The Deep Squat (Part 2 - In the Clinic, In the Gym, How to Train it)

Part I went over the benefits and disadvantages of the deep squat.  In Part II, I will describe how I approach the squat in different settings and how I train it.  Contrary to Part I, which was a collection of the current research and physiological facts about the squat, Part II is mostly empirical evidence and professional opinion.

In the Clinic

Is the Deep Squat a Physical Therapy Intervention?

As movement therapists, should we have people deep squatting as an exercise?The answer is that it all depends on your priorities and the patient's limitations.If someone is in physical therapy for pain, they will likely have many other impairments and dysfunctions that need to be corrected first.  The deep squat might be pretty far down the line for them.  Why?The deep squat is a high level, complicated movement.  It has many parts coming together for a complex movement pattern.  Most patients I see are not ready to perform this movement as an exercise.  They need a lot work on the "parts" just to get to be able to perform a clean unloaded deep squat.  As a result, you may need to master more primitive movement patterns before you attempt the deep squat.

Which Patients Should Deep Squat?

Squat On

Don't get me wrong.  I'm not saying that the Deep Squat doesn't belong in rehab.  In fact, I think there are many patients that can benefit from this exercise while in physical therapy.If the deep squat correlates with their injury, impairments, movement deficits, goals, and lifestyle, then the deep squat should be a focus.  For example, if someone comes in with lateral knee pain, weak quads, and needs to squat down to play with their kids, then the deep squat might be a great exercise (eventually).  If someone comes in with weak glutes, valgus moment at the knee, and likes to play squash, then the deep squat might be a great exercise to work on.

Think Twice Before Deep Squatting

More times than not, the patient is so far away from a deep squat that it would take longer than the average bout of physical therapy to get them to where they need to be.  For example, if someone comes in with back pain and can't touch their toes, brace their abdominals, or hip hinge, then the deep squat is not a priority.If someone has a structural pathology that cannot be changed (eg hip OA, bone spurs, meniscus pathology), then the deep squat may never be part of their program.  For example, if someone comes in with chronic knee pain, meniscus pathology, and a hip impingement, then the deep squat is not a good exercise for them.Now I'm not saying that these patients should never squat.  Many of these patients can eventually learn to squat.  But when they walk into the clinic, there are usually many other variables that need to be addressed first.Keep in mind that as physical therapists our goal is to decrease the patient's pain and help them move better; not to force the most complicated movement pattern on them to perfection.

In the Gym

It's not much different in the gym than in the clinic; priorities and limitations are still the name of the game.

Not Everyone Wants to Deep Squat

Some people may not be in the best position to deep squat and would need a lot of work to gain this ability.  Plus, you have to respect the fact that some people have different priorities.  Some people don't want to spend the necessary time to improve their movement patterns.  Some just want to get their heart rate up and sweat.  Forcing the deep squat on someone who won't put in the work to improve their movement quality is dangerous.

Building a Better Athlete

However, if your client is in the gym because they want to get stronger, move better, and improve performance, then the deep squat needs to be a goal and trained consistently.  The abundance of benefits from the deep squat are just too good to pass up.  Simply put, if you're not squatting, you are missing out on some major strength, stability, and mobility gains.Not only does it generate strength and mobility, but many consider the squat as one of the most important strength and conditioning movements (others: push, pull, hinge, loaded carry).  Missing out on one of the most fundamental exercises is a recipe for disaster and will handicap anyone's athletic development.From a movement pattern perspective, the deep squat has a big carry-over to many other movements.  Much like how a solid deadlift sets a great foundation for kettlebells and horizontal force development, the deep squat sets a great foundation for the olympic lifts and vertical force development.Going beyond the weight room, the squat also prepares athletes for what Charlie Weingroff has termed "level changing".  The ability to vertically change your center of mass (COM) in relation to gravity is what the squat is all about.  Athletes are forced to do this over and over in their sports.  The defensive end has to go from low to high and explode off the blocks, the squash player has to go from high to low to get to that drop shot, the basketball player has to from low to high when attempting to block a shot.  If the athlete is inefficient and doesn't have adequate vertical real estate to perform these movements, they'll have to compensate and waste valuable energy.

