The Great Squat Debate: Toes Forward or Angled Out?

Toes Forward Debate Cover

During a recent Squat University seminar, I was approached by an athlete who wondered why I had asked everyone to show me his or her squat with their toes straightforward. This was definitely not the first time I’ve been asked this question. There’s a lot of controversy in the fitness world today when it comes to recommended foot position during the squat. Some experts say our feet should be straightforward all the time. Others advocate the toes should turn out at an angle. So who is correct?

This is actually a trick question. The answer is both. Let me explain.

Argument for Toes Forward

The squat is a movement first and an exercise second. When I screen a new athlete, I want to see their ability to squat with shoes off and toes facing forward. My goal is to assess their MOVEMENT. This method allows me to see any weak links with the athlete.

Squatting with your feet straightforward is more difficult than with the toes pointed slightly outward. I don’t think many would argue with that notion. However, that is the point of the screen.

Toes Forward Explination

In order to squat to full depth with the toes straightforward, an athlete must have adequate ankle and hip mobility and sufficient pelvic/core control. They must also have acceptable coordination and balance. By turning the toes out at an angle, it allows a majority of people to achieve a full depth squat with a more upright chest position. There will always be a few individuals who are simply unable to get into a deep squat position due to abnormal anatomical reasons. Some people are born with genetic abnormalities. With that said, most athletes should be able to reach ass to grass with a squat.

The bodyweight squat sets the movement foundation for other athletic actions such as jumping and landing. Many knee injuries occur when you land with your foot pointing out and with the knee caving in. Players who have to jump and cut will tear their ACL when the knee caves in and rotates. My goal is for athletes to land and jump with good mechanics therefore decreasing their lack of season-ending injuries.

Argument for Toes Out

As soon as you pick up a barbell, the squat now becomes an exercise. For this reason, there are slight changes in the movement pattern that are more “sport specific”. This includes turning the toes out slightly. Doing so creates a mechanical advantage for the squat. Not only does it give us a slightly wider base of support, but it does not challenge our pelvic control and mobility to the fullest extent (1).

Toes Out Explination

This is why some athletes can squat deeper when they turn their toes out. By externally rotating the hips we can usually achieve a deeper and better-looking squat.

When our hips externally rotate, the adductor muscles on the inside of our legs are lengthened. As we squat these muscles are put in a better position to produce force (length-tension relationship). This simply means the adductors are turned on and recruited to a greater degree during the squat if you turn your toes out slightly (2). The adductor magnus specifically has been shown to help produce hip extension (the action of standing up from a squat) (4). More help from the adductors means a stronger and more efficient way to move the barbell.

Adductor
The Adductor Magnus

Turning the toes out, however, only changes the activation of the adductor muscle group. The glutes and quads (the main movers in the squat) are not significantly activated to a greater extent (3). Research has shown that turning the toes out more than 30-degree is less effective (2). For this reason, you should perform barbell squats with your feet turned out anywhere from 10-30 degrees. Always use a position that is most comfortable for your body. Remember, no two squats will look exactly the same. It’s normal and expected for you and your friend to have different squat stances while lifting the barbell.

Final Thoughts

The argument is simple. I believe we should have the capability to perform a bodyweight squat with the toes relatively straightforward. If you cannot, more than likely there are some things you need to work on. I recommend turning your toes out when you squat with a barbell for optimal performance.

Toes Argument Post

This is the difference between training and screening. Screening should point out and illuminate limitations in how we move. Training should reinforce and strengthen our current movement capabilities. When coaching athletes, it’s your job to know the difference between screening and training.

Until next time,

SquatBottom
Dr. Aaron Horschig, PT, DPT, CSCS, USAW

With

Kevin Photo
Dr. Kevin Sonthana, PT, DPT, CSCS

**If you haven’t ordered your 4th of July SquatU shirt yet, they are still available! Sale ends this Sunday, June 19th! 

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Resources

1) Movement: Functional Movement Systems: Screening, Assessment, and Corrective Strategies.Gray Cook, editor. On Target Publications: Santa Cruz, California, U.S.A.2010

2)Pereira GR, Leporace G, Chagas DDV, et al. Influence of hip external rotation on hip adductor and rectus femoris myoelectric activity during a dynamic parallel squat. JSCR; 2010. 24(10):2749-2752

3) Clark DR, Lambert MI, & Hunter AM. Muscle activation in the loaded free barbell squat: a brief review. JSCR; 2012. 26(4):1169-1178.

