Rebuilding You: Part I

Part I: Relearning the Squat from the Ground Up
Written by: Dr. Elizabeth Chamis, DPT

In part one of this segment, we will discuss proper squat form and offer solutions to dysfunctional patterns built over time. If you have back pain, knee pain or foot pain, this series will be especially helpful and could potentially alleviate some of those symptoms simply by fine-tuning your form.

The squat is a foundational movement that everyone performs on a day-to-day basis. Whether you are an Olympic athlete, weekend warrior, or just trying to maintain your health, you use the squat every day for a variety of activities, including movements as simple as sitting-to-stand during dinner, using the toilet, or picking up your child. Because this movement is called on frequently, it makes sense to perfect the technique to maximize movement (especially when loaded).

The problem...
Over the years many coaches and health professionals argued that pointing the toes out during the squat opens the hips, allows for greater depth, and provides the best base for performing a lift (see Photos #1a & b). While this is a popular belief, and indeed does allow an athlete better hip mobility, it sacrifices torque and stability in the lower extremities through excessive external rotation and decreased muscle control in the entire kinetic chain (from feet to hips). This predisposes an athlete to medial collapse at the knees and navicular drop (dropped arches/over pronation) at the feet, a position that places unwanted wear and tear on the ligaments and joints of the knee. An excessive navicular drop can lead to shin splints and plantar fasciitis (see Photos # 2a & b). 

The solution...
To produce maximum force, strengthen the lower extremities, and protect the joints while squatting, a recommended alternative is to have the toes pointed in forward direction (Beginner’s suggestion: approximately 0-10 degrees external rotation) with an active foot stance (if you are unsure where your optimal foot/leg position is during the squat, your Physical Therapist can quickly assess this for you based on your anatomy). This limits the amount of excessive pronation as your lower leg moves forward during the squat. Then, externally rotate the thighs, which will turn the knees outward (see photos 3a & b).​

Another point of performance when addressing the lower extremity mechanics of a squat is to keep the shins vertical. There are many shearing forces placed on the knee when the lower leg translates too far forward. Therefore, it is imperative to maintain this proper position (see Photos #4a & b).​

The test...
​Try these techniques for yourself and see how this foot position engages the posterior chain (glutes/hamstrings) significantly more than when feet are in a duck position.  

Dr. Kelly Starrett in his book, “Becoming a Supple Leopard”, addresses this topic in depth and stresses the importance of a proper setup of feet and knees prior to conducting a squat. He also has devised several tests for coaches and athletes to compare the various foot positions in order to decide where the greatest torque can be achieved. Check out his book or visit him on the web for more information.

Be sure to check back for Part II of this series where we will discuss spinal stability and positioning while squatting.​