The squat is one of the most commonly performed movement patterns that we do right from the early development years as toddler through to old age. We as humans need to be able to perform a squat pattern in many of the activities that undertake on a daily basis. In the strength and conditioning arena, the squat is one of the most commonly prescribed exercises because it trains the entire body and also replicates many movements required to play sport and be active. It also allows the individual to train power and strength in the lower body that can translate into increased jumping, running and moving peformance. In a clinical sense, the squat is one of those movements that many clients presenting to the clinic with musculoskeletal injuries often demonstrate a poor ability to execute correctly.
Looking At The Squat Pattern In The Early Developmental Years And Across Cultures
Looking at the early years of development you will observe many toddlers readily performing either squatting or deadlifting patterns when getting up and down from the ground or picking things up. It is truly amazing to watch these small humans perform these movements with such ease and without any movement, strength or motor control issues. The truly great thing about watching toddlers perform squat and deadlift patterns is that they perform these movements naturally and without any teaching like us adults often need.
When we take a look at different cultures across the globe, we see many people from various cultures still readily performing these movement patterns compared to many in the Western world. Many westerners have lost the ability to squat, with some of the reasons for this possibly relating to mobility issues from too much sitting, a lack of strength and motor control from general inactivity. When we look at many Asian cultures and countries, it is very common to see many people still adopting squatting positions in everyday life. It is simply amazing to look at people of all ages (right up to the ages of 70 and 80 years) where people can simple squat and hold these positions with such ease. Something that I commonly ask my clients and try myself, is to simply get into a full squat position and see how long I can hold this position for. It is amazing how many people have lost the ability to do this or simply find it too difficult to maintain this squat position.
Assessing The Squat
Assessing ones ability to perform the squat can tell us a lot about their body’s ability to move. The squat is a great movement to assess because it involves both lower and upper body integration, as well as both left and right sides of the body. It requires the individual to have good mobility, stability and motor control from the lower limb right through to the upper body and therefore tells us a lot about their general function.
Assessing The Squat Movement Pattern
When I ask my client to perform the squat, I try to limit my coaching and demonstration of the squat to get a more true sense of how they move. The squat means many things to many people and looking at how they perform their version of the squat can give us a great deal of information.
I have listed below some of the common observations of variations of squats performed by many of my clients which help me to identify further areas of assessment to determine if their is a mobility, stability or motor control issue. This list is not exhaustive and further assessment is required to determine what the clients major limiting factor might be.
- An ability to perform the squat movement full stop. Some people simply cannot squat and this could be a result of poor movement, stability or motor control.
- Shallow squat pattern that is limited in range. This again could represent a mobility, stability or motor control issue and further testing is required to determine which is the biggest contributing factor.
- Squatting through their knees and limited mobility through their hips. A common pattern adopted by many clients who have forgotten how to hip hinge. Often people performing squatting patterns like this who exercise find themselves developing knee related issues at some point in their life.
- Squatting and looking at how they counterbalance their movement. Some people can perform a perfect squat pattern with arms reaching out in front, others find it difficult to squat effectively with arms by their side or above head. It is important to see how the client performs these variations of squat patterns as it can give us more information as to mobility issues through the trunk and shoulders or lack of stability and motor control.
- A lack of closed chain dorsiflexion through their ankle. Clients may find it easier to perform a good squat pattern when heels are placed on a wedge. This could be as a result of poor mobility, motor control or stability in the trunk lower limb. Often one of the key areas that I assess in this is to look at their closed chain dorsiflexion range. It is important to rule out tightness through the gastrocnemius and soleus or joint limitation through the talocrural joint.
- Knee diving in on the squat. This could be a result of poor foot mechanics or mobility or stability issues through the hip and pelvis. It is important to assess these areas to rule out other contributing factors.
- A shift in their pelvis to one side when squatting could be a result of poor mobility or dysfunction in movement. It is important to assess the foot and hip/pelvis to identify this.
- A rounding of the spine whilst squatting could be an issue with hip or spine mobility or an ability to disassociate hip and lumbar spine movement.
