The Squat: Part 3

This is the final installment of the squat series, where we will discuss the myriad of ways you can incorporate squatting into your workout. In part one we discussed the many health benefits that simply squatting provides throughout the day. In part two we discussed some of the fine nuances of form that make a proper squat and those that are detrimental in terms of poor form. As we discuss the various ways that you can incorporate squatting into your workouts, remember that you are in charge of your body and how it works. Many of the squats that we will discuss will be fine for a person to perform if they own perfect movement mechanics but for someone who is movement challenged these squats may very well aggravate your system.

I will breakdown the squatting by starting with the least challenging or the least functional squatting and then slowly progress to the most challenging and the most functional. Notice that I lumped the words challenging and functional together which was done on purpose. Typically, but not always, a movement that is very challenging to perform also has a high correlation to function. Full body movements that are challenging to the central nervous system are such that the exercise becomes self limiting. Mindless repetitions cannot be performed and these self limiting exercises seem to help asymmetries, movement pattern problems and minimize the chance of incurring a repetitive trauma type injury. Are you ready??? Here we go.

Barbell Back Squat in Durango CO | Tomsic Physical Therapy
Barbell Back Squat

The barbell back squat has been around since man invented the barbell. This type of squat is the least functional for a number of reasons. The first being – what type of daily activities do you perform where you have a load on your back and you repetitively squat up and down. Rarely if ever. The second issue is that with the back squat you can have absolutely horrible form and still complete the squat which of course is a bad idea to continue this habit. Second, because the bar is on your back you can perform this type of squat with fairly heavy loads and again still complete the movement which will place unnecessary stress on your spine. Third, because you can lean forward with the weight on your back, you increase the lever arm on your spine which ramps up the stress on the lower lumbar discs and, again, place unnecessary loads on the spine. Many traditional athletes and coaches still swear by this type of squat as being the holy grail of training but in recent years we have seen many new age coaches understand the limited carryover of this type of squat to actually improving their athletes performance on the field. I should mention that the picture that I choose above displays horrible form yet the squatter was probably successful in lifting the weight. Personally, I would never encourage anyone to perform this type of squat.

Barbell Front Squat in Durango CO | Tomsic Physical Therapy
Barbell Front Squat

The barbell front squat is a common exercise to those who know the Olympic lifts. It is a much more challenging exercise than the barbell back squat and for many reasons a much more functional exercise. First by the nature of having the barbell across the front of the shoulders and resting on the fingers much less weight can be used than during the barbell back squat. Since less weight can be used during this squat, there is less strain on the lower back and that is always a plus. Second, because the weight of the barbell is resting on the shoulders and fingers the spine or trunk must be upright and if the trunk starts to lean forward you are surely going to drop the weight forward. The fact that the spine/trunk must stay very upright also places less strain on the lower back. Third, because the shoulders, elbows, wrists and fingers are stretched to maintain the front rack position this helps maintain a level of flexibility in these joints that is not stressed in the barbell back squat. This exercise has more carryover to daily activities then the barbell back squat. I recommend this type of squat even for beginners.

Barbell Overhead Squat in Durango CO | Tomsic Physical Therapy
Barbell Overhead Squat

The king of barbell squat exercises. This exercise is the most challenging barbell squat exercise because the arms are now holding the entire weight of the barbell in an overhead press position. This type of squat demands maximum thoracic extension, scapula mobility and shoulder stability. Plus while the thoracic spine is staying in extension the lumbar spine is slightly flexing at the bottom of the squat requiring a high level of core flexibility and stability. This type of squat demands thought while you are performing the exercise so it is very central nervous system (CNS) intensive. You can not perform mindless reps of this exercise while watching the TV at the gym, the overhead barbell squat requires total focus. When you become proficient in performing this exercise with heavy weight, normal daily activities will seem like a breeze. This exercise will also carry over into improving other functional activities such as sprinting and jumping. I recommend this type of squat for intermediate level lifters.