Prerequisite to Train the Squat

Mobility

There are many prerequisites before someone can begin to work on the deep squat.  The most important prerequisite is to have adequate mobility to achieve the bottom position without compensations.For some, this may take a long time to correct before they can start to deep squat.  Others may only need a few weeks to clean up some restricted areas.  A big part of this is going to depend on their genetics, development, history, and whether it's more of a structural adaptation or a neurological phenomenon.The 4 main areas you need to focus on are

1. Ankle Mobility
2. Knee Mobility (rarely needs work)
3. Hip Mobility
4. Thoracic Mobility

As always, there are many different ways to achieve the same result.  First assess and find the specific local impairment.  Then use whatever you're good at to help the patient achieve the necessary mobility to squat cleanly.

Training the Squat

One of the best things I've learned from Gray Cook is the importance of movement patterns.  It's often not a strength or mobility issue; it's a neurological movement pattern issue.With that in mind, you want to start training the movement patterns in the right level of challenge.  If it's too difficult, they won't be able to adapt to the movement.  If it's too easy, they won't be challenged enough to improve the pattern.As a PT, I sometimes see people that need to start from ground the ground up, literally...from the ground.  Below is a progression I often use with people.  The prerequisite before each exercise is proficiency in the one before it.  However, this isn't set in stone, it's just an example.  The progression should vary per individual, but the concepts should remain the same (unloaded before loaded, assisted before unassisted, etc.)Another important part of training the squat is to make sure you have clean movement before you add a load.  If you load up a compensated pattern, you will be reinforcing that faulty movement pattern.  You will be "saving" the compensation.  And this "saved" movement pattern can come out at a time when it can seriously damage the athlete.  This is one of the reasons why many need to "maintain the squat, train the deadlift" (another Gray Cookism).So if the movement pattern needs work, don't load it up.  But once they've got the movement pattern down, feel free to load it up with the goblet squat, front squat, and/or back squat.

Quadruped Rocking

https://www.youtube.com/watch?v=Zd4io3ltqu0Quadruped rocking is a great place to start for 2 reasons.One, it provides a movement that unloads spine, hip, knee, and ankle joint.  It also allows the patient to "grease the groove" of lumbar/hip dissociation.  Thus, it can be a great starting point to train neutral spine.Two, as Stuart McGill has pointed out, this quadruped position can provide an appropriate assessment to determine squat stance.

TRX Deep Squat

https://www.youtube.com/watch?v=LAExqeGDHOoThe TRX deep squat allows patients to use their upper extremities to partially unload the movement.  Plus, it provides the necessary support to prevent compensatory motion.  If someone can't fully resolve their ankle DF or hip flexion, the TRX can allow them to work around this impairment by shifting the COM posteriorly.

Heels Elevated Squat (COM/BOS Modification)

https://www.youtube.com/watch?v=VKFpyqq_0N4This progresses from the TRX by removing the UE support and loading the movement pattern.  However, the elevated heels does not only mean that you have adjusted for ankle mobility deficits.  There's much more biomechanically going on (e.g. joint alignment, anterior chain stability requirements, posterior chain mobility requirements, etc).This exercise provides is a posterior shift of the COM in relation to the base of support (BOS).  Modifying the COM/BOS orientation causes a cascade of changes that alters the global movement pattern, not just the ankles.

Progressive Box Squats

https://www.youtube.com/watch?v=hn2GFBfqldIThe Box Squat is one of the more common squat variations I use to train the squat pattern.  It allows beginners and those with non-optimal mobility to squat without having to control their COM in the difficult transition phase (eccentric to concentric).  It is also a great way to teach the squat from the bottom up.

Goblet Squat

https://www.youtube.com/watch?v=ZnG3Z7ZgpzsThe Goblet Squat is my favorite squat exercise; both for movement pattern work and for loading.  Adding a load into the system helps to create more tension in the body, which can aid in stabilization.  The act of holding the weight anterior of your COM allows for ease with posterior weight shift during the squat.  And the proper Goblet Squat form ensures that there will be no valgus collapse because your elbows will be in the way.

Front Squat

The Front Squat and Back Squat are exercises for intermediate/advanced strength and performance training.  These are highly technical lifts that require a great deal of strength, mobility, and skill.Specifically, the front squat requires a great deal of ankle dorsiflexion to perform without compensations.  But it is a great way to start loading up the squat that doesn't involve too much trunk flexion.