4) Dostal WF, Soderberg GL & Andrews JG. Actions of hip muscles. Phys Ther. 1986; 66:351-359. 

 

Can The Knees Go Over The Toes? (Debunking Squat Myths)

Lu Front Squat

 

Welcome back to Squat University. Last week we discussed the myth that squatting deep is dangerous for the knees. After looking into what actually happens at the knee joint we were able to debunk this misconception. Healthy athletes can perform the squat to full depth without worrying about hurting their knees given proper training methods. We should all feel free to squat ass-to-grass as long as correct technique is used and we don’t max out every day.

Today I want to tackle another common myth of the squat. There is a strong held belief by many that the knees should never go over the toes when squatting.

Just last week, I was guest lecturing to a class of physical therapy students at the University of Missouri. I asked a simple question, “How many people here think we should never have our knees go past the toes while squatting? Following my inquiry, every single student held their hand raised. The next thing I said was, “You’re all wrong.”

No one is certain where this myth started. However, it has become a mainstay in today’s fitness and medical world. The instruction is even a part of the National Strength and Conditioning Associations (NSCA) guidelines for how to teach a proper squat (1).

Yet, is it really all that dangerous? For over 10 years I have had the opportunity to watch and compete on the same platform with some of the best weightlifters in the United States. To lift the most amount of weight during the clean a weightlifter must catch the barbell in a deep squat position. In order to remain upright with the bar secured on the chest, the knees of many lifters will move past their toes. Are these weightlifters putting their knees in harms-way every time they lift the barbell?

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Knees over Toes?

The cue to limit the knees from moving past the toes during the squat is really nothing more than a quick fix to a deeper problem. In hindsight the originators of the cue were likely well-intentioned strength coaches or physical therapists.

When an athlete squats poorly, they often move from their ankles first. As the ankles move it causes the knees to hinge forward. The weight of the body is then shifted forward on to the balls of the feet. This type of movement problem has been called the “knees first” approach. Moving in this way leads to greater shear forces on the knee joint and contributes to increased risk of injury and eventually to pain (2).

Incorrect Squat "Knees First".png

To many individuals, this issue would appear to be a problem of the knee. Athletes who squat poorly by moving their knees forward often develop pain. Therefore limiting this forward movement solves the problem…right? However, limiting the knees from moving only addresses the symptoms of a bigger problem.

The issue is actually with balance. The knee is only a hinge joint. It will only move forward based on what goes on at the ankle and hip. Instead of focusing so much on what is going on at the knee, we should really be focusing in on the hip and ankle joint when we squat.

One of the absolutes of squatting is that our center of gravity must remain over the middle of our foot. This allows our body to remain balanced and work efficiently to produce strength and power. During a bodyweight squat our center of gravity is located around our belly button. When weight training, the barbell now becomes our center of gravity. The efficiency of our movement is dictated by how well we can maintain this weight over the middle of our foot.

When the knees hinge forward early in the squat the athlete’s center of gravity is shifted forward onto the balls of their feet. Therefore the cue to limit the knees from moving forward is actually correcting for a weight shift problem. It has little to do with the knee joint itself and more to do with ensuring the athlete stays balanced.

Balanced Squat Explination.png

Sitting Back in the Squat

So how do we correct for moving from the ankles first? The cue to “sit back” or to “push the hips back” allows the athlete to move from their hips first instead of their ankles during the descent of the squat. This engages the powerhouse of our body (the posterior chain). Doing so also limits pre-mature forward movement of the knees. This allows the athletes center of gravity to remain over the middle of their foot.

Correct Squat "Hips First".png

However, the cue to limit the knees from moving forward only works to a point. In order to reach full depth in the squat there comes a time when the knees must eventually move forward. The deeper we squat, the more our knees will have to move forward in order to remain balanced. This concept can be hard to understand for many in the medical community. Let me explain.

In order to reach full depth in the squat, the hips must eventually be pulled under the torso. This allows us to remain balanced and keep our chest upright. Because the knee is a hinge joint that moves based on what happens at the hip and ankle, it will be forced forward at this point.

Bodyweight Squat Transition.png

It is very normal for athletes to have their knees move forward even past their toes. It all comes down to weight distribution and the ability to maintain our center of gravity over the middle of our foot.

We should be concerned on when the knees more forward past the toes, not if.