When it comes to assessing the squat, I will often vary up the squat movement in many ways to look at how one can move through a squat. This could involve looking at the squat pattern in the following ways:
Changing the start position of the foot i.e. split squat, toes in, toes out, width of stance, position of the arms and looking at ones ability to perform a single leg squat and lunge. Each of these varations can give us further information as to how they move through the foot/ankle, knee, hip, spine and upper body with more or less base of support, change in centre of gravity and range of movement.
Teaching The Squat Movement
When it comes to getting your clients to squat. There are many different ways to skin a cat as they say and the same can be said about teaching the squat. Depending on what you do and who your client base might be, teaching the squat will differ for each and every professional. When it comes to improving ones squat pattern, it is important to identify any mobility limitations and address these. Failure to improve mobility through the foot/ankle complex, hips and spine could be the major limiting factor to their ability to squat. If strength is a major limiting factor, then progressing the client and training these deficits is important to improving their squat. This could involve simply overloading the squat movement pattern or training specific areas of the body with supplemental exercises. If the individual demonstrates poor motor control, then specific approaches to improve this is integral to improving their squat.
Teaching The Hip Hinge
One simple way to start teaching the client to squat is to teach the hip hinge. This involves teaching them how to disassociate hip movement from the lumbar spine. In simple terms, teaching the individual how to move the butt backwards as they move in the downwards phase of the squat. I have listed a few example of how this could be taught.
- Use a dowel stick along the clients spine (touching sacrum, thoracics and head). Have them hold the stick along their back (one hand in the lumbar lordosis and the other in the cervical lordosis). Ask them to squat and maintain three points of contact with the stick along their back.
- Have the client start in the 4 point kneeling position. Get them to find a neutral spine position and then place a foam roller across their lumbar lordosis. Have the client rock back towards the heels and ask that they maintain the foam roller on their lumbar spine without losing it. Remember, there will be a point in the movement pattern where lumbar flexion starts to occur. So work between this point of the movement and the starting position.
- Have the client standing facing away from the wall and then ask them to squat until their bottom hits the wall behind them. The starting point between heels and wall can be progressed depending on your clients success.
Squat To The Sitting Position
Using a chair or plyometric box (this offers greater flexibility with progressions as you can start with a higher box for teaching squatting and then progress to a lower box as they improve). Have the client sit back onto the chair or plyometric box and control this movement. Many clients demonstrate poor ability to control this downward phase of movement and therefore they need to control this movement. Initially you may start with teaching them just the downward phase to a sitting position to then teaching them to touch the chair and then come back up. A chair or box is a great tool as it gives the client confidence that there is something behind them in case they lose control.
Assisted Squatting Using Upper Limb Support
Using upper limb support to provide greater stability is a great way to teach clients to squat. By giving them greater support, it allows the client to groove their movement patterns and test out deeper ranges of the squat movement that they haven’t perhaps seen in some time. Some examples of tools that can be used for this include:
- TRX Suspension System – Holding onto the straps
- Swiss Ball – Placed in the small of the back
- Chair – Holding in front
- Truetretch – holding onto the bars
- Powerrack/cage beam or any other equipment that allows them to get a good grip
Having the client squat with greater stability allows the individual to explore deeper ranges of the squat. Often when clients squat into deeper ranges, they will describe a feeling of areas of tightness. Assuming there are no pathological or structural risk factors, it can be useful for them to spend some time in this position for a short period. This can help transfer over to improving their squat because all of a sudden these dormant areas are woken up and proprioceptively turned on. It is important to remember that when increasing mobility, it is important to train stability into these new found ranges.
Squatting By Changing The Range Of Closed Chain Ankle Dorsiflexion
Some clients may be limited in their squatting by restricted closed chain ankle dorsiflexion. If this is a result of tightness through the calf complex (ensure there is no ankle impingement in the joint), then having the client squat with their heels on a small wedge (this could be 2 books that are an inch thick or 2*1.25 or 2.5kg plates), it gives the individual the opportunity to explore greater ranges in the squat pattern. Remember, the goal is to address the mobility, stability and motor control issues in the squat and therefore it is important to address these areas so that the individual will be able to eventually perform a flat stanced squat pattern.