Back Squat

The deep back squat is difficult to perform well.  I see many people hacking this one up at the gym by performing some weird type of box squat romanian deadlift hybrid where they end up lifting most of the weight with their back.  This occurs either because of poor technique, impaired ankle mobility, and/or the inability to get into their hips.  Regardless, if someone's back is sore after they back squat, you may want to consider regressing them to the front squat or goblet squat.For more information on the front and back squat, check the references below.

Bottom Line

In the end, it's just important to realize that everyone is different.  No one will have the exact same squat.  Some will easily be able to drop all the way down, some will only make it to a little below parallel.  Some people may need a lot of mobility work, some may need a lot of stability work.  And everyone will have different kinematic motion.  Therefore, everyone will require a different training progression, different cues, and different "parts" work.For some, it is not a realistic goal or one worth chasing.  For others, it's a great opportunity to improve movement and performance.The key is to respect people's individuality, don't force it, and respect that it may take a long time for the tissues to adapt to the specific demands of a deep squat.

Dig Deeper

Kjaer, M. "Role of Extracellular Matrix in Adaptation of Tendon and Skeletal Muscle to Mechanical Loading." Physiological Reviews 84.2 (2004): 649-98

HENNING, C. E., M. A. LYNCH, and K. R. GLICK, Jr. An in vivo strain gage study of elongation of the anterior cruciate ligament. Am. J. Sports Med. 13:22-26, 1985.

Klein K. The deep squat exercise as utilized in weight training for athletes and its effects on the ligaments of the knee. J Assoc Phys Ment Rehabil 15: 6–11, 1961

Escamilla RF. Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc 33: 127–141, 2001.

Meyers E. Effect of selected exercise variables on ligament stability and flexibility of the knee. Res Q 42: 411–422, 1971.

Chandler T, Wilson G, and Stone M. The effect of the squat exercise on knee stability. Med Sci Sports Exerc 21: 299–303, 1989.

Bloomquist, K., H. Langberg, S. Karlsen, S. Madsgaard, M. Boesen, and T. Raastad. “Effect of Range of Motion in Heavy Load Squatting on Muscle and Tendon Adaptations.” European Journal of Applied Physiology 113.8 (2013): 2133-142.

Hartmann, Hagen, Klaus Wirth, and Markus Klusemann. “Analysis of the Load on the Knee Joint and Vertebral Column with Changes in Squatting Depth and Weight Load.” Sports Medicine 43.10 (2013): 993-1008.

Caterisano A, Moss RF, Pellinger TK, Woodruff K, Lewis VC, Booth W, Khadra T. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res. 2002 Aug;16(3):428-32.

Steiner M, Grana W, Chilag K, and Schelberg-Karnes E. The effect of exercise on anterior-posterior knee laxity. Am J Sports Med 14: 24–29, 1986.

Esformes, Joseph I., and Theodoros M. Bampouras. “Effect of Back Squat Depth on Lower-Body Postactivation Potentiation.” Journal of Strength and Conditioning Research 27.11 (2013): 2997-3000.

Salem, George J. et al.  Patellofemoral joint kinetics during squatting in collegiate women athletes.  Clinical Biomechanics 16:424-430, 2001.

Bryanton, Megan A., Michael D. Kennedy, Jason P. Carey, and Loren Z.f. Chiu. “Effect of Squat Depth and Barbell Load on Relative Muscular Effort in Squatting.” Journal of Strength and Conditioning Research26.10 (2012): 2820-828.

Schoenfeld BJ. Squatting kinematics and kinetics and their application to exercise performance. J Strength Cond Res 24: 3497–3506, 2010

Escamilla, RF, Fleisig, GS, Zheng, N, Lander, JE, Barrentine, SW, Andrews, JR, Bergemann, BW, and Moorman, CT. Effects of technique variations on knee biomechanics during the squat and leg press. Med Sci Sports Exerc 33: 1552–1566, 2001a.

