Welp... I've done it again. Every time I sit down to write an article, I give myself the same pep talk- "Be clear, be concise, be clear, be concise." Without failure, I somehow always find a way to violate the whole 'concise' part of this...
I've been anxious to write this one, as there's been a ton of debate and discussion regarding squats in the strength training realm over the last few months (and yes, even more so than usual). I felt it was not only timely on my behalf to push this article out, but also felt there were some important details I wanted to outline and hopefully clear up some ambiguity on. With that said, this will be the first of two parts I'll be posting this week on 'all things squatting'. This article does get a bit more on the technical side, but still includes how I personally go about things. Between the two parts, we will cover quite a few subtopics, including:
I.) Contraindicating injuries for squatting
II.) Position, posture, and squat set-up
III.) Squat variations
IV.) Squat kinematics and kinetics
V.) Depth, transfer and specificity
Alright, now before we get to the meat of the article, let's clear the air on a few things first:
1.) Is squatting bad for your knees? --> No (unless you have bad knees or bad technique)
2.) Is squatting bad for your back? --> No (unless you have a bad back or bad technique)
3.) Should everyone squat? --> Yes. Not everyone should barbell back or front squat, but yes, everyone should perform some squat variation at least infrequently.
4.) Do you need to squat to below 90° for it to be effective? --> No.
5.) Are bilateral or unilateral squats better? --> Yes.
The narratives that squatting is bad for your back/knees/marriage/kids’ social status/pet’s health dates back probably as long as formal strength training has existed. We’ve doused this fiery conversation in kerosene over the last decade or so (shout out Twitter and Instagram) and damn near anyone with a Wi-Fi connection and knee sleeves has been able to throw their two cents in. I honestly can’t think of a concentrated discussion topic in strength & conditioning that has been more heavily misconstrued or outright bastardized than that of squatting. Some of the takes I’ve heard (including some takes from recognizable coaches) have been nauseating. Everything from if you perform barbell back squats, you’re a ticking time bomb for herniating a spinal disc, to squats don’t transfer, to anything that isn’t ass-to-grass doesn’t count, and damn near everything in-between.
I feel like a broken record with some of this now, but it’s so important to understand that these overgeneralized black/white comments- even from highly reputable and credible coaches- is complete horse shit. There are very obvious do’s and don’ts that simply require common sense on the coach’s behalf. For instance, about 50% of my athletes have had a major back surgery at some point, and for that reason alone, I’m not going to put them under a barbell for heavy back squats. Why? Well because that’s fundamentally inept. But aside from these obvious cases, it’s impossible to simply say squats are good or squats are bad. No different than anything else, they’re good for some, bad for others, and can always be modified to appropriately fit the athletes you work with.
I.) Contraindicating Injuries
Okay, let’s just go ahead and get this out of the way first. Truth be told there is a population that simply has no business getting under a barbell for squatting. For the most part, this will not be the case in the high school or collegiate athletic realm, although I’d argue that there are some that simply shouldn’t perform conventional back squats in this population either. But the majority of those who outright should not barbell squat are those with significant injury histories. Namely, those who have had major back or neck surgery, those who have had multiple knee or hip surgeries, extensive shoulder surgeries, or those with chronic ankle/foot issues. Now, this is the important part, just because we can’t perform conventional, bilateral, barbell back squats, does NOT mean they can’t squat. It means they can’t squat THAT way. The easiest example on this, again, is major back surgery (i.e. microdiscectomy, spinal fusion, vertebroplasty), this population just has no business performing barbell back squats. However, I’ve had multiple athletes with these surgeries and have had them alternatively perform belt squats (specifically on a Pit Shark) and had some who can goblet squat no problem. Additionally, I’ll have these athletes perform a variety of split squat variations with no issue (normally loaded with kettlebells/dumbbells). So again, just because we can’t bilateral back squat, does not mean we can’t squat.
Primary contraindicating injuries at the hip joint are going to be labrum tears, severe SI joint dysfunction (or fusion), or severe hip fractures/dislocations. Severe hip injuries aren’t nearly as common as back or knee injuries, but they most certainly aren’t to be overlooked. I’ve had a few athletes who’ve had labral hip tears that have had no issues squatting. I’ve had others with the same pathology that will be in pain simply by looking at a squat rack. I have no idea why, but this is a highly variable injury, and presents differently in every individual with high variability. If there’s any hip fusion, including SI joint, I personally won’t even bother trying to back squat them. This is one of those things that I don’t need evidence to sway me one way or the other, intuitively that just doesn’t make sense to me, so I’ll always just seek an alternative for this crowd.
As for the athletes with knee issues, I think this is more variable, and highly dependent on the athlete at hand. What I’ve noticed most with knees is the influence of trunk position or inclination, as well as where the load is positioned. For mild-moderate, intermittent knee pain, having the athlete perform squats with a higher degree of trunk flexion could bypass a good amount of knee irritation alone. Recall that one of the quad muscles, the rectus femoris, is a biarticulate muscle (1). Meaning, the rec fem both extends the knee, but also flexes the hip. If we have an athlete with moderate knee pain or irritation (without diagnosis), we can take some stress off the knee by increasing our trunk inclination and getting the rec fem to work a little more optimally for us. Increasing the trunk angle will also change the levers at play, ultimately reducing the moment arm between knee and position of load. Shorter moment arm = reduced torque = happier joints.
