Do you know how to squat correctly?
Squats. Love 'em or hate 'em, ALL of us need to do them. From little kids to the elderly, we all do it several times a day. If there was one exercise that all people need to perfect is the squat – athletes or not. We're not necessarily talking about putting a bar on your back and doing maximal effort squats. We're alluding to simply performing sit to stand from a chair, or getting on/off the toilet with proper squat technique. That said, so many compensatory patterns and muscle substitutions take place from the ankle to the trunk. This is one of the first things we look at during a physical therapy evaluation, and you may not even know it, but we're looking the minute we see you in the waiting room. Watching you get up from the chair is the first clue as to how you are performing this activity. We almost immediately have an opportunity to help you or your loved one before we've even talked! There are many reasons that poor squat form can occur – lack of mobility in the hips, knees, or ankles or lack of stability in the core region. Figures 1 and 2 show some poor squat form because of these areas. Figure 1 shows a forward trunk lean, and Figure 2 shows the heels elevated. You may have one or all of these regions causing you to not perform a proper squat. We can help you determine which areas are the sources of your dysfunction. The purpose of this blog post is to teach you how to squat correctly and talk about some ways to perform a proper squat movement to not only help improve function, young or old, but for the active patient, provide a foundation for more advanced leg strengthening. It even amazes us how many people are taught incorrectly by people that are supposed to know how! The squat is a basic tenet of any strengthening program and should be perfected prior to adding external resistance.
What does a good squat look like?
First of all, see Figure 3 for good squat form. The feet are slightly more than shoulder width apart, the trunk is leaned forward, the head is up, and the knees are behind the toes. Many people struggle with achieving these basic points. For what it's worth, watch a toddler squat – they have perfect form! As we get older and taller, we get lazier and stop using our hips like the kiddos do. Many people in physical therapy complain that their knees hurt when they go down stairs or when they squat. When you go down the stairs, your knees go IN FRONT of your toes which increases compression of the patella ("kneecap") into the femur ("thigh bone"). The same thing happens if you don't use your hips and "sit" back when you squat – the knees go in front of the toes and there is pain.
Next, you may not be able to perform a proper squat due to hip weakness. In this case, your knees will collapse inward (Figure 4) when you descend during the squat. Hip weakness leads to a myriad of problems in the lower extremity and spine. Therefore, hip weakness should be addressed in physical therapy. If you bend forward too far and end up looking at the floor, this indicates hip flexor restrictions and likely some associated gluteal weakness as well. There could be a few reasons for this and your physical therapist can help you determine which one is the source of your inability to perform a proper squat.
So I can't squat correctly. How do I fix it?
In figure 5, you'll see the subject holding on to a cable attached to a weighted stack. Basically, what this provides the subject is some stability as they descend. Usually, people stop their descent with the squat because any lower, they will fall back. You can confirm this by getting to the bottom of the squat and then letting go of the cable a little – if you fall backward, you are the ideal person to need this! As you get better at this, you can release one hand, try and hold on less, or get to the bottom and pause without holding on. Another alternative to work on a proper squat is to do a "box squat", whereby you lower your hips and touch a bench, table, or chair without actually sitting down. Using the cable however is a useful and easier first step. If you don't have a cable or are teaching this to a relative at home, any immovable object that the person can hold on to will work. The key is only use as much of the support as you need – do not use it to "pull" yourself back up.
In figure 6, you'll see another modification with the heels elevated slightly. This is actually a way to help someone squat with tight calves or lack of ankle mobility from joint or soft tissue restrictions. Again, these issues can be addressed in physical therapy. However, this method is also good because by virtue of shifting weight to the toes, the hips have to go backward – equal and opposite reaction. As you improve, you can either lower the height your heels are elevated or use nothing at all. The elevation of the heels effectively acts as a "buffer" or "buys you time" until ankle or soft tissue mobility is restored in physical therapy.
It would be a privilege to serve you and partner with you in your care. Give us a call – we have two convenient locations to serve you, one in Overland Park and the other in Prairie Village.