Walter, Chip. Last Ape Standing: The Seven-million Year Story of How and Why We Survived. New York: Walker &, 2013

Lieberman, Daniel. The Story of the Human Body: Evolution, Health, and Disease. New York: Pantheon, 2013. Print

Cook, Gray. Movement: Functional Movement Systems: Screening, Assessment, and Corrective Strategies. Aptos, CA: On Target Publications, 2010. Print.Eric Cressey - (Here & Here)Mike Robertson's Squat Tutorials (Here and Here)StrongFirst (Here & Here)Dan John (Here)T-Nation - Squat Articles (many great articles here)Westside Barbell - Squat ArticlesDeepSquater ArticlesBret Contreras (Here)Squat vs. Hip Hinge   --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

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The Deep Squat (Part 1 - The Good, The Bad, & The Not So Ugly)

The deep squat (aka full squat, aka ass to grass/ATG squat) is one of the most debated, talked about exercises/assessment we have in human movement.  Some talk about the deep squat as if it's the cure to cancer, some talk about it like it's going to cause the apocalypse.  I have found that I always get mixed information and many take either a full medical approach, a full evolutionary approach, or a full performance approach.My goal here is to provide a blend of these approaches.  As a PT that loves S&C and evolutionary medicine, I hope I can give some evidence, some reasoning, and some clinical judgement on the deep squat as an exercise.Let me again emphasize this is through the lens of the deep squat as an exercise; the squat as an assessment is a whole different story (PRI, FMS, SFMA, Loaded, ADL, etc.).If you want to stop reading here, please consider the conventional wisdom of great S&C coaches:

• Squatting is not bad for you, the way you squat is bad for you

Disclaimer

I think a big part of the discrepancy with the performance with the deep squat is that there are so many variables associated with this movement pattern.  These variables include local physical impairments, movement history, exercise history, injury history, education, neuroception, structural changes, coaching, motivation, and culture.So if you took 100 people off the street and had them deep squat, you would see a smorgasbord of different movement patterns.This surfeit of human variables leads to a problem when trying to generalize one of the world's most complex exercises, let alone trying to create a study.But this abundance of variables isn't the only problems with the studies.

3 Reasons Why Evidence isn't the Gold Standard for the Deep Squat

1. The populations vary from individuals who are young and have experience with the deep squat, to older individuals with possibly no experience with the deep squat.
2. The studies don't seem to take into consideration any of the physical impairments; someone with an ankle dorsiflexion restriction is going to squat much differently than someone with a ankle motor control problem.
3. The definition of the deep squat is completely different in some papers (some have mentioned parallel femurs as a deep squat).

So you can't expect too much from PubMed due to the inconsistent populations, lack of data on physical inputs, and a poorly defined task. 

Defining the Deep Squat

I'm going to call the deep squat simply a squat below parallel with a neutral spine.If you can't get below parallel with a neutral spine, you can't do a deep squat as an exercise.Getting below parallel with spine flexion is great if it's unloaded (SFMA, PRI), but in this article I'm focusing on the act of loading the deep squat for strength, performance, & movement enhancement.

We Used to Always Squat

Tired of standing? Squat down.Need to check something out or inspect an object? Squat down.Hanging out, shooting the shit around a camp fire? Squat down.This was the life for our ancestors (and for some of our current species in different cultures).It's Phylogenetics, the evolutionary history of our species.  It's our species' "family tree" from the beginning of time.The way our bodies have evolved over time has resulted in the movement pattern of the deep squat.But it's also Ontogenetics, the developmental history of an individual.  It's how the interaction of genetics, developmental programming, and environment affects the physical form throughout a lifespan.I've mentioned in a previous post that we have culturally evolved at a rate that far surpases our physical evolution.  Meaning, the world we live in is not made for our physical structures (chairs, shoes, school/work, technology, etc.).This mismatch means that the person in front of you trying to squat should be able to squat (phylogenetics), but may not be able to because of the way they have interacted with their environment (ontogenetics).For example, think of how a 4 year old can deep squat with no problem (phylogenetics), but the 50 year old, life-long sedentary, American desk jockey that can't flex his hip past 90 degrees because of structural changes in his femur/acetabulum has no chance at a deep squat (ontogenetics).But before you start analyzing your patient's phenotype, you should first understand the benefits, risks, and drawbacks of the deep squat exercise.