The Barbell Squats

In the sport of powerlifting, athletes will commonly use a low-bar back squat technique. This position secures the bar further down on the back over the middle of the shoulder blade (scapula). The athlete will use the “hips back” approach during the squat with an inclined trunk position in order for the bar to remain balanced over the middle of the foot. This allows the majority of the weight to be hoisted through the strength of the hips and minimal forward movement of the knees (5). Because our hips are extremely strong, athletes use this technique to lift over 1,000 lbs!

However, this squat technique can only descend to a certain point. If an “ass-to-grass” squat were to be attempted with the low-bar back squat, the athlete would eventually fold in half like an accordion!

In the sport of weightlifting athletes will commonly use the high-bar back squat, front squat and overhead squat techniques. These barbell movements resemble the positions an athlete will use during the competition lifts of the snatch and clean & jerk. These lifts require a more balanced approach between the hips and knees in order to maintain an upright trunk. Athletes must descend as deep as possible in order to effectively lift tremendous weights.

By allowing the knees to eventually move forward, the weightlifter can descend into a deep clean or snatch without falling forward. For this reason, the weightlifter cannot perform the front squat like the low-bar technique of the powerlifter.

Squat Balance Shot

While shear forces have been shown to increase in the deep squat position with forward knees, the body can handle them appropriately without risk for injury (2). If done properly with a “hip first” approach, the knees going past the toes is not only safe but necessary.

Take Away

The next time you watch someone squat, focus on what joint moves first. Someone who moves poorly will move with a “knees first” approach. On the other hand an athlete who moves with good technique will move with the hips back first.

Science has shown that the knees of healthy athletes are relatively safe in the bottom of a deep squat (2,6). There is no denying this research. As long as excessive loading is limited and good technique is used, the knees CAN and MUST move past the toes in the bottom of a squat in order to allow the hips to drop fully.

Strength coach Michael Boyle once wrote: “The question is not where does the knee go, as much as where is the weight distributed and what joint moves first” (3). Remember, the knee is only a hinge joint. As long as it is kept stable (in line with the feet) we should not worry about them. Proper squatting is all about moving at the hips first and staying balanced. The rest takes care of itself.

 

Until next time,

SquatBottom
Dr. Aaron Horschig, PT, DPT, CSCS, USAW

With

10985901_10152775697961717_3089916301038642033_n
Dr. Kevin Sonthana, PT, DPT, CSCS

 

Resources

1) Earle RW & Baechle TR. Essentials of Strength Training and Conditioning. Champaign, IL. Human Kinetics, 2008. Pp 250-351.

2) Schoenfeld BJ. Squatting kinematics and kinetics and their application to exercise performance. JSCR. 2010;24(12):3497-3506.

3) Boyle M. “Knees over toes?” Strengthcoach.com. Web. 25 Jan. 2016.

4) Fry AC, Chadwick Smith J, & Schilling BK. Effect of knee position on hip and knee torques during the barbell squat. JSCR. 2003; 17(4): 629-633

5) Swinton PA, Lloyd R, Keogh J WL et al. A biomechanical comparison of the traditional squat, powerlifting squat, and box squat. JSCR. 2012;26(7): 1805-1816.

6) Hartman H, Wirth K, & Klusemann M. Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Med. 2013;43:993-1008.

 

 

 

 

Debunking Squat Myths: Are Deep Squats Bad For The Knees?

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The squat is a staple exercise in almost every resistance-training program. Today athletes of all ages and skill levels use the barbell squat to gain strength and power. However, a good amount of controversy still exists on its safety. There are many opinions when it comes to optimal squat depth. Some experts claim squatting as deep as possible (ass-to-grass) is the only way to perform the lift. Others believe deep squats are harmful to the knees and should never be performed. So who should we believe?

History 101

To start, we need to discuss where the fear of deep squatting originated. Let’s take a trip back to the 1950’s. We can trace the safety concerns with the deep squat back to a man by the name of Dr. Karl Klein. The goal at the time was to understand the reason behind the rise in number of college football players sustaining serious knee injuries. He suspected these injuries were in part due to the use of full range of motion deep squats during team weight training. Klein used a crude self-made instrument to analyze the knees of several weightlifters who frequently performed deep squats.

In 1961 he release his findings, stating that deep squatting stretched out the ligaments of the knee (1). He claimed this was evidence that athletes who performed the deep squat were potentially compromising the stability of their knees and setting themselves up for injury. He went on to recommend that all squats be performed only to parallel depth.