Goblet Squat in Durango CO | Tomsic Physical Therapy
Goblet Squat

The Goblet Squat is probably the most functional dumbbell or kettle bell based squat. Look at the position of the kettle bell, it is exactly in the same position you would be carrying an item that you needed to squat down to the floor with. While the overhead barbell squat requires more coordination, flexibility and stability, the goblet squat more closely resembles a daily activity therefore has more carryover to enhancing a movement you are more apt to perform. That is what training is all about. Proper form in the goblet squat allows an upright trunk which stays in neutral allowing the hips, knees and ankles to perform all the motion. This is congruent with the principles we discussed in the Squat Part 2. If you have never squatted before as an exercise this is probably the best introductory weighted squat for you to incorporate in your training. I highly recommend this type of squat even for those who have never lifted a weight before in their life.

Dumbbell Overhead Squat in Durango CO | Tomsic Physical Therapy
Dumbbell Overhead Squat

The Dumbbell Overhead Squat is another variation of the overhead squat. Obviously holding separate weights in each hand instead of a bar places more challenge and demand on this exercise and that is a good thing. If you have an asymmetry in one shoulder vs the other this type of squat with typically expose that issue. That is why these challenging and purposeful exercises are wise to perform periodically because they help you realize a movement issue by challenging the CNS and your musculoskeletal system. A barbell back squat will not challenge the system like this squat will and therefore a shoulder or trunk or hip problem might go unnoticed. I perform this type of squat once a month as a warm-up for heavier barbell overhead squatting simply to test my movement. I recommend this type of squat as a warm-up or test but not as a heavy exercise unless you are an experienced lifter.

Pistol Squat in Durango CO | Tomsic Physical Therapy
Pistol Squat

Life is not all about being on two feet all the time. Think about sports, are you on both feet all the time. Rarely! The majority of sports require running, sprinting, cutting, decelerating, hopping or jumping. This predominantly requires each leg to be able to perform independently of what the other leg is doing. This requires near perfect trunk control to be able to balance and coordinate the action of standing on one leg and allow full weight bearing through maximal range of motion. This is not a beginner exercise! Only those desiring maximal athletic performance and bulletproof joints should perform this exercise. As a prerequisite you should be able to perform all of the above squats with at least bodyweight as resistance prior to trying the pistol squat. If you have any known back, hip, knee, ankle or foot malady this squat is not for you. This squat should also be performed without resistance first to see if you own the balance, flexibility and control required. Then once you display competency external resistance can be added. The risk and reward for this squat should only be accepted for the extreme athlete therefore I am highly cautious in recommending this exercise unless I have observed your movement level.

squat-3-7

The Candle Squat in Durango CO | Tomsic Physical Therapy
The Candle Squat

Are you serious? The candle squat as created and probably only able to be performed by Jerzy Gregorek. For those of you unaware of this man’s ability, I implore you to visit The Happy Body website where Jerzy outlines a baseline level of nutrition, flexibility, strength and stability that is unparalleled. If you were looking for the gold standard in squatting than this is platinum. This gentleman’s ability to move makes me absolutely jealous. A picture is worth a thousand words so I will stop writing. If you are even remotely close to possessing the ability to perform this squat then stop reading my blog as reading any further could only surely cause you some level of dysfunction and we wouldn’t want that.

Conclusion

To summate all that we have discussed in this three part series on the squat, I must confess that there is surely an awful lot that I have not discussed or by constraint omitted. The subject of squatting is vast and the breadth of information fills whole books. The important point that I wanted to convey over the past few months on this blog is the importance of correct daily squatting.

Just like your motor vehicle requires oil changes, tire air pressure checks and other routine maintenance your body requires daily squatting as maintenance for baseline musculoskeletal health. Your body requires other daily movement different than squatting to maintain its health as well. Dr. Kelly Starrett has come to the conclusion that 10 minutes a day in the deep squat is a good baseline. Proper daily squatting is similar to eating whole food for your nutrition and getting eight hours of sleep a night in terms of health for your body.

I encourage readers to educate themselves on their own performance by having your movement assessed by a professional. Having your movement assessed by a trained individual can be enlightening, eye opening and explain if you have been consistently injured or stuck in a rut with your performance. Please call our office and I will be glad to run you through a functional screen. Two people who possess near perfect movement ability and should therefore be emulated are Jerzy Gregorek, who was mentioned earlier, and Steve Cotter of IKFF and kettle bell fame. Both of these people can be found on YouTube and their websites on the internet. Here’s to your health, happy holidays and happy new year!

