Why squats are so important as part of a physiotherapy assessment

Squats are frequently used as a screening tool in professional sports to help improve performance and decrease injury risk. This is because squats require mobility, stability and strength. By comparing a patients squat or deep squat to the correct technique (see below diagrams) tight, overactive, weak muscles and stiff joints may be seen and can then be further investigated in the physiotherapy assessment.

As an exercise squats are brilliant for back, hip, knee and ankle rehabilitation because a good squat

requires.....

1. Flexible but controlled feet- They should be facing forward, equal weight through them both, not rolling in or rolling out.

2. Good ankle flexibility- Calf muscles can get quite tight in our sedentary lifestyles, especially with fashion foot wear. If your calves are tight you wont be able to get the bottom building blocks of the squat right and your weight will be forward making you unstable.

3. Good knee strength and flexibility- Your knees are the middle point for the rotational forces coming from

your ankle and hips and need to be able to transmit these forces safely. Knees should not be in front of ankles.

4. Good hip strength and flexibility (for me the most important thing i'm assessing) as most of movement in a squat comes from bending your hips. A lot of the time people don't do this- they compensate for lack of control and movement in their hip by curving their back or bend their knees forward too much. Also weak hip muscles can lead to knees falling inwards (which then causes feet to fall in and we are back to No. 1).

5. Good core stability and strength- (once in the correct position with feet and knees) you then need your

core muscles to work to keep the control in your spine and not overload the discs or joints by being in spinal flexion or extension.

6. Symmetry- the left and right sides of your body should be doing the same things at the same time.

Squats also replicate a movement which you do throughout the day - when you sit to stand. As soon as you have pain you alter this movement which then puts additional loads through the body. People with lower back pain tend to avoid leaning forward and use their arms to push themselves up keeping their body upright. Or when people have leg pain they avoid putting weight through it when they stand, they shift their weight onto their good side which creates a rotational twist in their pelvis and spine.

All these variations create asymmetry and altered movement patterns which don't always go back to 'normal' after the pain has gone. This can then lead to overload of the tissues in future and further pain and injuries. That's why looking at squats are important following pain and injuries and to retrain during rehabilitation.

From an injury prevention and performance perspective, if you cant manage squats on two legs then chances are you wont have the correct position or control on one leg. You need to control of one leg when walking/running/stairs/playing sports etc. One common example of poor squat technique is when knees fall in, this then translates into poor hip and knee control and one leg both standing still and moving.

To correct this you start how to do a 2 footed squat properly before progressing the exercises to include single leg squats and more dynamic exercises such as jumping and hopping.

So what goes wrong with squats????

- weight is too far forward (no gluts working, overloading front of knees hard to be stable in this position)

- knees are too far forward over ankles (increased forces through the front of the knee)

- one or both knee falling inwards or outwards (weak hip muscles which pull knee into correct alignment or/and poor foot control)

- poor hip flexion making lower back curved (increased loads through discs in spine and makes it hard to look upright)

So hopefully I have explained why assessing squat technique and retraining the movement following an injury or trying to prevent an injury is pretty important to me as a Chartered Physiotherapist. If you regularly do squats in the gym get a friend to take some photos and have a good look at your technique- can you try and improve it given what has just been discussed? If you have had an injury or pain recently have you had treatment or rehabilitation to assess your movements to make sure you are not compensating? If not again get a friend to take photos and see. If you have pain at present then I would advise you to see a Chartered Physiotherapist for further assessment (Find your local physio).

I am available in the North West (Wirral, Cheshire, Lancashire, Merseyside) and North Wales for physiotherapy assessment, treatment and rehabilitation at your home or sports club. If you have any questions feel free to contact me.

Keep posted for exercises for you to do to help you squat technique!

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Jennifer Taylor

Chartered Physiotherapist and Veterinary Physiotherapist

Jennifertaylor@pegasusphysiotherapy.co.uk