the torso ipsilaterally, or to the same side (on the left in picture).  Another muscle group that we cannot forget about is the multifidi. These small muscles live on the posterior vertebra and have short connections at each level. Rather than acting as a strength muscle that creates movement, they are stability muscles that control rotation. So as my torso rotates left, my right side fires more than my left to control the amount of rotation allowed.  Training these muscles for strength and motor control are important to maximize power through rotation and decrease the rotational load on the lumbar spine. Rotation at your hips, trunk and then arm are the secret to a powerful throw/swing and minimize damage at these joints. If your thoracic spine is not mobile, the hips and shoulders will take the brunt of the force. This often results in early rotator cuff damage and impingement as well as issues up and down the kinetic chain in the elbow, back, hips and knees. Spinal mobility and strength is the foundation of overhead sports. Check your thoracic mobility: kneel on the floor, hands and knees. Put one arm behind your head and then rotate your shoulder and torso on that side up toward the ceiling. How far do you get? For an overhead athlete, it would be ideal that you elbow and shoulder could be straight up. Be sure not to just crank your elbow back, its more about the thoracic spine and shoulder position!  “Wow, people can really rotate in this position?”--if that’s you, then it’s time to begin some thoracic mobility work! Check these out: Better Upper Back mobility: This one is great for those who sit the majority of the day or who tend to have poor posture (that should have covered 98% of us!) All you need is a double lacrosse ball or Yoga Tune Up balls like those that Danny has in the video. The thoracic rotation mobility drill is great to perform as part of a warmup. Beginning in position A, take a deep breath and open up the shoulders, lowering the top shoulder down towards the floor to reach position B. On exhalation, try to sink further into the stretch. Stay there for about 5 seconds then back to A. Move through this with your breath 10 times in each direction.  “That was easy!”—if you said this then let’s focus on your strength and control. Try these versions a Pallof Press. This exercise as described in the video is great for anti-rotation. The picture depicts another form that works on anti-extension. Just be sure that when you move your arms overhead, your ribs remain stacked above your pelvis. We want to avoid overextension of the back and the ribs poking forward. What I mean by “anti-“ exercises is that you are resisting the band tension that is trying to pull you into rotation and extension, thus working the muscles we highlighted earlier.  As I mentioned before, thoracic mobility and torso strength are just the beginning to a successful and long career as an overhead athlete. Hip complex rotation and shoulder rotation will be highlighted in later posts! But for now, it all starts here! All of this overhead sport talk has me missing volleyball. So for that, here’s a #ThrowbackThursday.  Thanks for reading!
Dr. Jackie In the words of Jay-Z, “I’ve got 99 problems but wrist pain ain’t one.”  Nice front rack Mr. Farris! Well maybe those aren’t his exact words but since I’m actively giving up using profanity (which is very hard to do) we’ll keep this quote the way it is. We know that Jay-Z doesn’t have wrist pain but in the last CrossFit Movement and Mobility Trainer Course I taught, about half of the class had wrist issues. Usually when I informally poll the class to see what problems most people are having,back pain comes up number one. This weekend wasn’t any different until the Sunday course. Wrist issues were a plague for this group, predominately in the front rack position. So we spent a ton of time working on the wrists right? Wrong, we fixed their shoulders! How many of you have seen big strong guys/gals that can back squat a ton of weight but when you get them to front squat their weight drastically decreases? These are typically males that used to love bro'ing out at some globe gym where everyday is bench press day. They are pretty strong but have never put in some legitimate mobility work in their lives. Don't be this freaking guy! Let’s be clear on one thing. There are many reasons for why someone could have a very weak front squat compared to their back squat. In this example however, we are going to focus on improving the front rack position and unloading the wrist. The higher you can keep your elbows during the entire range of motion of a front squat, the easier that movement will be. High elbows also allow for the wrist to be unloaded during the lift. How do we get those nice high elbows? By having enough shoulder flexion and lateral rotation. In coaching terms this allows us to keep our arms parallel with the ground and maintain a strong front rack position. There are multiple problems that occur when the elbows start to drop in the front rack. It’s a huge loss of force production potential but also puts the poor wrists in a terrible position.  A combination of these two movements at the shoulder makes up the front rack position. Here’s a quick test. Un-rack a decent amount of weight (75-90% of your 1RM front squat) and hold it in your front rack position like the example in the top section of the picture below. See how your wrists feel and see if you can hold it for 30-45 seconds. Now do the same test but hold the weight in the position like the athlete in the bottom of the picture below. No wrist wraps allowed!  Thanks to www.twinfreakscrossfit.com for the photo. Which one were you able to hold longer? Which one felt more comfortable? For the majority of athletes the first position will feel dramatically easier when holding the load. If you have terrible front rack mobility you will always end up in some variation of the dreaded lowered elbow position. This is wrecking havoc on your wrists and costing you PRs. If your wrists hurt, fix your shoulders! Now how do we fix the shoulders? Here is an old school (2011) Mwod video of Kelly going over fixing the front rack position. If you haven’t checked out Mwod recently, you really need to. Mwod Pro is only $8 a month and has new mobility techniques to help improve your performance and resolve pain everyday. That’s about the cost of two lattes! In the words of Kelly himself “make a better decision”. Take a crack at fixing this stuff yourself first! If you're still having issues come and see us at Athletes' Potential! If you don't live in the Atlanta area, check out this out the 4 Keys To Picking The Right Physical Therapist in your area. - Danny  This used to be me, minus the 16 year old Asian kid part.
