by David Cruz, DC, CSCS
The ability to perform a squat or partial squat is an essential movement in life we must all be able to perform whether you are 18 or 80 years old. When we think of a squat most of us associate this with weight training or a specific sport activity. However we all perform a variation of a squat everyday with activities of daily living from picking up a box to lifting up a child. Our ability to do this in a safe and correct manner can be the difference between injuring yourself and living a healthy pain free life.
When done properly the squat is a safe and effective exercise that can be used for strengthening your entire body. Performing a correct squat requires the upper and lower body to work in unison activating over an estimated 200 muscles. In addition to musculature stability and postural control, dysfunctional movement patterns can also be identified.
As clinicians, we assess patients passively in the acute phase with orthopedic tests.
After they become asymptomatic is a perfect time to introduce a movement assessment as you transition them into wellness care. Performing a basic squat assessment can provide us information about a patient from their feet to their head.
With the #1 and #2 causes for injury being a history of a previous injury and asymmetrical movement, a squat assessment can provide us insight into the compensation patterns leading to a patient’s recurrent problems. The image below from Assessment and Treatment of Muscle Imbalance – The Janda Approach demonstrates this dysfunctional movement and pain pattern our patients undergo.
Performing a Squat Assessment
To perform a squat assessment, instruct your patient to wear shorts and a short sleeve shirt. This will make it easier to identify faulty movement patterns. Position the patient so that you can observe them from the front and side view as well as being able to observe any rotational movements in the transverse plane.
Begin by verbally instructing them to stand with their feet shoulder width apart with the inside of their feet aligned with the outside of their shoulders. Feet should be straight forward and arms extended above head. Instruct them to descend as far as comfortably allowed while keeping their heels on the ground. The tempo should be 2-3 seconds on the way down. Do not attempt to cue them on improper movements you initially see. Have them repeat 3 times.
Start Position Key Points:
- Arms extended above head
- Feet shoulder width apart
- Feet pointing straight
- Eyes fixed straight ahead
Bottom Position Key Points:
- Arms stay straight
- No excessive forward lean
- Feet stay pointing straight
- Heels stay on ground
- Knees stay in line with feet
Common Compensations seen during the overhead squat
Front View
- Knee – Knees buckle inwards
- Potential Dysfunction: Gluteus Medius/Maximus, external hip rotators
- Arms – Arms bend at elbow or sway excessively forward
- Potential Dysfunction: Thoracic or Shoulder mobility
Side View
- Ankle – Heels lift off floor, unable to achieve 15-20 degrees of ankle dorsiflexion.
- Potential Dysfunction: gastrocinemius flexibility, talo-fibular joint mobility
- Hip and Low back: Excessive forward lean with upper body and shoulders. Lumbar spine looses neutral spine position and excessively flexes for extends.
- Potential Dysfunction: hip mobility and/or thoracic mobility.
By following the above guidelines you will be able to identify basic movement faults with your patient before they potentially become a problem. Keep in mind this should be done once your patient is out of pain and always within their tolerance. For more information regarding movement assessments and corrective exercise strategies visit WebExercises.com and select the Education link at the bottom of the page. Motion capture analysis using PostureScreen Mobile app (http://postureanalysis.com/mobile) can be an invaluable tool to help identify these problems as well as educate your patients.
References
Schoenfeld, B. (2010) Squatting Kinematics and Kinetics and Their Application To Exercise Performance. Journal of Strength and Conditioning Research. 24(12)/3497-3506.
Fry, A., Smith, C., Schilling, B. (2003) Effect of Knee Position on Knee Torques During the Barbell Squat. Journal of Strength and Conditioning Research. 17(4), 629-633.
Bazrgari, B., Shirazi, A., Arjmand, N. (2007) Analysis of squat and stoop dynamic lifting: muscle forces and internal loads. European Spine Journal. 16:687-699.
Page, P., Frank, C., Larkner, R. 2010 Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign, Il. Human Kinetics.
Cook, G. 2010 Functional Movement Systems: Screening, Assessment and Corrective Strategies. Aptos, CA. On Target Publications.
