Reciprocal Innervations Personal Training
Personal Trainer Vancouver / Holistic Health

 

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It was my understanding that the full range back squat is a contraindicated movement due to iliosacral instability. I have always been taught by my exercise therapists of many medical backgrounds that the kind of squat that touches the hamstring to the calf is unsafe.

Recently on a strength blog I was reading, there was a video demonstration of the high bar back squat(link above…. sorry I can’t directly post it because I do not know enough about the intrawebz). There, I saw these full squats being recommended with no explanation of how it is achieved without risk to the lumbar disks or iliosacral soft tissue.

 

If you know me, you know that I am not one to blindly follow crud I find on the Internet. It is dangerous. There is wrong information out there that can hurt you. However, one tends to look for serviceable information and sometimes one finds a great deal of good information in one place. Such had been the case with me and this source. This was the reason I investigated. Please do not look at this post as the be all and end all of your squat education. If you like what I say, look into it for yourself. What you may find could surprise you as much as I was surprised.

 

This is what we we’re taught in personal training school:

” Don’t teach full range squats. They are bad for the back and hard on the knees.” In fact I was told by an employer at reputable sports club chain that I was NOT to teach full range squats. They would not accept liability. Until this time, I only taught the squat full range. I mean why are squats bad for the back? Do you know?

Well, at the time I did not know. I was a newly certified personal trainer in 1998! I didn’t understand “shear force to the sacrospinal muscles” or “shear force to the sub-patella tendon”. I thought I knew everything; I didn’t know shit.

I did, however, go ahead with company policy and only taught the half squat. At least for a while…

 

 

After years of teaching the squat, to half range, I just decided to give up on it. I just didn’t seem to be getting results from clients. Indeed I found that I could replace the half squat and a clients results would be equal to and in some cases less risky that those that performed the half squat. Some clients would begin to experience knee pain that required rehab. Others might have  increased incidence of low back pain. Pain that would go away when we discontinued squats.

In spite of not teaching squats to others,I still performed half squats myself. I had achieved some strength in that lift. However,  I must admit that over years of doing the half squat, incidence of  low back pain did occur. I’m sure that it was the squats that did it because the stiffness would happen within 24 hrs of a squat workout when I attempted heavy weights. In fact, if I was not adamant about my hip mobilizing exercises and stretching I surely would achieve back spasms. These are not fun.

But if the half squat was a “safer” exercise for the back than the full squat, imagine what pain I’d be in were I to go “ass to the grass”!

After my last foray into half squats, I blew my back out considerably. The worst in 5 years. I was lifting too heavy. I needed Jerry, my Chiropractor. He has a gift. He does not want me to do squats. To be quite honest, I wasn’t sure if squats were going to be in my future. If the half squat leads to this much pain, who needs it?

Still I wondered to myself , “How the heck do these athletes do it? How can they squat for years pain free?”

So, I became very interested in this video in which a respected strength coach takes this athlete through a full range front squat. And I wasn’t alone.

Almost instantly other trainers post on the blog about the dangers of this form. It seemed clear in the video that the squatter began the motion with her knees. Trainers are taught to teach that the motion must be initiated at the hips. A point which was brought up. Also, at the bottom of the motion, it seemed the squatters hips would tilt posteriorly. Trainers are taught that this is a no-no because if the hips tilt backwards the lumbar spine goes into flexion. Low back flexion increases risk to the disks. So I posted a question asking if the tilt was okay.

One of the coaches from the site posts:

” this is real squat, but you you guys do probably only half squat or powersquats, in strenght traning and training for athletes we only do full squat, begining with knees, not hip, begining with knee put much more involvement of VMO[ Vastus Lateralis Obliquus: the teardrop looking muscle of the quadricep, image below… more to come on this…], but begining with hip there is way to much lower back involvment and probably soner or later, pain and your VMO will remain weak. And if you would know any basics of human anathomy, you wouldnt make such a stupid statement, and to Ryan that tilt is okay.”

 

 

This statement told me a couple things:

1- Somebody somewhere is starting the squat action with their knees.

2- This guy thinks that there is a difference between the athlete and strength trainer vs. most everyone else with respect to the squat.

3- I needed to learn more about VMO and low back involvement.

4- Some people are really touchy.

