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Squatting is simple- get down and get back up. It’s an essential movement for everyone. Children often hold a squat and play. We all must squat, to differing heights, to get on and off the toilet. The elderly need to be able to sit down and stand up on their own to promote quality of life and longevity- this is a squat! But squatting actually isn’t simple. There are 101 ways to squat, some awesome and some not so awesome. However, there are five “principles” that are true across all of the barbell squats. I’m not sure these are the only principles, in fact I know they are not, and I’m not sure principle is the right word. Anyway, these are five pieces of the squat that I am constantly emphasizing with patients. #1 Set up and create tension while the barbell is in the rack- Place your hands, set your feet under the bar, full grip on the bar and elbows down. Then unrack the bar and maintain this while you squat.  #2 Toes stay down- Feet should remain fully planted. Big toes and heels stay down, screw feet out into the floor and descend into your squat.  #3 Maintain Stacked Position- Use a PVC or broomstick to check your ribs and pelvic position throughout the range. The stick should remain in contact with back of your head, mid back (between the shoulder blades) and hips.  #4 Hip Below Knees- This position is not unsafe or bad for your knees. In fact, it is healthy for your knees to have full range of motion. Warning: this will lead to glute gainz that might lead you to needing new pants. #5 Bar over midfoot- Regardless of the type of squat, the bar should still be aligned over the middle of your foot. Take some film of yourself the next time you squat and see how it looks!! If you have pain when you squat, try applying these principles. This is a great way to find major movement deficits and clean them up. If you can’t seem to add weight to your squat, apply these principles. Creating more tension with shoulder and foot set up can be enough to help you put up bigger numbers. Maybe your squat is perfect... Probably not. Apply these principles! Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS
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Often times, patients that have trouble or pain with squatting can chalk it up to mobility issues. Ankles and hips seem to be the major culprits. But what if mobility isn’t YOUR problem? Even if you have an ATG (deep) squat you may still experience: Back and/or hip pain Hamstrings and glutes not getting stronger Increased soreness in the inner thigh (adductors) Plateau of performance in squat based activities Does this sound like you? Keep reading. Motor control is the process of using the neurological system to coordinate your muscles and limbs as you perform a skill. Without motor control, we will have trouble controlling our body in space. This can lead to undesirable positions while we are under a weighted barbell. Unfortunately, many of us do not have ideal motor control—particularly as we add fatigue to the system. Fatigue can come in the form of heavier weight or multiple reps. How do we judge motor control from the outside? Technique. Form. So we know you have an ATG back squat with the chest upright and feet flat. If you add weight and that changes, you need to practice motor control. This is rewiring the system so that as we move our extremities or add weight to lifts, the form looks the same as squat without weight. Many times this has to do with the initiation of the squat. It should always start with a hip hinge. Now, some athletes who think they are hinging are simply over-extending their back. This means they send their hips “back” by poking the pelvis back and allowing the ribs to flare up. Rather, the space between your ribs and hip bones shouldn’t change as you hinge your hips back. The same pop of the pelvis back can be a problem as you get close to the bottom of the squat or start to drive back to extension. A great drill to test out your squat is using a PVC for 3 points on contact. Holding the PVC against your back, you should have contact with the back of your head, midback and pelvis. Keeping this alignment, hinge your hips back then drop into a squat.  Some faults that are common with squatting will be demonstrated when the PVC pipe leaves one of the points of contact. Below, the left picture shows a rounding of the midback that causes the PVC to leave the pelvis. This often happens at the bottom of the squat too. The fault on the right demonstrates over-extending the hips and changing pelvic position rather than hinging the hips. I find this to be more common on initiation of the squat, particularly for those complaining of back pain. If you noticed that the PVC left your body at some point, try filming yourself as you practice!  Improving motor control takes reps and practice. The PVC drill is great as a warm up for squats. You could also perform tempo goblet squats (see video below). Holding the weight in front will help you engage your deep core and stabilize your ribs and pelvis to keep the torso in the ideal position. Moving at a slow tempo is more challenging to the neurological system and will help engrain that movement pattern. The same rules from the PVC pipe drill still apply!  Inside of thighs really sore after squatting? The large muscles running along the inside of your thighs are the adductors. They function to bring your leg closer to midline, stabilize the hip and knee, and work synergistically with glutes and external rotators (squats?!). Going along the lines of motor control, be aware of the speed of your descent and “bouncing” out of the hole. The squat should not be a fall to the bottom and a bounce off the calves. You want a controlled descent; taking advantage of the stretch-shortening cycle at the bottom can be helpful but the torso alignment should still be maintained. If you are a free-faller or a bouncer, try to slow it down and control the movement. Similar to the goblet squat, this will improve control but also strength! If you look like the woman squatting above, this is your starter plan for improving motor control and strength. Take the time to assess your alignment and control through the movement. Cleaning this up will decrease pain and improve your performance drastically.