The Squat: Part 2

In this second of three part series on the squat we will discuss foot placement, form and posture which aid in making a more efficient squat. In the first part of this series I discussed some of the important reasons as to why we should squat. Before I delve into specifics about aspects of squatting I want to remind the reader of some important details. First we all learned how to place ourselves in the squat position by starting on the ground first and allowed trial and error to “find” our own perfect squat form. No teacher stood next to us giving us cues or suggestions or tips—we simply kept trying and trying until we “got it” and we probably smiled when we achieved our first squat. My point is that it will truly take “you” to take yourself through trial and error and possibly endless repetition to slowly improve your squat. No one can do this for you but you.

Chances are you are past your teenage age years if you are reading this and years of sitting in classrooms, traveling in cars, making poor exercise choices and the litany of other daily environmental dysfunction has tarnished your once stellar squat. You are not alone. Very few young people today even in their college years possess an unblemished squat. Whole movement like a squat demand that multiple joints, muscles, fascia, motor control and lack of pain are working in total harmony. That ankle sprain you experienced in middle school, the torn ACL you injured on the ski slopes or that hip pain you developed while training for a marathon might already predispose you to a poor squat. The take away here is to acknowledge if you already are aware that you possess a movement problem. How well do you know yourself?

squat-1

I’ve met people who know how fast it will take them to hike up Smelter Mountain within a few minutes but have no idea if they can squat well. Similarly, some people are oblivious to how well they can lunge or how well they can balance on one leg. Can you stand with your knees straight and touch your toes or touch the floor? Knowing how you move with just the force of gravity and the ground underneath you is the most basic movement information you should know about yourself. Why? Because from the second you left your mothers womb till about 12 months of age that is exactly the environment in which your brain learned how to move.

Your body, gravity and the ground in Durango CO | Tomsic Physical Therapy
Your body, gravity and the ground- let the learning begin!

Yes you learned how to move. Most of the other primates and all other mammals popped out of mommy and within minutes to hours are up on their feet and walking around. Their nervous system was hardwired with the basic locomotion software to get them moving within day 1. You and I and every other human that ever walked this earth and every human that will ever walk this earth learned how to move through progressive patterns building on each other and culminating into efficient walking. Your brain is learning every second of the day you are awake. You are either learning something new every second or reinforcing something you already knew. You can always teach an old dog new tricks as long as the old dog wants to learn them.

Our brains’ awesome ability to continuously learn is a double-edged sword. It’s double-edged, because you can’t cherry pick what you want it to learn and what you don’t. What ever you are experiencing at the moment your brain is taking in the experience and learning something from it. When we were babies and learning to move we were full of mobility and a desire to move. We didn’t have sprained ankles, torn ACLs or unhappy hips, we were basically free from dysfunction and our brain learned how to move based on this clean slate. Once we developed handed-ness that was the beginning of dysfunction. The more asymmetrical you are in terms of what one side of your body can accomplish vs the other increases your risk of injury while you perform daily activities. Previous injury to a body part increases your risk of injury. Your brain has learned to overcome this issue.

At the top of the hierarchy about what your brain cares about is not how well you squat. It cares about survival! When you were younger and running around the yard and tripped on your knee you got up, assessed the situation and because your knee didn’t hurt “that” bad you kept running around. Except now instead of running around with flawless gait you are limping a little. Your brain doesn’t care, good or bad, you are experiencing a new way to move, right or wrong, optimal or not—you are still learning and you are learning how to run with a limp. The more you run with a limp the more your brain is learning a new pattern of running and if you continue to run in this new fashion your brain will totally re-write its software pattern. Until, you start running “normally” again and then your brain will re-learn the original pattern and your running pattern should return to its near original efficient pattern. Your brain cares about your survival. If you are still alive and you run with a limp, your brain is ok with that. Are You?

The Squat in Durango CO | Tomsic Physical Therapy
The most amazing thing that scientists have discovered in our universe and you own one! This guy can be your best friend or your worst enemy- be good to yourself!

Why bring up how your brain learns? Because your squat pattern has probably been
slowly progressing into an inefficient pattern through the years or maybe you simply don’t squat at all. That is good news! You have realized your current baseline and since your brain has the ability to learn, you can learn a new and more efficient squat pattern. All you need is the desire and the right path. Let’s see if you are ready!

Test to see if you are ready to squat in Durango CO | Tomsic Physical Therapy
This simple test tells me that you are not ready to squat.

