Pete McCall by Pete McCall

Have you ever tried over and over to teach a client an exercise that should be simple to learn yet they don’t seem to get it?  Teaching clients how to do an exercise correctly can be one of the most frustrating challenges that we face as a trainer.  One time I was working with a young woman with knee issues (she complained of general soreness with no specific injury).  When I asked her to demonstrate a squat the first movement she did was moving the knees forward into flexion before she hinged forward at the hips so I thought: “aha, there’s the source of the problem, she needs to learn how to squat correctly.”  There is no way to know for sure whether or not this was the specific cause of her soreness but we do know that if the knees move into flexion without concurrent action at the hips then it can put a lot of stress on the patellar tendon and cause discomfort.

As I set about trying to teach my client how to squat correctly she kept telling me that she was afraid of injuring her knees and had heard that her knees should never go past her toes while squatting.  I explained to her that her form might be the cause of the problem and that if she learned the proper mechanics then it would actually help her knees and reduce the discomfort.  She was hesitant but when I explained that being able to perform squats would help move her towards her goal of getting ready for the little green bikini she wanted to wear on an upcoming vacation she was bought in (let’s face it we need to learn the proper motivational techniques for each client, anytime I wanted her to focus I simply said: “green bikini” and we were back on track). 

I spent the better part of the next ten minutes or so trying to teach her how to hip hinge by using a dowel to keep her spine straight and driving her hips back to create a top-down movement of hip flexion (the first movement in the descent of a squat should be the pelvis moving into flexion on the femurs before the knees start to move).  It was probably my teaching style but she was having some difficulty learning the action.  She stopped to take a drink of water and as she was reaching for her water bottle she accidently knocked it over.  She immediately went to wipe the water off the floor when I yelled: “FREEZE!”  Without thinking about it she had dropped into a perfect squat, her heels were on the floor, her spine was straight and she had sunk back into her hips as she went to clean up the water. 

I pointed out her current position and asked if her knees bothered her; BECAUSE at this point her knees were past her toes and since she had the proper range-of-motion (ROM) in her hips her answer was: “NO.”  It turned out she had the proper ROM in her joints to do the movement but because she had listened to the myth of not letting the knees go past the toes had never learned how to do squat correctly.  Once I made a minor adjustment to her stance to make it a little wider than hip-width and taught her how to move her hips back while keeping her feet pressed firmly into the floor she was able to perform a perfect deep squat without any discomfort in her knees.

The fact is that squats are one of the fundamental patterns of human movement and an important exercise to incorporate into any training program because they involve a number of joints, and prepare our clients to perform a wide variety of common movements.   However, like the young woman I was working with, many clients tend to want to avoid doing squats out of fear that they could cause injury to either their backs or knees.  Any movement like the squat which involves multiple joints is a specific skill or task that takes time to learn correctly.  It’s important to take steps to teach the proper sequence of joint actions so a client can learn how to perform the exercise safely, efficiently and effectively.

One way to teach an exercise progression leading to learning how to squat is:

  1. Supine floor (glute) bridge: this teaches proper ROM for hip flexion and extension with a neutral spine
  2. Standing hip hinge: it teaches how to move the hips over relatively fixed femurs similar to the motion needed for a squat
  3. Assisted squat: using neuromuscular feedback to teach the correct pattern such as using a band or cable machine with hands (so the client can hold on like water skis) to help train the proper movement while maintaining balance; or using a bench to provide a target for where the hips should go during the descent phase.
  4. Bodyweight squat: simply performing a squat while extending the arms out front; the arms provide a counter-balance to the backwards motion of the hips
  5. Loaded squat: my preference is to use dumbbells (hold them in front of the shoulder liker preparing for an overhead press) or a bar across the shoulders to do a front squat which helps maintain a tall, neutral spine
  6. Squat jumps: the same motion performed explosively to focus on the serial elastic component of the muscle action (which helps improve power output of the involved muscles)

When done correctly squats require an optimal ROM from the mobile joints of the ankle, hip and thoracic spine.  If these joints are working correctly then performing an effective squat pattern should not cause any discomfort to a client, however if a client loses mobility from any of these joints that it could adversely affect the joints of the knee or lumbar spine which are designed for providing structural stability. 

When teaching the squat it is perfectly fine for the knees to move past the toes IF a client has the necessary mobility in the ankles (during tibia/fibula on talus/calcaneus dorsiflexion) and the hips to allow the spine to remain in a neutral position through the full ROM.  The enclosed picture of USA Weightlifting champion Ingrid Marcum is an excellent example of a deep squat with necessary ankle and hip mobility.  Try telling her or any other Olympic weightlifter that their knees should not go over their toes.

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