In addition to musculature stability and postural control, dysfunctional movement patterns can also be identified. The inability to perform a squat can be a predictor of a low back or ACL injury. Part 2 will discuss intervention strategies to correct these dysfunctions.
Ask your client to wear shorts and a short sleeve shirt for the assessment. This will make it easier to identify faulty movement patterns. Position the client so that you can observe them from the front and side, as well as being able to observe any rotational movements in the transverse plane.
To perform a squat assessment, begin by instructing the client to stand with their feet shoulder width apart inside of their feet aligned with the outside of their shoulders.
Feet should be straight forward and arms straight above head or with hands gently behind their ears Figure 1. This position retracts their shoulder blades and activates the upper back musculature providing stability. Their head should be in alignment with their shoulders and eyes gazing straight forward. Instruct them to descend as far as comfortably allowed while keeping their heels on the ground and pushing the hips back as if sitting in a chair Figure 2.
The tempo should be seconds on the way down. Do not attempt to cue them on improper movements you initially see. Have them repeat the squat 3 to 5 times. Forward head posture has been associated with neck pain, shoulder pain, and temporomandibular joint dysfunction, therefore it is important to assess Figure 3. From the anterior and posterior view the head should remain in midline and not move side to side.
Eye gaze is also important to monitor as it indicates ones ability to disassociate eye from head movement. As they perform the squat, eye gaze should remain straightforward and not move upward with any head tilt. Hyperkyphosis or excessive rounding of the upper back has been associated with forward head posture as well as limiting cervical range of motion. When performing the squat assessment a slightly extended thoracic spine position is recommended to maintain a chest up position Figure 4.
This will also allow the scapula to be retracted. Any rounding of the shoulders and scapula protraction similar to upper cross syndrome should be quickly identifiable. Maintaining a neutral low back position with a slight lordosis is essential to proper and safe motion Figure 5.
Intravertebral disc pressure increases as lumbar lordosis is lost, putting one at risk for injury. It also allows for proper abdominal bracing necessary to maintain the intra abdominal pressure for proper support.
Pelvic rotation and tilting should be assessed as this could be due to compensation for the low back or hip musculature. Monitor the level of the hips in relationship to the floor. If the hips lack mobility then this may be seen with excessive thoracic forward lean as the body attempts to compensate. Proper pelvic alignment also allows the muscles of the lumbar spine, erector spinae, quadratus lumborum and oblique muscles to function optimally providing support to the lumbar spine reducing the risk of injury.
ACL injuries occur at a four to six fold greater incidence in females than males and have been associated with increased knee valgus angles. As the client squats down pay close attention and note if the outside of their knee crosses their medial malleolus. There is a general consensus among fitness professionals that increased tibial translation allowing the knees to glide past the toes is harmful and should be avoided.
Although knee torque increases as tibial translation occurs, there is no evidence to support ones risk of injury is increased Figure 8. This is supported by Fry and colleagues who demonstrated limited tibial translation inappropriately transfers forces to the hips and low back. A stance with feet forward, or with a slight degree of external rotation, and approximately shoulder width apart is desired as a wider stance will change the torque about the knee and hips as well as the muscle activity of the lower extremities.
From the lateral view assess if the heel is rising, which may be due to an ankle dorsiflexion limitation of the joint or from overactive gastrocnemius muscles. It is of utmost importance that clients are pain free when performing any movement assessment.
Part 2 of this article will discuss appropriate corrective exercise intervention strategies based on the movement dysfunctions identified here.
See how to use the results of a squat assessment to incorporate corrective exercise strategies and potentially lower injury risks. Given the most common cause of injury is due to a previous injury in the same region and the second most common cause due to asymmetrical movement patterns, a corrective exercise strategy should be a primary goal when working with clients.
Once this is achieved, clients can be progressed to regular fitness or sport-specific exercises. After a client has been assessed and the movement dysfunction is identified, there are two options regarding a starting point; a ground up approach beginning with the foot and ankle complex or to correct the most noticeable movement dysfunction.
Since the foot and ankle complex has the greatest potential to influence the rest of the body, as described in NASM Essentials of Corrective Exercise 5 , this is a logical starting point.
For example, if you ask them to perform a squat and notice significant tibial translation with the knee moving past the toes it would be appropriate to further instruct them with cues. Try telling them to squat by sitting the hips back as if attempting to sit in a chair. If they still exhibit the same movement pattern as previously displayed then they are likely unable to perform this correctly.
Using the above example with a client that has difficulty squatting properly, one technique to further help confirm your findings is to have them perform this same movement by removing gravity. This can be done in the supine position on the floor with the arms above the head as if they were in the starting squat position. Then instruct them to perform triple flexion of their lower body by maximally flexing the hips, knees and ankles.
Although it is preferable to have them perform with the entire body at once it can be broken down, isolating the upper body and lower body to gain further insight. If your client is unable to fully attain this triple flexed position while maintaining their arms above their head on the floor it can be assumed muscles are overactive, limiting their mobility thereby confirming your findings.
However if they are able to easily attain a triple flexed position when supine but not when weight bearing, they likely have a strength deficit that prevents them from moving properly when their joints are under load.