If they haven’t had anything specifically diagnosed, I would just continue to play with the position of the athlete and change the position of the external load until you find a remedy. Of course, that’s in combination with traditional treatment protocols, and it’s important to note that if pain persists, we’re doing something wrong. As for those with multiple ligamentous injuries/surgeries, or degenerative cartilage (i.e. arthritic knees, menisci tears/removal, or patellar injuries) I personally will rarely have them perform conventional bilateral squats. For me, this crowd will predominantly perform unilateral variations. Because the knees aren’t as fixed as they are in a bilateral stance, a unilateral (or split) stance typically allows them to squat without much or any pain. Speaking specifically to the ACL crowd, once they’ve completed all stages of rehab (thinking 12-16 months post-op), I actually haven’t had much issue with getting athletes under barbell squats. I feel like they’ve gotten so damn good with ACL repair by now, this usually cleans up well and presents little residual issues. If the athlete has had multiple ACL surguries performed, either same or between knees, I will be significantly more cautious about bilateral squats.
The ankle is pretty straight forward as far as squatting is concerned- the more impaired dorsiflexion is, the less likely they’re able to perform bilateral squats with proficiency. Normative values for dorsiflexion are somewhere between 15-30° (1) and is often the most overlooked aspect of squat mechanics. For whatever reason, if dorsiflexion is compromised beyond 10° (i.e. reduced from 15° to 5°) back squats should be off the table for a while. Just think about it like this, if the ankle doesn’t move properly or completely, NOTHING up the kinetic chain will function properly. So, if it’s a case where dorsiflexion can be independently improved first, then squatting can be feasible thereafter. If this is a permanent issue, again, I would transition to exclusively using alternative options. Especially in a fixed, bilateral stance, impaired ankle function also creates compensatory patterns at the foot and intrinsic foot strength. This could accumulate and become problematic. An easy alternative for transient ankle dysfunction is using a small prop (i.e. wooden block or plate) to place under the heels, which will help facilitate dorsiflexion for the athlete. This is a great 'band-aid' solution for athletes with moderately impaired, transient ankle dysfunction but is not a solution strategy. Additionally, front-foot elevated split squats usually work well for athletes with ankle impairments because this set-up allows the athlete to maintain a relatively neutral tibia while going through the squat pattern.
The primary takeaway for contraindicating injuries for me is very simple. Before having your athletes perform any type of squatting (or anything, really), know exactly what you’re working with. Exercise prudence and good judgement and remain malleable. Not everyone can, should, or needs to bilateral back squat, so find an adequate alternative when needed. If alternative options still produce pain, you need to continue to seek other options or refer out.
II.) Structure and Set-Up
As we all know, no two athletes are built the same. Age, sex, height, weight, training history, injury profile, limb length, the ratio of limb length, torso length, tissue quality, hip socket, proportionality of muscular strength, and a host of other traits are all items to be considered during an assessment. This pertains to squat mechanics along with any other movement or exercise. But before we throw someone under a barbell, we need to understand exactly what (or who) we’re working with before we blindly have them squat.
According to a study conducted by (5), the average femur length is 17” and 18.2” for adult females and males, respectively. The average length for the tibia (lower leg) 14.2” and 15.2” for females and males, respectively (4). Segmental leg length is one of the premiere considerations for squat depth and set-up, but the ratio between the two is what you really want to focus on. Using the values listed above, the average femur:tibia ratio for females is 0.835, and for males 0.85. But the averages are just the averages, and candidly, this is just one study (although these seem to be pretty consistent across the literature I’ve looked through).
What is important to note, however, is when you have athletes that deviate from these averages, irrespective of male or female athletes. Athletes with abnormally long femurs (think basketball players), or abnormally long or short tibiae are things that you need to be aware of before having your athletes squat, because this will substantially impact their squat mechanics. Additionally, the torso length is another predominate factor that will determine squat mechanics, and again the ratio of the lower limbs and torso collectively is the full scope. Here’s a simplified explanation of how limb length changes squat patterns that should help provide clarity: Limb Length and Squatting (video via: Personaltrainingdotcom).
The next item to be cognizant of is how the femur articulates in the acetabulum (hip socket). This one is a bit more difficult to construe, considering we really can’t know the shape of someone’s femur, or how the joint is situated without having an x-ray… so in other words, we’re just taking educated guesses based on what we see. But that being said, we have two items to be aware of regarding hip socket articulation, those are coxa vera vs. coxa valga, and anteversion vs retroversion. Coxa vera/valga refers to the angle of inclination between the femoral neck and shaft. Normative values for adults are between 120-135°, coxa vera is an angle <120° and coxa valga is an angle >135° (1).
Anteversion and retroversion refer to the angle at which the socket sits relative to the hip. The normal angle between the long axis of the femur and condyles is about 15° for adults (1). Anteversion is defined as 35° of excessive internal rotation, and retroversion is defined as excessive external rotation of 45° (1). Here is a short clip from the true experts on all things squatting on how to identify hip socket articulation, and how that transposes into squat stance set-up: Craig’s Test (video via: Squat University).