A Visual Approach to Squatting

Before discussing the benefits and potential drawbacks of the deep squat, it's best to understand exactly what is happening at the knee joint through varying degrees of knee flexion.Here's a diagram with the degrees of knee flexion and the associated forces/EMG activity.This is based on several studies, listed below. * Most studies don't mention any activity beyond 135 degrees.  So this is unknown and why there is nothing beyond 135** It seems the force shifts from anterior to posterior between 50-60 degrees.  This is why there is an overlap.  Yes, I know it's impossible to have both anterior and posterior shear forces at the same time.

Why it's Good

It cures cancer!But seriously, the deep squat exercise has a ton of benefits (see chart below).In general, the deeper the squat, the greater the quad and glute activation.Plus, the deep squat spares the knee of shear forces and prevents ligamentous strain (see figure above).  Since most lower extremity injuries involve weakness and aberrant shear forces, the deep squat can provide a great exercise to help reduce injury.From a performance perspective, the deep squat provides a great exercise for increasing strength (legs, thighs, hips, core) and improving vertical (y-axis) movement efficiency.

Why it's Bad

Ontogeny

The bad often comes from ontogeny.  Everyone was able to squat as toddlers, but what they've done since then will influence what they can do now.  In other words, the way someone has chosen to live their life may make the deep squat a bad exercise for them.  Everyone was born to squat, but not everyone has grown to squat.  This is due to the body adapting to life's imposed demands (mechanotransduction, Wolffe's Law, Davis's Law, bioplasticity, etc.).  Think of it as a structural SAID principle.Someone that spends their life in an anterior pelvic tilt, wearing high heels, and sitting for 80 hours a week will have structural changes in their ankles, hips, and lumbo-pelvic area that will prevent them from a deep squat.  This person would need years of specific training in attempt to reverse some of these adaptations to allow them to squat without compensations.

Compressive Forces

Another potential danger is the high compressive forces (tibiofemoral & patellofemoral) with a deep squat.  Since there is an inverse relationship between shear and compression forces, the benefit of less shear is at a cost of more compression.  For most, this isn't a big problem if you apply the SAID principle and progress slowly.  But for some it may be an issue.

Mobility Restrictions

In general, you should avoid prescribing the squat with people who do not have optimal mobility in their ankle, knee, and hip.  Simply stated, if you do not have adequate mobility in these joints you will compensate and cause more harm than good.

Pathologies

Getting more specific and research-based, I would be very careful to squat with people who have: meniscus pathology, PCL pathology, hip impingement pathology (labral tear or bone spur), chondromalacia (depending on location of pathology), or advanced symptomatic osteoarthritis.However, you should always treat the patient, not the script/image/anatomy.

But What About...

Many times in medicine, one of the first studies that come out on a subject becomes the most popular and becomes dogmatic.  This happened with the 1961 research article by Klien.  Klien reported that squatting was dangerous and increased laxity in the knee.  Everyone jumped on the anti-deep squat bandwagon back then, and some are still dogmatically against the deep squat; even though Klien's results have been refuted in many research articles since.Here are some questions that many have about the squat and it's safety.

Isn't it Bad for Ligaments?

"Because the squat generated lower ACL strain compared with walking or jogging, it was concluded that the squat was a low risk exercise in rehabilitation of the ACL". - Henning et al.

"In conclusion, basketball players and distance runners experienced a transient increase in anterior and posterior laxity during exercise. Power lifters doing squats did not demonstrate a significant change in laxity." -Steiner et al

Isn't it Bad for the Tissues Around the Knee?

"With increasing flexion, the wrapping effect contributes to an enhanced load distribution and enhanced force transfer with lower retropatellar compressive forces...Contrary to commonly voiced concern, deep squats do not contribute increased risk of injury to passive tissues." -Hartman et al.

Isn't it Bad for the Knee Cap?

This is basic physics (Force = Pressure x Area).  There is increased compression with the deep squat, but there is also increased retro-patellofemoral contact area.  Meaning the direct pressure on the knee cap is dispersed among a greater area, thus less focal retro-patellar forces.  Just keep in mind the location of the retro-patella forces associated with the different degrees of knee flexion.

Isn't it Bad for Knees?