Stand up with your feet together and keep your knees straight. Now bend forward and touch your toes. Can’t reach your toes? YOU are not ready to SQUAT!

Why not?

Your hips are not bending enough. If you try practicing a full depth squat your back will be flexed forward to such a degree that it will be dangerous for your lower lumbar discs. There is a saying in physical therapy that proximal stability allows distal mobility. For every action there is an equal an opposite reaction. Therefore distal mobility allows proximal stability. If your hip joint which is distal to your core is stiff then reflexively your core cannot be stable. I have good news for you. You can still squat but off of a box. Off of a box you say. Does that sound strange. It shouldn’t because you do it everyday and have since you were in kindergarten. What kind of a box am I talking about — a chair!

So if you fall into this category of not being able to touch your toes in standing you need to work on the flexibility of your hips and work on box squatting. Box squatting is like squatting with training wheels on and I have clients squatting off low stools and benches all day long. For those of you that can touch your toes please read on.

Perfect Squat in Durango CO | Tomsic Physical Therapy
Perfect!

So you can bend forward in standing with your knees straight and touch your toes. Now you are ready to squat down to full depth. Place your bare feet about shoulder width apart or a little wider. Keep your feet facing straight ahead. Start lowering yourself down with a combination of bending your knees and flexing your hips. Try to keep your spine as vertical as you can. As you are lowering down try to actively push your knees outward using your hip muscles. Also as you lower yourself down keep your heels flat on the floor. If this a real struggle or impossible then we need to possibly re-assess matters. There are 3 big aspects of the squat we need to respect. Heels down. Feet facing straight ahead. Knees tracking over toes or tracking wider. Period.

Why do my heels have to be on the ground? When your heel bone, calcaneus, is on the ground then the posterior chain of your body becomes activated. The posterior chain is comprised of all the muscles on the back side of your body. If your heel comes off the ground the base of your support naturally becomes less and you are now performing a balancing act versus a stable squat. If your heel comes off the ground then your knee will pass over your toes considerably and the pressure in your knee can reach dangerous levels. This brings up the conversation of shoes with a raised heel, boots or “heels”. If you are wearing footwear with a raised heel and your job, workout or daily life requires you to squat repetitively expect to experience some anterior knee pain sooner or later. You were designed to walk, stand, squat, lunge, jog, sprint, jump, hike, dance and step all without a raised heel — so stop wearing them!

Squat Form in Durango CO | Tomsic Physical Therapy
Heels down, knees happy!
Knee Pain in Durango CO | Tomsic Physical Therapy
Very fashionable- Let me know how your knees feel when you are 50!

Why do my feet have to face forward? This makes it much easier for your knees to track over your toes or on the outside of your feet. The more your feet toe out the more you have to push your knees out even wider. So if your feet are facing forward when you squat and your knees buckle inward, push your knees out. If you can not because your hips are too weak then stop squatting. If you squat with your knees buckling inward you stand a good chance of injuring your meniscus, medial collateral ligament or your anterior cruciate ligament or a combination of the three. We talked earlier about your brain and the fact that its learning all the time. If you squat with your knees bucking inward and then perform that repetitively then you are learning how to squat poorly and this will create a hard habit to break. Also when you actively use your hips to push your knees out wide and your feet face forward you tend to elevate the arch in your foot— simply another bonus.

squat-8

There is one caveat.

Do you have hip anteversion or retroversion? This is where the femoral neck is rotated forward or backward instead of normal alignment. If this is the case then your knee will naturally be rotated inward in the case of femoral anteversion. If your hip is retroverted then your knee will be facing outward. Similarly, your feet will face the same direction as your knee. You may have noticed throughout your life that you walked pigeon toed (feet facing towards each other) or walked more like a duck (feet facing outward). Now, it is wise to have a physical therapist check this status as you could simply have hip tightness which is giving a false positive that your hips are rotated. If that is the case you want to start walking and squatting with your feet and knees straight. If you have true hip anteversion or retroversion then a concession needs to be made about your feet placement. Get this checked out!

Squat in Durango CO | Tomsic Physical Therapy
We need to check this out first!

Are you afraid that pushing your knees out wider than your feet is just as bad as allowing them to collapse together? Fear not! There are no anatomical structures that are in peril when we push the knees out wider than the feet during a squat.