Reactive Neuromuscular Training
This concept is taught within the Functional Movement Systems by Gray Cook. It is also widely used by many manual therapists within the realms of rehabilitation. The idea behind this is that if you have a poor movement pattern e.g. knees dive in on a squat. Then the trainer or therapist should exaggerate this and apply some further exaggeration of the knees dropping in whilst the client squats. The dosage of pressure will be individual specific, however must be applied so to not overpower the client performing the squat. Often the natural response of the client will be to push out against your resistance and therefore correcting their poor movement patterns. It is also important to communicate with your client when performing this and ask them to “not let you push their knees in”. This is a great strategy for training many dysfunctional movements and can be progressed to using external equipment such as thera-band, tubing bands and power bands. The example of this being that the client places a powerband around both thighs and have them maintain tension on this band when squatting.
A Look At The Conventional Squat Versus Sumo Squat
The conventional squat involves a squat with the feet placed approximately hip width apart. It is important to train clients to be able to squat in a variety of positions. The truth is, often when squatting at home or at work, rarely do we have our feet always at hip width or sumo stance position. Therefore grooving movement patterns with feet and upper body in a variety of positions can mean the client is better prepared for squatting in all situations. Often I will lean more towards a sumo squat when teaching clients initially as it offers them the ability to feel what it is like to push the butt back when squatting. It is also a great way to teaching squatting to clients who have mobility issues through the foot/ankle, hip or have knee pain. Teaching the client to sit back so that their shins are vertical to the ground can help to reduce shearing force through the knees. Once they have mastered this and mobility limitations have been addressed, I will move to training other squat patterns.
Remember To Also Think About Teaching Single Leg Squatting and Lunge Patterns
These are two other important exercises that I often have my client focus on in their training if there aren’t any contraindications. The single leg squat and lunge pattern has the client focus on just one side of the body. The single leg squat requires a great deal of stability and often this is only trained once they have proved that they are capable. The lunge is another great exercise to train as it requires the individual to perform a flexion pattern through foot/ankle, knee and hip with a much smaller base of support. The squat pattern, single leg squat and lunge patterns are movements that we perform everyday and if you can improve these in your clients, then not only will you be helping improve their athletic performance, but everyday movement in general.
Loading Up The Squat With Resistance
Progression of an exercise and overload is an important part of any good exercise program. Below are some examples of different exercises that I prescribe for my clients once they have mastered good squatting patterns. Each of these squat variations requires the individual to control the weight in a variety of different manners and has a specific focus area.
- Goblet Squat – Requires the individual to hold a dumbbell or kettlebell at the chest and squat down.
- Dumbbell Squat – The individual can simply holds the dumbbells by the side of the body to squat down.
- Barbell Back Squat – This is the most traditional form of squatting. The bar typically rests across the top of the deltoids.
- Sumo Box Squat – This type of squat requires the individual to have a wide stance with feet often pointing outwards. It requires the individual to sit back onto the box and is a great way to train power and strength into the lower body without causing too much shearing force through the knees.
- Barbell Front Squat – Changing the position of the bar to the front changes the position of load on the body. A front squat is often adopted for those wanting to create a more quadricep dominant squat. Individuals with poor mobility through the shoulders may find certain bar holds difficult to maintain.
- Belt Squats – These are great for those wanting to maintain good lower limb strength without overloading the spine. For those wanting to avoid spinal compression, the belt squat is a great way to load up the lower body and improve strength and power.
- Overhead Squat – Clients must be able to demonstrate adequate shoulder and spine mobility to perform the overhead squat. Failure to do so may result in poor squat patterning and an increased risk of injury.
Osteopath Heath Williams is owner and director of Principle Four Osteopathy, one of Melbourne City CBD 3000 leading Osteopathic clinics. The Osteopathy clinic is located at 29 Somerset Place, Melbourne City CBD 3000. To find out more about the clinic, please check out www.principlefourosteopathy.com. Appointments can be made by calling 03 9670 9290 or booking online.