Like most kids in the United States, sports were a huge part of my life growing up. If you would have asked the 10-year-old me what I wanted to be when I grew up, it wasn't a physical therapist, it was a professional baseball player (that obviously didn't happen). When I do look back on my athletic career (I guess you could call it that), it's riddled with injuries. Here's a list of the major injuries I have sustained playing sports to include, football, baseball, basketball, soccer and dabbling in military combatives. -Broken right ankle at the growth plate age 15. -Non-contact related right meniscal tear requiring surgery age 16. -SLAP labral tear right shoulder age 18. -Torn disc lower back L4-5 causing nerve root compression for 6 months age 24. (High volume deficit dead lifts with poor technique, my own damn fault) -Torn disc neck C5-6 causing nerve compression for 3 months age 26.(Army combatives, accidents happen) Looking back all the injuries that I have sustained it's a fairly long list. Some people would say that I'm injury prone, others may blame it on my genetics. I blame it on my horrific lack of mobility! When I was in elementary school, I can remember taking the President's Physical Fitness Test. It was a big deal to me back then, mainly because I was sure I would be a professional athlete one day. I did great on all of the events and went into the last event with my confidence at an all time high. The last event was the sit and reach and I failed it! I could not for the life of me reach forward and just touch my damn toes. I was an emotional train wreck, my whole life revolved around sports and I couldn't even pass a national standard. That's a tough pill for a 10-year-old to swallow. I think back to that test and I think of something different that could have come out of that. An educator, my parents or a coach could have seen that as a red flag or a warning sign. Sadly, the reality is that mobility is often overlooked and brushed aside as just being "tight". If you are making all-star teams and progressing in your athletic skill sets, who cares if you are a little on the tight side, right? Wrong, that's a big mistake and it needs to change. We as coaches, parents and physical therapists have to prioritize movement first. That comes down to two components, motor control and mobility. Motor control is the ability to perform a movement correctly aka technique. Mobility is having enough available range in your joints and tissues to perform that movement optimally and safely. You need both to have proper movement, one without the other is worthless. For me, mobility was my greatest obstacle to achieve better movement. Working on mobility sucks! I know, both as an instructor and from personal experience. Shit, two years ago I couldn't even touch my toes and now I teach Movement and Mobility courses across the country. It's very humbling for me to teach these courses for CrossFit and it's because I know first hand how much it can change people's ability to perform at a high level and stay injury free. Since adding MWOD concepts into my training I have not been injured once. I did get hit in the face with a surfboard that broke my nose a couple years ago but no amount of mobility/technique would have changed that. Some injuries are unavoidable but they are very rare. Here's my advice for all my CrossFit athletes in Atlanta. If you suck at something, you need to focus on trying to improve that weakness everyday. This is not what most people want to hear. If you're flexible, you will enjoy yoga. If you're strong, you will enjoy powerlifting. The reality is, that super flexiblity yoga practitioner would benefit a hell of a lot more from doing some heavy squats than working on her pigeon position. Find your flaws, chase them down, go for the throat and don't let go until your weakness becomes an asset! -Danny  Often times, external rotation is the focus in athletic movements. When the shoulder is externally rotated, it can be packed into the back of the capsule to improve stability and congruence. It also rotates the humerus in a way that the anterior structures of the shoulder have room to move without being pinned between bones. Many of the stretches people gravitate towards for the hip involve external rotation: sitting figure 4 stretch, pigeon, etc. What is internal rotation and why do I need it? Internal rotation is one of the movements of a ball and socket joint, such as the shoulder and hip. In the shoulder, it allows you to reach behind your back and pull your wallet from your back pocket or tie your bikini behind your back. More importantly for athletes, it allows you to keep the bar close to the body during Olympic movements and arrive at the bottom of a ring dip safely. Hip internal rotation is needed for athletes for proper biomechanics during any form of a squat or while running. Without full internal rotation, you will likely have a “butt wink” or your low back will slightly round at the bottom of the squat. It is also important for runners to have full internal rotation, coupled with extension, to allow correct biomechanics in the trail leg.   