"The squat does not compromise knee stability, and can enhance stability if performed correctly. Finally, the squat can be effective in developing hip, knee, and ankle musculature, because moderate to high quadriceps, hamstrings, and gastrocnemius activity were produced during the squat." -Escamilla RF

"In conclusion, there is scant evidence to show that deep squats are contraindicated in those with healthy knee function." -Schoenfeld BJ

Bottom Line

The squat can be a very valuable exercise for both rehab and performance.The question isn't about whether squatting below parallel is good for people.  We know that squatting below parallel affords many benefits and few risks.The questions has to deal with what the individual's environment and lifestyle has done to them over time (ontogeny).  What are the patient's physical limitations and adapted structures developed to deal with?  Which ones can you change?  Which ones should you change?Understanding the phases of the squat and the associated forces/EMG activity will help one prescribe the exercise more effectively.Part I deals with understanding the deep squat.  Part II will deal with implications for rehab, performance, and how to train it from the ground up.

Dig Deeper

Evolution:Evolution goes much deeper than phylogeny and ontogeny.  Ontogeny is an umbrella term that includes many more detailed concepts (e.g. phenotype plasticity, epigenome, etc.).  Special thanks to the great professors who helped clarify some of these concepts for me: Daniel Liberman, Robert Boyd, Kathleen Smith, Jennifer Brisson, Jean-Jacques Hublin, Squat Stuff:Brad Schoenfeld has some of the best articles on the deep squat.  Best place to start in my opinion.  Scroll down for the articles - The Biomechanics of Squat Depth, Squatting kinematics and kinetics and their application to exercise performance .James Speck - 5 Reasons to Start Full SquattingChris Beardsley - Squat Depth for Glute Activation, Squat DepthBret Contreras - 7 Reasons to Squat Like a ManHuffington Post - Nick EnglishStrongfirst Front SquatDean Somerset - Do You Need to Squat DeeplyKevin Neeld - The Truth About Deep SquattingVincent St. Pierre - Are Deep Squat SafeNick Tumminello - 7 Reasons This is a Ridiculous MythMenno Henselmans - Partial ROM vs. Full ROMBrent Brookbush - A Kinesiological Approach to the Overhead Squat (16 Video Series)

References

HENNING, C. E., M. A. LYNCH, and K. R. GLICK, Jr. An in vivo strain gage study of elongation of the anterior cruciate ligament. Am. J. Sports Med. 13:22-26, 1985.Klein K. The deep squat exercise as utilized in weight training for athletes and its effects on the ligaments of the knee. J Assoc Phys Ment Rehabil 15: 6–11, 1961Escamilla RF. Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc 33: 127–141, 2001.Meyers E. Effect of selected exercise variables on ligament stability and flexibility of the knee. Res Q 42: 411–422, 1971.Chandler T, Wilson G, and Stone M. The effect of the squat exercise on knee stability. Med Sci Sports Exerc 21: 299–303, 1989.Bloomquist, K., H. Langberg, S. Karlsen, S. Madsgaard, M. Boesen, and T. Raastad. "Effect of Range of Motion in Heavy Load Squatting on Muscle and Tendon Adaptations." European Journal of Applied Physiology 113.8 (2013): 2133-142.Hartmann, Hagen, Klaus Wirth, and Markus Klusemann. "Analysis of the Load on the Knee Joint and Vertebral Column with Changes in Squatting Depth and Weight Load." Sports Medicine 43.10 (2013): 993-1008.Caterisano A, Moss RF, Pellinger TK, Woodruff K, Lewis VC, Booth W, Khadra T. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res. 2002 Aug;16(3):428-32.Steiner M, Grana W, Chilag K, and Schelberg-Karnes E. The effect of exercise on anterior-posterior knee laxity. Am J Sports Med 14: 24–29, 1986.Esformes, Joseph I., and Theodoros M. Bampouras. "Effect of Back Squat Depth on Lower-Body Postactivation Potentiation." Journal of Strength and Conditioning Research 27.11 (2013): 2997-3000.Salem, George J. et al.  Patellofemoral joint kinetics during squatting in collegiate women athletes.  Clinical Biomechanics 16:424-430, 2001.Bryanton, Megan A., Michael D. Kennedy, Jason P. Carey, and Loren Z.f. Chiu. "Effect of Squat Depth and Barbell Load on Relative Muscular Effort in Squatting." Journal of Strength and Conditioning Research26.10 (2012): 2820-828.Schoenfeld BJ. Squatting kinematics and kinetics and their application to exercise performance. J Strength Cond Res 24: 3497–3506, 2010Escamilla, RF, Fleisig, GS, Zheng, N, Lander, JE, Barrentine, SW, Andrews, JR, Bergemann, BW, and Moorman, CT. Effects of technique variations on knee biomechanics during the squat and leg press. Med Sci Sports Exerc 33: 1552–1566, 2001a.