Good Bad Squat in Durango CO | Tomsic Physical Therapy
Good Bad

The last aspect of squatting we will discuss is keeping the spine in neutral and trying to keep the spine as vertical as possible. Keeping the spine in neutral is a much safer position for the spine and forces the hips into more flexion. The hips are designed for this flexion and maximizing hip flexion keeps the glute muscles working properly. When the spine is more vertical during a squat the pressure on the lower lumbar discs decreases. This is a win-win!

Spine Neutral Squat in Durango CO | Tomsic Physical Therapy
Spine Neutral-YES! Spine Flexed-NO!
Spine Neutral Squat in Durango CO | Tomsic Physical Therapy
Outstanding!

I will conclude this part two on the Squat with some more images and then a final thought. The third and final installment of this series will elaborate on how to incorporate the squat into your exercise program.

Bad Squat Form in Durango CO | Tomsic Physical Therapy
No!
Bad Squat Form in Durango CO | Tomsic Physical Therapy
No!
Spine Neutral Squat in Durango CO | Tomsic Physical Therapy
Yes!
Spine Neutral Squat in Durango CO | Tomsic Physical Therapy
Yes!
Spine Neutral Squat in Durango CO | Tomsic Physical Therapy
Yes!
Spine Neutral Squat in Durango CO | Tomsic Physical Therapy
Yes!

squat-18

Why is it that non domesticated cultures squat so well? Maybe because they don’t know what a chair is. They probably don’t know what a TVA is, or a posterior glute medius nor an external oblique muscle. Why is that? Because they just simply squat as a sitting position. They don’t focus on reductionism nor muscle function. They simply squat be cause that’s what they have always done and if its not broke why fix it. They have not introduced chairs because, why bother, they already know how to sit. This begs the question- who is the more advanced society? The one who forces their society to sit in a non-functional way creating dysfunction? or the one who perpetuates challenging yet functional squatting in their culture? I’ll let you make up your own opinion.

The Squat: Part 1

By: Jeffrey Yaskin, PT, MPT, MTC, CSCS

Do you know how to squat? Squatting is an activity that we should be performing many times throughout the day, hopefully, without even thinking about it nor realizing we are doing it. We don’t think much about walking from one spot to another and nor should we think much about squatting from a standing position down to the ground. Squatting is very healthy for the musculoskeletal system and as well as for the gastrointestinal system. It is also a very functional movement. Somewhere along the line, unfortunately, some people have come to the conclusion that squatting is bad for you. In this first of a 3 part series on squatting, we will touch on the functional aspects of squatting.

A child naturally squats to interact with objects on the floor. If you have children aged 1 to 5 and they are playing with items on the floor they simply squat down and “sit” in the squatting position with no issue until they are ready to stand. What you do not see is a child that age bending over to reach the same object on the floor. “The squat position is typically acquired after 10-12 months of development”(1). Squatting is more stable than standing which is why children adopt it earlier than standing. “ Standing in free space is not typically achieved until a child reaches 12-14 months of development”(2). Why squat over bend? Squatting is more stable and places less stress on your joints. Bending over in a standing position is less stable and places much more stress on your lower back. Interestingly, at this young age no one tells nor teaches the young child to perform this activity, it is innate. We all squatted this way and it begs us to question, why did we stop as we became older.

Correct
Correct
Incorrect
Incorrect

Were you glued to the TV watching the Olympics this summer? I believe it was during the wee hours of the night that the Olympic Lifting portion was telecast. With the explosion of Crossfit as an exercise philosophy, Olympic Lifting has become mainstream. The two lifts are the clean and jerk and the snatch. Both start in a deep squat position with the bar on the ground. Lift the bar with an upright trunk to the chest and stabilize yourself in another deep squat with the bar resting on your shoulders. In the clean and jerk, the second squat you have the bar resting on your shoulders and then you stand up pressing the bar overhead. “The clean tells you a lot about an athlete”(3). In the snatch, the second squat you have landed with the bar pressed overhead and then you stand up with the bar pressed overhead. “Nothing will tell you more about an athlete’s range of motion and understanding of the midline stabilization and torque principles than the snatch”(4). Both lifts are extremely technical and require copious amounts of time training to fully master. Any Olympic Lifting coach worth their mettle will agree that both of these lifts begin and end with a perfect squat.