Klein’s theory was eventually picked up in a 1962 issue of Sports Illustrated. This was the catalyst he needed to spread the fear of deep squatting and save the knees of athletes everywhere. The American Medical Association (AMA) soon after came out with a position statement cautioning against the use of deep squats (2). The Marine Crops eliminated the “squat jumper” exercise from their physical conditioning programs (2). Even the superintendant for New York schools issued a statement banning gym teachers from using the full depth squat in physical education classes (2).

There were some individuals who disagreed with Dr. Klein. In May of 1964 Dr. John Pulskamp (a regular column in the notorious Strength and Health) wrote, “full squats are not bad for the knees and they should certainly not be omitted out of fear of knee injury” (5). Despite Dr. Pulskamp’s best efforts, the damage that Klein inflicted had been done. By the end of the decade strength coaches across the country stopped teaching the full depth squat. In some cases, the squat was dropped from training programs all together (1).

Thanks to the advancement in exercise science and biomechanics research, we have learned so much more about forces sustained during squats. Lets now go over what we have learned in the past few decades in order to better understand what exactly happens at the knee joint during the deep squat.

Squatology 101

When we squat our knee sustains two types of forces: shear and compressive. Shear forces are measured by how much the bones in our knee (femur and tibia) want to slide over each other in the opposite directions. These forces in high levels can be harmful to the ligaments inside the knee (ACL and PCL). These small ligaments are some of the primary structures that hold our knee together and limit excessive forward & backward movement.

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Compressive force is the amount of pressure from two parts of the body pushing on each other. There are two different areas that sustain this type of force in the knee. The meniscus absorbs the opposing stress between the tibia and the femur. The second type of compressive force is found between the backside of the patella (knee cap) and the femur. As the knee bends during the squat, the patella comes in contact with the femur. The deeper the squat, the more connection between the patella and the femur.

KneeCompression.jpg

PatellarCompression.jpg

When we look at these forces (shear and compression) we see that they are typically inversely related. This means when the knee flexes during the squat, compressive forces increase while shear forces decrease (6).

Ligament Safety

Some medical authorities have cautioned against the use of deep squats due to excessive strain placed on the ligaments. However, it appears these concerns are not based in science at all.

Science now tells us that the ligaments inside our knee are actually placed under very little stress in the bottom of a deep squat. The ACL (anterior cruciate ligament) is the most well known ligament of the knee. ACL injuries are common in popular American sports such as football, basketball, soccer, lacrosse, etc. The stress to the ACL during a squat is actually highest during the first 4 inches of the squat descent (when the knee is bent around 15-30°) (7). As depth increases the forces placed on the ACL significantly decrease. In fact, the highest forces ever measured on the ACL during a squat has only been found to be around 25% of its ultimate strength (the force needed to tear the ligament) (8).

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The PCL (posterior cruciate ligament) is the second ligament that is found inside the knee. During the squat it sustains max forces just above a parallel squat position (around 90° of knee flexion) (10). Just like the ACL, this ligament is never placed under excessive stress during the squat. The highest recorded forces on this ligament have been only 50% of the estimated strength in a young athlete’s PCL (10).

In fact, science has shown that the deeper you squat the safer it is on the ligaments of your knee. Harmful shear forces are dramatically decreased due to an increase in compression. Also, the muscles in our legs work together to stabilize the knee. As we squat the hamstrings work with the quadriceps to counteract and limit excessive movement deep inside the knee (6).

Thus, the ACL and PCL stay unharmed no matter how deep the squat!

Knee Stability

The original studies by Dr. Klein claimed squatting deep stretched out the ligaments that hold the knee together and ultimately leaving it unstable. However, these claims have never been replicated. Researchers have even used a copy of Klein’s testing instrument in their own studies. Their findings disapproved Klein’s research. They found that athletes who used the deep squat had no difference in the laxity of their knee ligaments than those who only squatted to parallel (3).

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Science has actually shown that squatting deep may have a protective effect on our knees by increasing its stability! In 1986 researchers compared knee stability among powerlifters, basketball players, and runners. After a heavy squat workout the powerlifters actually had more stable knees than the basketball players (who just practiced for over an hour) and runners (who just ran 10km) (9). In 1989 another group of researchers were able to show that competitive weightlifters and powerlifters had knee ligaments that were less lax than those who never squatted (4). Again and again, research has shown that the deep squat is a safe exercise to include in a healthy athlete’s training program.

When can deep squatting be harmful?

Theoretically, most of the damage that the knees would sustain from deep squats would be due to excessive compression forces. Some authorities claim that because deep squats raise compression forces at the knee they cause the meniscus and the cartilage on the backside of the patella to wear away. While an increase in compression would lead to a greater susceptibility for injury, there has been no such cause-and-effect relationship established by science!

