Jessica Bento, Physical Therapist (Creator DVRT Rx Health Knees Course, DVRT Restoration, Pelvic Control, & Shoulder Course)
If there is something that really frustrates fitness professionals it is when they hear doctors tell patients, “don’t perform squats, it will hurt your knees.” At first glance you might want to bash the doctor for saying such a thing, but the reality is most people don’t know how to perform squats and to be honest, many fitness and therapists don’t either!
I can say this because as a physical therapist and I will be one of the first to say that I wasn’t taught how to squat in any level of my education. Even those that do get exposed to squatting techniques often get bad information as well. So, at some level, you can’t blame doctors for being skeptical that people can squat without getting hurt. Add to the dilemma is the fact that I know I have seen many people come to the clinic for knee issues that were caused by bad squatting.
Of course that is the key..bad squatting. The question is what makes a squat good or bad? It isn’t always as evident as you may think!
Are All Squats Created Equal?
There is no shortage of squats out there, the key is to know what is ideal for most people. For example, a friend of mine had an accident where she badly damaged her hip. She went to physical therapy (no, not me;) and they had her doing plie squats. Why is that an issue? The external rotation that the hip has to go through as you squat puts a lot of stress through the hip joint, so an example right there of a therapist actually prescribing the wrong type of squat!
For the great majority of people, the squat that I show below is what we are aiming for in our training. Why? If we go back to the idea that the squat is first and foremost a movement pattern, not an exercise, then we want to use it to achieve things like better mobility in the ankle, knee, and hip. Why does that matter?
Why is ankle, knee, and hip mobility? They create a powerful chain together that is responsible for reducing many issues with our knees and low back along with helping us be explosive like in running and jumping. The ankle especially plays a big part in our ability to be strong and resilient. As world renown therapist, Gray Cook states, “The ankle is a key component in rehabilitating knee problems—because it is often one of the causative factors of knee stability problems in the first place. Valgus collapse and pronation can be results of limited ankle dorsiflexion mobility. And yet the individual with the limited ankle persists in participating in activities, like squatting, lunging and running, that do require functional ankle mobility.”
This is exactly why I am not a big fan of sumo squats for most people. Yes, I know, powerlifters do it, but are you a powerlifter? Also, such an argument implies powerlifters don’t have orthopedic issues and that simply isn’t the case. Most of all, the reason I don’t like sumo squats is that it allows us to use the wide base of our body to use structure to substitute for stability. That means we don’t get as much out of the exercise and our body doesn’t learn how to be smarter with its movements!
Where Do We Start?
There are two big issues that cause people to struggle with their squats, the ankle/foot along with core stability. These two issues are linked, but if we can improve the two we will see great improvements in the ability to squat well and reap all its benefits!
When we look at the model of the body that Gray Cook and Mike Boyle created in the “Joint by Joint” we can see why the foot is such an issue!
If the foot/ankle aren’t doing their job it impacts EVERYTHING up the chain and you see the next joint up is the knees! This can also be seen through concepts like the fascial “spiral line” where you can see how this chain begins at the foot.
What I’ve seen recently in regard to people seeing that the foot/ankle is key in squats that actually help the knee, is that they elevate the heels on a wedge or something of the like. I understand they are trying to address limited ankle mobility, but here is the issue. In doing so, we increase the shear on the knee so we trade one issue for potentially another. Instead, I’d rather try to teach people how to use their feet to build a better squat. How can we do so?
You see how the feet change the position of the knees through what the hips do when the feet become active. Now, if this doesn’t help, you can also use a simple cue of when the person is trying to do their squats, try to lift up their toes! Tell them to try to resist and you will find people start to properly “grip the ground”.
Besides helping the knees through changing the position of the hips, having the feet active also helps our ankle mobility. How? Our body is stacked in a very specific way, if one area isn’t doing the job it is designed to do, then the body compensates and it is the joint right above and below that is most impacted. In the case of the ankle, if the foot isn’t creating stability, the ankle will try. What is the easiest way to do so? Tightness is the easiest way for the body to try to protect itself and try to find stability. So, we can stretch and mobilize the ankle all we want, if we don’t activate the foot correctly we won’t be able to help ankle mobility in the end.
Josh is actually a great example because he is SUCH a mess! I say that of course very lovingly, but it is also true. Over a decade of competitive basketball has made his feet/ankles some of the worst I’ve seen (his images are just scary!). Add in a severe spinal disease that has also resulted in lumbar fusions, he is a prime example of what is possible if we engage the feet and the core properly.
At first glance at the picture above you may think it is just a counter load that is allowing Josh to squat that way. However, if he just held the Ultimate Sandbag out and squatted you don’t see anything close to the same. It is the combination of him getting his core to work from the ground up (through his feet giving his ankles more mobility too) and pressing out very specifically to get that range of motion and core engagement from the hands down.
Megan Berner does a great job breaking down some of the details that make this such a great way to teach squats and work on that mobility and strength at the same time!
Once we have these foundations in place, it is going to open the door for us to look at various ways that we can progress our squats to achieve better functional fitness and build that resilience that so many of us want to offer people. This for me, is not just giving you more information, but personal. I have knees that should HATE to squat because of joint degeneration. However, using these methods are the only way I can perform squats. I’m not the only one though. One of our favorite things is seeing how others have done so to regain their quality of life.
A great example is this woman who Josh met at a conference. She was suppose to have knee replacements because her knees hurt so badly. Not only do you see her squatting a great range here, but doing so pain free! Of course there are going to be instances where this can’t solve anything, but for many it can be truly a game changer and for most the start to learning how powerful squats can be beyond what we currently think!
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