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The Squat Exercise and the

Functional Integrity of the Knee


Joint
Is the exercise helpful? Does it
do harm?

Trevor Cottrell, PhD


Athletic Therapy Program Coordinator,
Sheridan College
Brief History of the Squat
• Weightlifters up until the mid
1950’s largely used the “split”
to lift heavy wts
– the squat was used but as a
supplement for leg strength
• “Odd lifts” (now power lifts)
became popular in the 1950’s.
The squat was a part of this
activity.
What is a squat?
Or maybe it looks like this…
Or this…
Where else do we squat?
Why do we train squats?
Why do we train squats?
Why all of the controversy?
Stop that!
You’re going to
hurt your knees.
Objectives:
1. Identify potential locations of knee injury
during squats
2. Evaluate research studying the safety of the
squat
3. Examine the benefits of squatting
4. Coach appropriate techniques for squat
progression.
The knee and its supporting structures

MCL – provides stability to the inner part of the knee


LCL – provides stability to the outer part of the knee
The knee and its supporting structures

ACL – limits rotation and forward movement of patella


PCL – limits backward movement of the patella
The knee and its supporting structures

Menisci – shock absorbers, stabilizers


Articular cartilage – shock absorbers, smooth movement
Common Knee Injuries and Problems

1. Arthritis
2. Cartilage injuries and disorders
3. Injuries to the meniscus
4. Ligament injuries
5. Tendon injuries and disorders
The Controversy Begins
Klein, K.K. “The deep squat exercise as utilized in weight training for
athletes and its effect on the ligaments of the knee.” J. Assoc. Phys. Ment.
Rehabil. 15:6-11, 1961

Hypothesis:
– the deep squat exercise will stretch ligaments of the knee
and cause knee instability
Methods:
– 128 experienced weightlifters who did full squats and 386
subjects who did not compete in weightlifting nor did full
squatting.
– The study used a device, which Klein had built, to measure
the amount of medial or lateral give in the knee
“Squats have a debilitative effect on
the ligament structures of the knee…”
Results:
• Greater MCL and LCL instability
in weightlifters when compared to
controls

Conclusions:
• Deep squats will cause increased
instability of the knee
• Parallel squats should be used in
place of deep squats
The Klein Fallout
• Highlites of the study were published widely
in lay-journals
• Thousands of coaches who were suspicious of
weights felt vindicated
• General acceptance in the medical community
of Klein’s data
• U.S. Marine Corps recommended the removal
of squats from their PFT program
Assumption #1: Knee laxity predicts
injury
Nicholas, J. Sports Med (1975):
• Based on five subjective mobility tests
demonstrated a likelihood of knee ligament
rupture with increased looseness in NFL
players.
Kalenak and Morehouse, JAMA (1975):
• Knee ligament injuries the same in loose and
tight knee joints using objective measures of
the knee
Assumption #2: Klein’s tests are reliable
Karpovich et al, Teor Praxe tel Vvch (1970):
• 10 week program of deep squats did not affect the stability of the
knee
Meyers, Research Quarterly (1971):
• using Klein objective device did not find differences in laxity of
the knee
Chandler et al, MSSE (1989)
• 8 week full squat program did not result in increased instability
Steiner et al, Amer J Sports Med (1986)
• No increased laxity in powerlifters
• Increased laxity in basketball players and runners
“ It appears that repetitive physiologic stresses at a high strain rate
produce significant ligamentous laxity, while a relatively few
large stresses at a low strain rate do not.”
Klein Rebuttal Summary
• Klein’s findings were not valid, accurate or
reliable
• Klein’s findings have been handed down
through generations of coaches, doctors, PE
instructors and everyday people
• Once something is in print, no matter how
inaccurate it may be, it can take years to
remove the damage that it may cause
So are squats hard on the knees?

Compression

Posterior Anterior
Shear Shear
Shear and Compression Highlites
1. Anterior and posterior shear forces increase with depth of
squats but are within tolerable limits
2. Shear and compressive forces on the knee increase with speed
of descent and load
3. Shear and compressive forces are reduced in experienced
lifters
4. Shear and compressive forces increase with fatigue
5. Increased compressive forces that occur with increased
loading result in decreased shear forces
6. Ligament injuries are rare with squatting

Escamilla et al. (2000) Biomechanics of powerlifting and weightlifting exercises,


Exercise and Sports Sciences, WE Garrett and DT Kirkendall (Ed.), Lippincott
Williams and Wilkins.
Arthritis and Chrondomalacia?
• No difference in degenerative
changes of the knee found between
weightlifters and controls
• Less symptomatic arthritis in retired
weightlifters
• No chondromalacia signs or
symptoms in 80 weightlifters
studied
• Low incidence of arthritis in those
who load the knee joint through full
ROM

Use it or lose it
Greatest concern = patellar tendonitis

• Quadriceps tendon and


patellar tendon (ligament) are
very susceptible to overuse
injuries during prolonged
squatting
• Too much load, too many
reps, too soon
Squat Conclusions
Squats, when performed correctly …
1. are safe
2. may prevent injury
3. are an effective rehabilitation tool
4. can enhance athletic performance
5. can enhance muscle strength and
power
6. can strengthen connective tissue,
bones, ligaments and tendons
7. has transferability to sport
Chandler and Stone (1991) The squat exercise in athletic conditioning:
a review of the literature. NSCA J, 13(5), 52-58.
Squat Techniques
• High bar squats • Half Squats
– Bar high on traps, greater load – Knee and Hip flexes to 60
on knees degrees
• Low bar squats • Parallel Squats
– Bar low on traps, greater load – Top of thigh stops when
on hips parallel to floor
• Front squats • Full Squats
– Bar rests on anterior deltoid, – Top of thigh goes below
greater load on knee parallel
• Olympic Squats
– Maximum knee flexion -
“rock bottom squats”
4-Level Squatting Progression

1/ Box step ups


2/ Supported squats
3/ Free-hand squats
4/ Barbell squats
Level 1/ Box Step-ups

Secondary progressions:
1. Increase box height

6” box
12” box
Start Finish

Coaching tips
– Don’t push off back leg
– Don’t lean forward
Level 2/ Supported Squats

Secondary progressions:
1. High ball/chair
2. Low ball/chair
3. Single hand support

Start/Finish
Coaching tips
– Set foot position
– Keep back flat
– Push hips back
– Weight towards the heals
Level 3/ Freehand Squats
Secondary progressions:
1. Hands in front
2. Hands overhead

Start/Finish

Coaching tips
– Sitting on a cold toilet
– Lift chest high
– Exhale on rising
Level 4/ Barbell Squats
Secondary progression
1. Add load
2. Front squats

Start/Finish

Coaching tips
– Squeezing traps
– Bring elbows back
– Keep head up
Correct bar placement
Golden Rule

Advancement through the levels can only


occur by sequential mastery of each level.
Take-Home Messages
1. Negative attitudes towards squats are the result of
generations of misinformation and meathead
approaches to teaching squat technique
2. Squats are a low-risk exercise with significant health
and performance benefits
3. The greatest injury risk with squats occurs from
overuse
4. By applying the 4-level method of teaching squat
progressions, anyone can learn how to squat safely
and effectively

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