The main takeaway from vera/valga and anteversion/retroversion is how wide the stance should be for squats. Again, broadly speaking, those with anteversion will favor a narrower squat with neutral foot position. Conversely, those with retroverted hips will favor a wide stance, with a slightly externally rotated foot. You’d be surprised how much you can clean a squat pattern up simply by adjusting the stance width.
A good rule to live by is simply going off of what you observe. In a nutshell, if it looks bad, it is bad, and if it’s bad, it needs to be addressed. There are a lot of coaches who observe poor squat mechanics and simply chalk it up to “whelp, guess that’s just their pattern” and either allow the poor mechanics to continue, or do away with squatting altogether. In either case, that’s lazy, imprudent, and not the way to handle the situation. Break the squat pattern down, adjust a few things like stance, bar placement and optimal depth, and let them try to optimize the pattern. If it’s still bad, or pain is still present, then we’ll scrap the back squat and seek alternatives such as a split variation or belt squat. But do your due diligence first.
Hi Bar or Low Bar…
Another debate that’s older than time itself, and another one that I’m going to throw a passive aggressively neutral answer at you. For starters, the bar position is going to be a non-discussion in select strength training disciplines. For instance, if you’re an Olympic weightlifter, you’re going to exclusively use a high bar set-up because this is directly reflective of the positions we see in competition. Conversely, if you’re a powerlifter, you’re going to exclusively use a low bar set-up because… yep you guessed it… this is directly reflective of how you perform in competition. As for team-based sports, there’s a little more room for discretion and personal preference. From my experience, basketball strength coaches tend to favor a high bar placement, and football coaches tend to favor a low bar placement. But again, there’s more crossover in these settings.
The difference between hi bar and low bar placement honestly isn’t that enormous, and for most athletes will be determined by structure and preference. But that said, the low bar position is going to create an increased hip extensor torque and decreased knee extensor torque (5). For hi bar squats, it will be the reciprocal- increased knee extensor torque (quads), decreased hip extensor torque (glutes) (5). A good example of how the bar placement could be significant for athletes in a general sense is to consider an athlete with chronic knee pain (i.e. jumpers’ knee), for this instance, we may want to try a low bar placement to see if we can take some stress off the knees. Another case would be someone who is coming off of, let’s hypothetically say an ACL surgery, and is seeking to build back quad muscle. In this case, (obviously at the appropriate time in rehab protocol, internet coaches…) we could use a high bar placement to increase the demand on the quads, specifically the VMO. Aside from these types of situations though, I generally just let athletes roll with what their preference is.
Wide or narrow stance…
Another common inquiry is whether to have a wide or narrow stance. As I alluded to above, this is something that is going to be more governed by anatomical structure than anything else. I’ll use myself as an easy example here… when I squat, I try to cover as much ground as I can. Being that I’m 6’4” with shit for hip mobility and more shit for flexibility, I want to try to reduce my range of motion as much as possible. Also, my hip structure heavily favors an externally rotated set-up. For these reasons alone, I will inherently favor a wide-stance setup.
Of course, we can specifically program wide-or-narrow stance for specific training qualities, but broadly speaking, athletes are going to be comfortable in either wide or narrow based on their individual structure. Long legs, retroverted hips (or coxa valga), or athletes with powerlifting backgrounds are going to tend to favor a wide stance set-up. The opposites being true for those favoring a narrower stance. But beyond that, there are some noteworthy differences between the two stances to be mindful of. According to Fry et al., a wider stance promotes increased activation for hip adductors and extensors. Conversely, a narrower stance appears more optimal for those seeking to increase activation of quads (namely the vastus medialis), and the gastrocnemius (6). Adjusting the stance will also alter the joint forces experienced during the squat, in which a wide stance will mitigate shearing stress on the knee due to reduced forward translation of the knees, while a narrow stance will mitigate the patellofemoral compression (3). The primary takeaway here is adjusting the stance to fit the athlete, as opposed to forcing athletes to use one or the other based on your personal preference.
Part 2 to follow shortly...
References:
1.) Baechle, TR. Earle, RW., (2008). Essentials of Strength Training and Conditioning (4th ed.). Champaign, Il: Human Kinetics, 2008.
2.) Dietz C, Peterson, B., (2012). Triphasic Training. Hudson, WI: Bye Dietz Sport Enterprise.
3.) Fry, AC, Smith, JC, and Schilling, BK. Effect of knee position on hip and knee torques during the barbell squat. J Strength Cond Res. 17: 629–633,2003.
4.) McKean, MR. Burkett, BJ. Does segment length influence the hip, knee and ankle coordination during the squat movement? J Fit Res. 1(1), 2012.
5.) Schoenfeld, BJ. Squatting kinematics and kinetics and their application to exercise performance. J Strength Cond Res. 24(12): 3497–3506, 2010.
6.) Senter, C and Hame, SL. Biomechanical analysis of tibial torque and knee flexion angle: Implications for understanding knee injury. Sports Med. 36: 2006.