Walter, Chip. Last Ape Standing: The Seven-million Year Story of How and Why We Survived. New York: Walker &, 2013

Lieberman, Daniel. The Story of the Human Body: Evolution, Health, and Disease. New York: Pantheon, 2013. Print

 --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

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Course Review - StrongFirst Kettlebell Workshop

On June 1st I had the pleasure of participating in a StrongFirst Kettlebell Workshop with Phil Scarito.  It was a 1-day course that went over the intricacies of the basic kettlebell movements (Deadlift, Swing, TGU, Goblet Squat, Press).  The theory is that it's better to master the fundementals than to be average at a bunch of different lifts.  Plus, it's these basic KB movements that that have the greatest impact on improving one's physical abilities and movement patterns.Phil Scarito was the instructor for the course.  He is extremely knowledgable on many levels and was able to translate his concepts to everyone from physical therapists to personal trainers to your average gym rat.  Phil is able to go into the greatest details of each movement to truly help you understand the movement at a different level.  He has a great YouTube page with tons of detailed instructional videos.Along with some posterior chain soreness, I learned quite a few things.  Here's some things I learned in one day with Phil Scarito and the StrongFirst instructors.

General

1) Your clients/students/patients will do what you do.  Make sure you can execute the move perfectly and they will too.2) Training barefoot is extremely important.  It allows you to maximally "root" your feet into the ground and give you more power.  Shoes deprive you of that important sensory information.3) Lose big toe contact = lose power4) Fast & Loose - keep moving during your training and use active rest5) Tactical Frog is a great mobility warm up6) Fix the deadlift.  When someone is having difficulty with a movement, often times going back and fixing their deadlift will resolve the problem.  "Don't fix the swing, fix the dealift" - Brett Jones7) "Try to make the light weight feel heavy, and make the heavy weight feel light" - Marty Gallagher8) Breathing is extremely important to develop stability.  Coordinate breathing with movements (biomechanical breathing).9) Think about driving your feet into the ground and pushing the earth away.10) Active Negatives are a great way to learn movement.  It also spares the agonist of eccentric load, allows for successive induction, trains the antagonist, and helps to "grease the groove".11) Always keep the wrists in neutral.  Don't let it bend to accommodate the bell.12) All you need for programming is TGU's and Swings.  Do those everyday and you will make tremendous gains.  (paraphrased Pavel advice)

Hip Hinge/Deadlift/Swing

1) The hip hinge is the basis for the deadlift.  The deadlift is the basis for the swing.2) "Rooting" feet into the ground is extremely important for power transfer.3) Reach down and stay tall before you pick up the bell.  This packs the shoulders while maintaining proper posture.4) It's important to start the swing off right.  This helps activate the lats to develop tension, increases power generation, and properly starts the movement with the right momentum.5) If you let the weight go at the bottom of the swing it should fly backwards, not down.6) Avoid the "high hip hinge".  Don't get lazy and start doing partial range swings.7) Timing is extremely important.  There should be a delay going up (KB "float") and a delay going down ("playing chicken with the KB").8) Don't over think quick lifts.9) Don't be so afraid of flexing your trunk forward.  Many people will bend at the knees to try to keep their torso upright instead of hinging at the hips.10) Make sure to "snap" your hips forward.  Finish the lift tall.http://www.youtube.com/watch?v=_z3T1CwP5bg

Turkish Get-Up (TGU)

1) You can take the TGU and turn it into a million different exercises.  Break it up, practice small parts of it, add a few TGU movements into other exercises.2) The TGU takes you through a full neurodevelopmental progression.  No other exercise can do that.3) Starting position will determine the success of the rest of the movement.4) The legs and arms should be parallel in the starting position, much like a starfish (or at 45 degree angles).5) You should be "rolling" to your elbow, not sitting up to it.6) When you get to your hand "think of wedging yourself between the bell and the floor" - Phil Scarito7) The "2 Lines" to look for:

• In Sitting Phase: Hand, Hip, and Oppoite Foot in line

• In First Kneeling Phase: Hand, Knee, and Foot in Line (same side)

8) Most people do the TGU too fast.  Should be a slow movement with at least a couple seconds in between movements.http://www.youtube.com/watch?v=RkVaQMi9wTQ

Goblet Squat

1) After your hips go below your knees it is all on the glutes to get back up.2) Don't get out of the bottom position too fast.  You want to go slow to prevent the hips from shooting up.3) Pull yourself into the bottom position with your hip flexors (active negative).4) Keep your feet pointed straight ahead and the exercise will naturally prevent valgus collapse at the knee.5) Don't sacrifice form for depth (avoid excessive lumbar flexion).6) A common fault is sitting forward into the knees.  Most people will need to focus on sitting back into their hips.http://www.youtube.com/watch?v=ZnG3Z7Zgpzs

Strict Press

1) You can't press with a hyper-extended wrist.  There's no power.2) Don't reach up.  Instead, think of pushing the whole body away from the KB.3) The plank and the military press are very similar exercises.4) Don't let the ribs flair and hyperextend the lumbar spine.5) Actively pull the bell back down (active negative).http://www.youtube.com/watch?v=WTmR-Qr32dg

Summary

More and more people are becoming interested in kettlebells.  As a clinician this means we have to have a better baseline level of knowledge so that we can assess, train, or refer out when we have patients that are using this equipment.Remember the rule with all exercises:

• Make sure you are competent with the movements before you prescribe or assess someone else.

The kinesthetic learning of this course cannot be matched by anything other than performing the movements while being coached by professional.  I highly recommend taking one of these workshop courses with StrongFirst if you have any interest in kettlebells.

Dig Deeper

Strong FirstPhil Sacrito - Website - YouTubePaul GormanGray Cook & Brett JonesKettlebell Studies

McGill

Jay K

Jay K et al

 --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

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The Best Posterior Chain Stretch

Inflexibility of the hamstring muscle is often a prominent kink in most people's posterior kinetic chain.  It's the reason why we have to sit down to tie our shoes, can't sit up-right with our legs straight out in front of us, and the reason why most of us would be very pathetic at martial arts.  Having a tight hamstring is a major concern as it can lead to increased risk of injury, decrease athletic performance, and cause pain and symptoms both proximally and distally (low back pain, achilles pain, etc.).A possible cause of this common impairment could be that the majority of the population spends a substantial amount of their time in the seated position (jobs, communting, watching tv, reading this post, etc.).  This seated position puts the hamstring in a shortened position.  The body responds and adapts to this habitually shortened position by decreasing the hamstring muscle length.To further complicate the problem, hamstring tightness is not just a result of muscle tightness.  Fascia and neural tension are a major component of posterior leg tightness.  So how can we address all of these aspects of hamstring tightness without spending 30 minutes of stretching a night?

90-90 Active Hamstring Stretch

This stretch will hit the entire posterior kinetic chain from your plantar fascia to your low back.  It also works all 3 aspects of hamstring tightness (muscle, fascia, neural tension).

How to Perform

1. Start on your back and grab the back of your thigh with both hands
2. Your thigh should be at 90° throughout the entire stretch
3. Slowly use your quadriceps to kick your leg up while flexing your foot towards you at the same time
4. Pause for a second when you reach your limit
5. Slowly relax your foot and drop your lower leg back to the starting position
6. Repeat for 3 sets of 10-15 reps

http://www.youtube.com/watch?v=s4wgP4wjeDc

Other Considerations:

• If you are very tight and not getting much motion at all, start off with your other knee bent (in hooklying) instead of straight
• Try not to flex your neck and upper back up during the stretch, use a pillow to support your head if you need to
• Best time to stretch is within 15 minutes after working out while your body is still warm
• 3 sets of 10 a day is not a limit - adjust to what your mobility needs are

Of course there are many other considerations when addressing hamstring tightness (posture, ergonomics, muscle weakness, compensations, etc.).  But I hope this article will at least give you a new way to stretch your hamstring and posterior kinetic chain.  Just taking a few minutes a day for this exercise can help improve your hamstring flexibility and possibly decrease your risk for injuries. --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

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