Therefore, your initial corrective strategy should emphasize either inhibiting or activating muscles depending on your findings. For the purpose of this article a strategy for the most common dysfunctions will be presented. To begin with, ankle dorsiflexion is essential for proper movement up the kinetic chain. If the heel rises off the ground as the client performs the squat, this may be due to an ankle dorsiflexion limitation of the joint or from an overactive gastrocnemius muscle.
Since ankle sprains are one of the most common injuries among active people 6 with the resultant scar tissue formation, both joint mobility and overactive muscles will be addressed. In order to inhibit and lengthen the gastrocnemius, a self-myofascial release SMR approach with either a foam roll or tennis ball can be utilized. SMR using a foam roll has been shown to be effective for increasing flexibility when combined with static stretching.
Mohr and colleagues demonstrated this when they compared foam rolling and static stretching of the hamstring muscles. Therefore, in order to maximize range of motion it is recommended to foam roll prior to static stretching.
Gastrocnemius SMR - Lift hips off floor. Slowly move foam roll throughout calf muscle, as tolerated, for 1 to 2 minutes. Maintain consistent pressure. If a tender area is found, stop rolling and REST on the area for 30 seconds, then continue. Repeat 3 times daily. Perform the half kneeling ankle mobilization exercise to address the joint range of motion. This half kneeling position puts the gastrocnemius in a mechanically shortened position eliminating this as a resistive factor.
Vencenzo and colleagues demonstrated an increase in dorsiflexion range of motion after a series of mobilization exercises similar to the one described here. Dorsiflexion Ankle Mobilization - Begin in a half kneeling position with dowel placed by the outside of the forward foot, parallel to shin. Knee should be behind the dowel. Lunge forward keeping the front heel on the floor. Allow the knee to move past the dowel. Keep core activated so as not to hyperextend the low back. Perform 2 sets of 10 repetitions.
This will increase time under tension for your muscles, which will make them work harder. Inhale while you lower, and as you squat down, your knees should track laterally above your first or second toe, Tamir says.
Tracking too far in can also make your knees collapse inward, and tracking too far out can put extra stress on them. Knees extending farther than your toes can happen due to anatomical differences in your bone length. Trying to restrict that movement can actually make you lean forward more, which can stress your lower back, according to a study in the Journal of Strength and Conditioning Research.
As for when you should stop the move? Once you reach the bottom of the squat, pause for a second so you are not using momentum to push yourself back up. You can also increase the length of your pause to add difficulty to the move. Make sure your feet stay planted throughout the duration of the squat, paying particular attention to driving through your heels on the way back up, says Tamir.
This will fire up your posterior chain—the muscles in the back of your body, like your hamstrings and glutes. You should also exhale on your way back up, says Tamir. Making sure you breathe throughout the move—inhale on the way down, exhale on the way up—is vital.
You definitely do not want to be holding your breath. At the top of the squat, try to tuck your pelvis into a neutral position. Just be careful that you are not hyperextending: A common mistake Tamir sees often is people pushing their hips too far forward, which can actually make you lean backward and stress your lower back. What it does: Strengthens the squatting muscles while practicing proper form.
How to do it: Perform this exercise as you would for box squats, but instead of sitting on the box every repetition, squat until you lightly tap the box with your butt, without fully sitting down, then stand up again, and repeat.
Like with the box squat, start with a taller box if you lack the ankle and hip mobility. What it does: Strengthens the main squatting muscles—the quads, glutes, and adductors—and also activates the back and core muscles as stabilizers.
The kettlebell acts as a counterweight, which can help you stay upright and achieve greater depth with good form. How to do it: Perform squats as described above while holding a kettlebell or a dumbbell with both hands at chest level. Remember to keep your feet and hips square, your spine neutral, and your knees tracking over your second toes—but not beyond. Keep your weight over your heels, and lower only as far as you can with good form, then push through the heels to stand up.
What it does: Strengthens the main squatting muscles. These place more load on the anterior chain front of the body and put more emphasis on the quads as opposed to the glutes. The bar allows you to increase the load of the goblet squat, which is limited to the weights of kettlebells. As with the goblet squat, holding the load in front of your body can help with muscle activation and to stay upright, so most people find it easier than a back squat.
How to do it: With an overhand grip, grab a barbell with your hands slightly wider than shoulder-width apart, then clean it lift the bar into a rack position , so it rests on the front of your shoulders with your elbows parallel and high. Perform squats as described above. These place more load on the posterior chain back of the body and put more emphasis on the glutes as opposed to the quads.
How to do it: Stand beneath the barbell in a rack, position it on the back of your shoulders, and grasp the handle with a wide, comfortable grip. Keep your elbows back and your shoulder blades engaged. Stand up to remove the barbell from the rack, and perform squats as described above. What it does: Works the typical squat muscles, with the addition of the deltoids shoulders and trapezii upper-back muscles to lift and stabilize the barbell overhead.
How to do it: No matter how good you think you are at front and back squats, the overhead squat is a different game. Start with a piece of PVC pipe to focus on technique before adding weight, and return to the wall. Hold the pipe with a wide overhand grip, then snatch it overhead. Keep your elbows fully extended with the bar in the air, slightly behind your head. Step up to face the wall, a few inches away, and perform squats as described above.
Once you have the overhead wall squat nailed, move away from the wall and practice it with a barbell only, then gradually add weight. When you buy something using the retail links in our stories, we may earn a small commission.
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