Clean and Jerk
Clean and Jerk
Snatch
Snatch

If you have ever been to a train station in one of the older and smaller Italian towns and have to use the restroom you were probably met with a hole in the ground. What am I supposed to do with that? Squat! That’s right squat down and do your business. Prior to the invention of the toilet we defecated as humans by deep squatting. “Squatting has been the natural defecation position for humans since time immemorial “(6). If you have ever been exercising outside and had to move your bowels you simply squatted down and no problem. “There is a muscle that encircles the gut like a lasso when we are sitting or standing, and it pulls the gut in one direction, creating a kink in the tube “(7). “Squatting leads to a nice straight intestinal tract, allowing for a direct, easy exit “(8). I know many of us are dog owners and how does your dog poop? Sitting? No they squat down! “Hemorrhoids, digestive diseases like diverticulitis and even constipation are common only in countries where people generally sit on some kind of chair to pass their stool.”(9) So for the health of your bowels add more squatting to your daily routine.

You’ll be #1 at going #2
You’ll be #1 at going #2

Properly functioning pelvic floor muscles are synonymous with deep squatting and are necessary for pelvic stability and proper bowel and bladder health. “Once below a parallel squat, a quad dominant individual will not be able to maintain balance. This person will fall backward, unable to release tension in the quadriceps to allow the glutes, pelvic floor and core musculature to take over and stabilize” (10). A stable squat involves proper balance of the quads, glutes, pelvic floor and core muscles. The pelvic floor muscles become eccentrically lengthened during a deep squat. Squatting increases the size of the pelvic outlet by 1-2 cm vs standing position. “By forcing the upper leg bones (femur) to act like levers on your pelvic bones, you can widen your pelvis opening by 20-30 percent” (11). Squatting with knees pushed out wide increases tension in the hip adductor muscles pulling on the pubic bones and opening the pelvic canal. The levator Ani muscles (pelvic floor muscles) counter the pull from the adductor muscles. This helps keep them healthy and functioning properly. Properly squatting deep throughout the day helps to keep the pelvic floor muscles functional.

Pelvic Floor Muscles These are the foundation of your core!
Pelvic Floor Muscles
These are the foundation of your core!

One way to assess your squat and muscle balance is Durango is a through a Functional Movement Screen(FMS). This is a seven-part screen for people without pain who want their basic movement ability profiled. This movement screen was created in 1998 and currently is standard practice in assessing Special Forces Operators, NFL-NBA-NHL-MLB players and Olympic athletes. Guess what movement is the first tested in the FMS? The Overhead Squat. Watching a person squat with their arms in an overhead position is very telling about that person’s movement health and efficiency. “Extremity mobility, postural control, pelvic and core stability are well represented in the deep squat movement pattern. The deep squat is a move that challenges total body mechanics and neuromuscular control when performed properly” (5). Are you starting to understand how important the simple squat is in our daily lives? We are certified in assessing the FMS and would be happy to screen you as part of our free injury screen program.

The FMS is #1
The FMS is #1

Thus far we have discussed many reasons to squat daily. Its functional and it helps to maintain the health of the viscera, hips,and pelvic floor musculature. In the second and third parts of this squat analysis we will closely look at what is considered a proper way to squat and the many faults related to squatting poorly.

References:

(1), (2): Kobesova, A, Safarove, M. and Kolar, P. Dynamic neuromuscular stabilization: Exercise in the developmental positions to achieve spinal stability and functional joint centration. In: Hutson, M. and Ward, A (Eds.), Oxford Textbook of Musculoskeletal Medicine. Oxford University Press: 66-83, 2015.

(3), (4): Starrett, Dr. K. Becoming a Supple Leopard: The ultimate guide to resolving pain, preventing injury, and optimizing athletic performance. Victory Belt Publishing: 183, 195, 2013.

(5), (10): Cook, G. Movement: Functional movement Systems. On Target Publications: 90, 196, 2010.

(6), (7), (8), (9): Enders, G. Gut: The Inside Story of Our Body’s Most Underrated Organ. Greystone books: 17, 18, 2015.

(11): Russell, J.G.B., “Moulding of the Pelvic Outlet”,J. Obstet. Gynaec. Brit. Cwlth, Sept. 1969, Vol. 76, pp. 817-820.