During internal rotation, the ball of the joint (humeral head and femoral head) will glide posteriorly and roll anteriorly. This movement can be restricted with a tight posterior capsule or muscles around the joint. Unfortunately, many people will have issues here due to increasingly sedentary lifestyles and desk jobs. As you sit all day, the hip rarely reaches full extension, allowing the posterior capsule to become tight. This in turn decreases the posterior glide and thus decreased internal rotation. The same deal happens at the shoulder when you sit all day at the computer with terrible posture. Interestingly, hip internal rotation deficits have been correlated with low back and sacroiliac pain. It is better to start improving internal rotation now rather than trying to manage back pain! How to check internal rotation It is easiest to accurately check internal rotation of the shoulder with a buddy. Lay on your back, arm straight out to the side and elbow bent (as in the picture below). Your buddy should provide solid but comfortable pressure to the front of your shoulder to avoid it from raising off of the ground. Now move your palm down towards the ground. Ideally, you would be able to get at least a fists-width from the floor! Be sure to check both sides because noting an asymmetry is important. Also, be sure to do this same test after practicing the mobilizations below!  To check hip IR, lay on your stomach and allow your feet to drop out to the side. Again, we are looking for asymmetries and major deficits. Ideally, your leg will move about 40 degrees or roughly halfway down toward the floor.  Mobilizations to Improve Internal Rotation Below are a few mobilizations for the shoulder and hip to improve internal rotation. They are by no means an exhaustive list but merely a starting point. Bully stretch- used to mobilize the humerus into the back of the shoulder capsule, which increases internal rotation. Pec smash- nearly everyone has a tight pec minor due to the poor postures we often keep throughout the day. This muscle is located in the front of the shoulder, so if it’s tight it can easily restrict the posterior glide! Internal Rotation Stretch- start with your foot flat on the ground and the other leg crossed over. Slowly walk your foot out to the side until you feel a strong but comfortable stretch in the hip. You should feel this in the bottom leg.  Lateral Hip Opener- this does not have to be banded if you do not have access to one, you will still feel a stretch! I hope this gives you a better understanding of what internal rotation means, how we achieve it and why it is needed. More importantly, I hope these videos give you a good idea of how to begin to manage internal rotation deficits! At Athletes’ Potential we want to help every athlete remain healthy and meet goals. You don’t have to be in pain to come see us. If you find asymmetries with tests such as these or know you have movement deficits, we can help you with proper movement and self-maintenance. We also have recovery options to further augment your fitness and health. We look forward to hearing from you! Thanks for reading, Dr. Jackie If you're in Atlanta and you have questions about our Physical Therapy or if you're frustrated with your current situation, contact us and let us help you! Photos:
http://rebellion.nerdfitness.com/index.php?/topic/79212-flex-follows-the-way-of-the-iron-dragonslayer-part-1/&page=6 http://www.catalystathletics.com/article/1848/A-Different-Thought-About-Snatch-Technique-Keeping-the-Bar-C/ https://it.fotolia.com/tag/sprinter http://www.spineandsportspt.org/exercises/shld_ir_stretch_sup.php  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:
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!  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! 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!  For those who do not have glaring mobility restrictions, the front squat is a great exercise to carry over for the clean. 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.  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! 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.  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.
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 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.  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 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!!  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.
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!
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! 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,  Thanks for reading,
-Dr. Jackie
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