The squat is one of the most essential primitive functional movements that human beings can execute.
It allows us to transfer weight from the ground to an elevated position in a mechanically efficient manner. The squat provides benefits not only for function but also for performance, which is why it is one of the most popular strength training movements.
Despite being a movement that we master as a toddler, the average person today is unable to execute a proper squat.
This is partly due to environmental factors, which have resulted in life style changes promoting convenience. This has reduced our need to use the muscles required to execute a squat.
Sitting on chairs throughout the day for work or schooling, sitting in a car, sitting on the toilet and sitting on couches have caused us to adapt to a new shape and form which limits the need to squat throughout the day. These shapes and positions result in deficient use of the proper musculature.
If you notice, toddlers will squat down to play with an item on the floor and they will sit there throughout the entire time as a resting position.
They also learn how to execute a squat because they need to learn how to balance the weight of their heads over their center of gravity for lowering their body down to the floor.
Without learning to use the appropriate musculature, they will fall over, which most do until they get the hang of it. Once they learn to sequence the muscles together, they can then execute the movement properly.
The back squat might be the “big boy” move aside from the dead lift when it comes to strength training but there are plenty of variations of squatting patterns used to help re-educate the movement for function and performance measures.
The number one mistake individuals make is that they add weight and loads to a dysfunctional squat.
Dysfunctional squats can predispose someone to excessive stress, pain and/or injury in the neck, low back, hips, and knees and even in the ankles. Ensuring proper squat form and technique is crucial before adding loads to the pattern.
To execute a proper squat, first you will need to ensure that you have proper mobility throughout the legs and the torso.
Mobility first, stability second!
If you don’t move well first, you can’t add loads to a dysfunctional movement.
You also should not continue to train and “learn” on a dysfunctional pattern. Practice does not make perfect. It makes permanent. Practicing the wrong concepts will only lead to improper results.
Before training the squat pattern, proper mobility is required in the ankles, knees and hips. There also needs to be proper mobility in the spine, especially the thoracic region.
Demonstrating full ankle mobility in an open kinetic chain position, meaning not connected to the ground, is good, but measuring how the ankle moves when it is weight bearing on the ground is more functional and practical.
The standing ankle mobility test is an easy way to determine this without equipment or measuring devices.
A good way to check knee and hip mobility in a position that replicates the squat form is in the supine double knee to chest raise test.
Thoracic mobility is important for the squat in that extension is required to ensure an upright position of the torso.
Flexion of the thoracic spine or kyphosis can limit proper squat form by causing the torso to pitch forward as compensation.
If you have full mobility throughout the legs and torso but cannot execute a proper squat, then the issue is not mobility but rather neuromuscular control.
Your body needs to re learn how to use these muscles together to execute the movement.
These variations demonstrate faulty patterns often seen with the squat. The picture to the far left demonstrates valgus collapse of the knee (inward movement) with ankle pronation (medial collapse). Also seen is the inability to get the hips below parallel.
The middle picture demonstrates a side shift and inability to achieve below parallel.
The far right picture demonstrates the ability to get closer or below parallel but with a significant forward trunk lean.
Not all variations are clear-cut results of mobility or stability issues. There could be a combination of deficits with each movement pattern which is why testing is done first to clear and rule out mobility vs. stability issues.
The picture to the left demonstrates a more appropriate squat form. Sometimes there still may be some limited thoracic mobility and a slight pitch forward at the torso. Using a dowel overhead can help to open up the thoracic spine into extension and cue a more upright torso.
It is important to note that the feet DO NOT have to be facing forward. This has been a debatable topic with the squat.
For screening purposes we will have a person keep their feet facing forward the best they can to see for excessive rotation compensation but natural external rotation is normal due to the anatomical differences of individuals’ hips.
Everyone has a different angle in his or her hip joint of the femoral head in the acetabulum. Fighting the natural anatomy can produce sheering forces at the joint resulting in labrum issues and impingement.
A good test to find your natural foot position is to stand with your feet about shoulder width apart. Squeeze your glutarals together and see where your feet naturally turn.
Once mobility is cleared you can then begin the retraining techniques.
The stool technique helps to isolate the posterior chain musculature by retraining the ability to posterior weight shift while maintaining a center of gravity with an upright torso.
A stretching sensation may be felt in the hamstrings as they are working to help control the pelvis positioning.
Repeat in sets of 10.
If there is some tightness still in the thoracic spine causing a slight pitch forward, adding a rotational movement by reaching up and back can help to work the mobility for rotation and extension.
If there is still difficulty maintaining balance while sitting back or pitching forward at the torso, using a heels raised assist can help to shift the center of gravity to allow for an easier movement. This technique can be used until control improves in the heels flat position.
Using an assisted band, heels raised and a stool is the full “training wheels” technique to execute a squat. It helps to retrain the ability to posterior weight shift, maintain an upright torso and control the knees while executing the actual squat movement.
Once control improves with the heels raised and stool technique, progressing to just using an assisted band with the feet flat and without a stool is the next step.
It still requires full control of the posterior weight shift and torso upright but with some added assistance still.
This technique requires more effort and recruitment of the torso stabilizing musculature.
Instead of having a band that unweights the body, now you have to pull on the band to help recruit the scapula, promote thoracic extension and engage the core more to stay upright.
Sets of 10-15 are sufficient. This is also a great warm up technique that can be used going forward before training squats.
Once control improves with the “Y” technique, progress to the goblet squat with the heels raised.
Focus on trying to execute all the key components of the squat with a slight assist from the heels raised.
Once control improves there, progress to the feet flat. When the full goblet squat becomes easy and you can execute repetitive repetitions with good form, you can then progress to adding weight.
As with anything, pain should always be considered with any movement and if it is persistent or limiting, having it evaluated by a licensed medical professional is best.
Ensure mobility before stability in that you need to move well before adding resistance. You want to ensure proper movement patterns and then add resistance to reinforce the muscles within that pattern.
That is what the principle of strength training is for. Do not add resistance and loads to faulty patterns, as that is where injury can occur.
About The Author:
Michael St. George PT, DPT has been practicing for 10 years primarily in the outpatient and orthopedic setting. He works for a physical therapist owned private practice based in the greater Philadelphia area and surrounding suburbs. Mike is certified through Functional Movement Systems for FMS, SFMA and FCS which consist of screens and testing used to measure movement quality and performance. Mike also has experience with working with numerous surgeons and physicians from the Rothman institute. Currently he works primarily with ACL, meniscus and post surgical recovery and sports injuries, return to sport testing and performance, running evaluation and re training and hand and upper extremity conditions.