At Athletes’ Potential, we work with athletes like you every day-- those who just want to move better and those that are in pain. If you are finally ready to feel better and improve at the gym, give us a call. We would love to help! Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS 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
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.  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.  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. 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. 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, 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. Where is your butt and what is it doing? This is the question I posed to a client of mine who was having some difficulty getting and keeping his pelvis in a neutral position. This particular client is on an FBI SWAT team. That, in it’s own right, gives him credibility that he’s basically a badass. Even bad asses can make simple movement errors that turn into larger scale problems! He, like most athletes that I work with and especially tactical athletes is constantly in an overextended lower back position. Add on to that wearing body armor and sitting in cars watching drug dealers all day. That’s a perfect storm for hip and lower back dysfunction. Weird, that’s the reason he was in my office.  The gluteus maximus is the largest muscle in the body. It’s primarily a hip extensor and lateral rotator. It also can be used nicely to help put our pelvis into a neutral position. This is the easiest way I have found to help athletes get out of an overextended lower back. The spine connects to the pelvis. Put the pelvis in a good position and the lower back will also end up in a good position.
Here’s a simple test. Stand up with your feet under your hips. Now squeeze your butt as hard as you can. I mean as hard as you would if someone threatened to credit card swipe you! Here’s the link to the urban dictionary definition of what Credit Card Swiping is if you don’t know. If you feel a large change in the angle of your pelvis, you are most likely living in overextension. If you have no change in your pelvis, you most likely have a neutral pelvic position, congratulations on being normal! You have to know if you have a neutral pelvis or not. This will effect you in almost all movements you do athletically. It sure as hell dictates what your back position looks like when you squat. If you have pain when you squat, do yourself a favor and squeeze your butt before you squat. It could be the difference between pain and a PR! -Dr. Danny, PT, DPT In the words of Jay-Z, “I’ve got 99 problems but wrist pain ain’t one”. 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. 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! 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 latte’s! 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. -Dr. Danny, PT, DPT When was the last time you dropped into a full depth squat? Honestly, think about it, ass to grass bottomed out squat. Hopefully your answer was today or at least yesterday. Sadly the majority of Western society squats very little. In Asian and Middle Eastern countries, the squat is a position of comfort. It's also necessary because eventually they are going to have to take a poo. Often times we hear the excuse that an athlete can't squat below parallel because of their height or leg length. This absolutely will be a determining factor on how easily you can remain in the bottom position of a squat. We do however feel that 99% of individuals can obtain a full depth squat with their heels flat on the ground. Below is a video of Andrew Killion of District Crossfit and Dr. Danny Matta of Athletes' Potential talking about similarities and differences in the squat pattern. We both advise athletes that want to improve their squat to start spending time in the bottom of a squat as often as possible. The body recognizes movement patterns very well and adapts to new positions.
Keep spending time in a squat everyday and hey, maybe one day you'll be able to take a poo in Japan! |
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