You Ain't Squat Unless You Squat

Earlier today after I finished working out I was rolling around on the foam roller and my Dad started talking about how he wished he could do some of the stuff I did workout-wise but he can't because of his knee. He had his entire (both medial and lateral sides) meniscus removed in his left knee about 20 odd years ago. Since orthopedics, physical therapy, and athletic training aren't what the are today, he has never had full pain-free function in this joint since. This has manifested itself into limited exercise ability, sometimes a painful gait (walking), and basically a pain in the ass all around. Enough background on my pops though, what would I, a responsible offspring do? Teach him to squat...duh....

Now perhaps you're of the opinion that people shouldn't squat, it's dangerous right? And well if they have a lower limb problem then squats are definitely out, right? My response to those comments are simply this: how exactly would you like me to get my butt on the toilet or get my butt off the couch? To keep this butt theme going, how would I upright myself from the floor/ground if flexion of the knee and hip weren't allowed? Now I must clarify, if someone has had a recent surgical intervention on a lower limb, then I wouldn't advocate mobilizing that joint just yet, or if someone has chondromalacia, or something like that. However if you're like 90% of the population you need to squat. So back to mi padre, a man with knee issues if I've ever seen one. How did I get him to squat pain free and thus embark on the road to better function and increased ability to perform exercise, daily activities, and plain move better? Read on...

The first step was to correct what in his mind was the correct squat stance. The CORRECT squat stance is with the heels almost shoulder width, possibly a touch wider, with the toes pointed out about 30*. Don't get the protractor out, this is an approximation. The reason why this is the correct squat is a multi-faceted answer, and also the reason why the commonly endorsed squat stances (narrow stance, toes straight, Plie', etc) are just bad coaching. I will go through them one by one. Narrow stance squats, with the feet being hip width apart force the athlete into a serious anterior pelvic tilt (hips rotated forwards) to maintain balance. This usually forces the pelvis to unlock and the lumbar spine to flex forward. This wouldn't be too big of a deal, unless you had some fairly heavy weights on your back compounding the issue. On top of that, it is extremely difficult to achieve proper depth without getting a soft tissue impingement in the hip. To clarify, proper depth in the squat is when the crease of the hip/thigh is below the top of the knee. If you can maintain a lordotic (neutral arch) lumbar spine while doing a narrow stance squat to these standards with a heavy load on your back AND don't feel the soft tissue around the top of your femur pressing against the joint capsule around the protruding hip bone (anterior supra illiac spine-ASIS) then my hats off to you, but you're still wrong. When engaging in a narrow stance squat you are forced to move your knees forward over your feet, maybe not all the way out over your toes, but damn close. This puts a lot of stress directly on the knee and specifically the patellar tendon. Magnify this by the weight you're squatting and this is a recipe for injured knees and/or chronic inflammation. If you still think narrow stance squats are the way to go, email me and we'll chat. On to the straight toed squats; if your toes are straight you don't allow for your hips to rotate effectively and engage during the bottom half of the squat. Also you are probably pushing your knees into a compromised position which can lead to a big angular force on the knee, which equals pain or injury. You will also probably have a hard time finding the proper depth, keeping your knees from caving in on the up portion, and maintaining a neutral spine throughout the movement. Next please. The plie' squat has gained momentum among the female crowd for inner thigh and glute development. While powerlifters often adopt a very wide stance, their toe angle is about half of what we see in the plie' squat. Furthermore, the plie' squat usually results in about half of the range of motion required to achieve proper squat depth. The lateral shear force on the knees is very high as well, and the lack of quadricep activation is startling. The most probable reason people don't get hurt doing this is because they are using very light (relative) weights to do this exercise, and have fairly healthy knees. Make a large person do plie' squats and you're in for some knee trouble, and weird looks from real athletes. So now that I've briefly gone over why the other squats are trash, let's go back to proper squatting form and why it's golden for people who say they have knee pain!

So your feet are at or slightly wider than shoulder width apart, and your toes are pointed out at approximately 30*. You should try to push your hips down and back while attempting to rotate your thighs outward (don't move your feet). Also the weight of your body should be in your heels. You should be able to wiggle your toes at the top and bottom of the squat. While doing all of this, you should keep your chest up as high as possible and maintain a neutral (slightly arched) spine/back. You should feel a stretch in your inner thigh as you get below parallel, and the main coaching point is to keep your shins vertical. If you push your hips back and down far enough, your shins won't move forward at all. This accomplishes a few things. One, with a vertical shin, all the forces on the patellar tendon and knee are non-existent, your hip adductors are engaged, as well as your glutes, hamstrings, and hips. After you reach proper depth, you should drive your heels into the ground to create the force needed to stand up. This calls on your glutes, hamstrings, hips, and quadriceps to pull you back up to standing. So let's see, we used the maximum amount of muscle to do the movement (so we can use the most weight and get the biggest caloric bang for the buck), took all the forces off the knees (by keeping the shin vertical and keeping the tibia -lower leg , in a good position relative to the knee), and got to proper depth to recruit the posterior chain. Sounds like a good deal.

So after instructing my pops in all of this I started him out like I would any client with knee pain and an unfamiliarity with squats. Couch squats. Simply stand very close to the couch or ottoman and do the same squat as outlined above and sit all the way down like you were gonna watch TV. Then stand back up. The magic is in the movement. Once this movement is down we can move to free standing bodyweight squats, then to a weighted back squat. Squatting properly will achieve full leg development, especially the often undertrained and underdeveloped posterior chain (hamstring, glute, hip, lowerback), and will actively lengthen the muscles from the large range of motion. No longer will tight hamstrings, inactive glutes, and tight hips bother us anymore, all because we are now doing the most basic, yet important, movement ever created. Remember, you ain't squat unless you squat!