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If this were true, we would expect to see extreme amounts of arthritis in the knees of weightlifters and powerlifters. Fortunately, this is not the case. There is little evidence of cartilage wear in the knees as a result of long-term weight training. In fact, elite weightlifters and powerlifters (who sustain loads up to 6x bodyweight to the knee in the bottom of a deep squat) have relatively healthy knees compared to you and me! (11)

Considerations for Squatting Deep

Every coach must consider a few things when determining optimal squat depth for an athlete. Everyone should have the capability to perform a bodyweight squat to full depth, period. That being said, the depth of the barbell squat should be based on the requirements of an athlete’s sport. A weightlifter for example needs to establish strength in the full depth squat in order to lift the most amount of weight on the competition platform. On the other hand, a barbell ass-to-grass squat is not necessary for a soccer player. He or she can still gain efficient strength and power from a parallel depth squat.

An athlete’s injury history also needs to be taken into account when determining optimal squat depth. Often athletes will ignore pain in their pursuit of performance gains. The phrases “no pain, no gain” and “know the difference between hurt and injured” cannot apply to the weight room. Pain is like the warning light in our car. The light is indicating something is wrong. Just as ignoring your car’s warning light on will lead to engine problems, pushing through pain in the weight room will lead to injury of our physical body. For this reason, if an athlete is injured and has knee pain, deep squats may not be the best choice. The depth of the squat must be limited to a pain free range if we want to stay healthy and continue to compete injury free.

Squat depth should also be limited if it cannot be performed with good technique. Poor movement only increases our risk for injury. An athlete’s body is like a finely tuned sports car. Constantly driving pedal to the metal and taking aggressive turns will lead the car to break down faster. The same goes for squatting. You can only lift so much weight poorly for so long before your body sustains an injury. Squatting to full depth poorly is a great way to invite injury.

Take Away

So what have we found out since 1964? Contrary to mainstream belief, we now know that squatting deep or “ass to grass” is actually not as dangerous as Dr. Klein made it out to be. Research again and again has failed to support the theory that deep squats are bad for the knees in healthy athletes.

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For athletes with healthy knees, performing the squat to full depth should not cause injury as long as heavy loads are not used excessively. Proper training programs should employ light, medium and heavy intensity cycles throughout the year in order to lessen any harmful effects of constant heavy loading. Now that you have a deeper understanding of full depth squats, feel free to get that ass to the grass!

Until next time,

 

SquatBottom
Dr. Aaron Horschig, PT, DPT, CSCS, USAW

With

10985901_10152775697961717_3089916301038642033_n
Dr. Kevin Sonthana PT, DPT, CSCS

 

References

  1. Todd T. Karl klein and the squat. Historical Opinion. NSCA Journal. June-July 1984: 26-67.
  2. Underwood J. The knee is not for bending. Sports Illustrated. 16: 50, 1962.
  3. Myers E. Effect of selected exercise variables on ligament stability and flexibility of the knee. Research Quarterly. 1971; 42(4):411-422.
  4. Chandler T, Wilson G & Stone M. The effect of the squat exercise on knee stability. Med Sci Sports Exerc. 1989; 21:299-303
  5. Pulskamp, JR. Ask the doctor. Strength and Health. 1964, May. p. 82.
  6. Schoenfeld BJ. Squatting kinematics and kinetics and their application to exercise performance. JSCR. 2010;24(12):3497-3506.
  7. Li G, Zayontx S, Most E, DeFrante LE, Suggs JF, & Rubash HE. Kinematics of the knee at high flexion angles: an in vitro investigation. J Orthop Res. 2004b; 27:699-706.
  8. Gullett JC, Tillman MD, Gutierrez GM & Chow JW. A biomechanical comparison of back and front squats in healthy trained individuals. J Strength Cond Res. 2009;23:284-292
  9. Steiner ME, Grana WA, Chillag K & Schelberg-Karnes E. The effect of exercise on anterior-posterior knee laxity. Am J Sports Med. 1986; 14:24-29.
  10. Escamilla RF, Fleisig GF, Zheng N, Lander JE, Barrentine SW et al. Effects of technique variations on knee biomechanics during the squat and leg press. Med Sci Sports Exerc. 2001a; 33:1552-1566.
  11. Fitzgerald B & McLatachie GR. Degenerative joint disease in weight-lifters fact or fiction. Brit J. Sports Med. 1980 August. 14(2&3):97-101