 

Basically, this video and subsequent comment scrambled my brain. Why would this respected strength coach, whom I have quoted on many occasions, be preaching such a contraindicated form? I imagine that I know the rationale for teaching the half squat. I imagine that I “know any basics of human anatomy” and I NEED an explanation as to WHY that posterior tilt is okay.

So I post:

” Wait , how do you reconcile the sacrospinal muscles turning off as they go from extension to flexion? How does a strong VMO protect the low back? How do you get around lateral instabilities? Also how does one prevent referral to the disks? Has there never been a low back injury amongst (your) trainers? I understand my human anatomy and I am not trying to be confrontational, but every athletic therapist; physiotherapist; chiropractor; sports-med doctor and; exercise specialist I talk to stops the squat before this flexion happens. In fact, I’ve been a trainer for 15 years and it is only CSCSs [certified strength and conditioning specialists] that I observe squatting this way any more. Ultimately it seems dangerous needlessly to me. I’m sure (you) would have enough knowledge to make me feel like crap about asking this, This thread and all those links don’t answer anything. Do I have to become a (CSCS) to get these answers? Can somebody recommend a book that answers these questions? Or message me?”

 

I wanted an explanation as to:

1- Why this person on the video was allowed to flex through her lower back at the bottom of the movement.

2- What the knees role in all of this was.

3-Where to begin the motion of the squat.

 

Someone was willing to give it to me.

 

“Look I don’t mind you quoting anything from me, But just be aware that it is still not black and white, and if someone responds to your blog posts, you have to be able to elaborate and justify exactly what you are saying.” Says Joe Lim, a soft tissue specialist from Sidney.

 

Joe has achieved level 2 certification with the institute in question. He wanted to make it clear that he wasn’t a die hard disciple of the organisation but might be able to answer any questions I had. I assured him that if I posted anything I would try to fully understand it so I could explain. He agreed to take me through his depth of knowledge on the squat.

“Well, it is my understanding that the full range back squat is a contraindicated movement due to iliosacral instability. I have always been taught by my exercise therapists of many medical backgrounds that the kind of squat demonstrated in (this) video is unsafe.
Here, we see these squats being recommended with no explanation of how it is achieved without risk to the lumbar disks or iliosacral soft tissue. If there is a way to strengthen VMO by doing deeper squats and preserving my back I’m all in. However, in practice, I observe that people who do these “ass to the grass” squats that include a posterior tilt of the pelvis at the end, invariably achieve back pain.”

 

What followed was a concise and detailed explanation of the anatomy and innervation pattern of the full squat…What followed was a schooling by a real pro. He sighted a very well-educated strength coach Tony Boutagy, (Australia’s best some would say); Stewart Mcgill and his book “Low Back Disorders“.

 

Cutting through all the stigma about possible knee or back pain, what would follow would change the way I train forever!

 

Joe:

“According to a very well-educated strength coach Tony Boutagy, (Australia’s best some would say), the squat can be done to full ROM provided that at the thighs parallel position, the lumbar lordosis is still present. Thereafter, any further rounding of the lumbar spine to full squat depth is considered safe. This is because if she (the video) can reach parallel with lordosis, when she reaches full squat depth, she is NOT approaching FULL lumbar flexion .It is FULL lumbar flexion (according to Stuart McGill) that creates problems with disc herniation.

You also mentioned about how the sacro-spinal muscles turn off during flexion,yes that’s true, but in the full squat position, the sacrospinal muscles are NOT required to generate a posterior shear force, as the person is quite upright. In the deadlift (DL), posterior shear forces are required, contrary to the squat”

 

Lumbar “lordosis’ is the natural extension or ‘arch’ in the lower back. most people have this when standing upright. Some have too much(lordotic) some have too little(flat back) these are postural imbalances.

 

 

What Joe was talking about here is the slight low back arch being present in the squat until the thighs get to the parallel to the floor position.

 

 

I’m just going to repeat this because it is the piece of information that I needed to totally change my squat form and go back to the full back squat:

 

 

in the full squat position, the sacrospinal muscles are NOT required to generate a posterior shear force, as the person is quite upright.”

The trick is to remain with the spine in the upright position.  Do not lean forward into the squat.
“.. there are ways to modify the squat to make it safe on the spine, then we should take advantage of those modifications ie; heels elevated, choose front squat variations and engage the intra abdominal pressure mechanism to reduce compressive loads by up to 40% (Paul Chek)”
When I looked into this further I learned that for every 5 degrees of forward bend in that there is, an additional 50lbs of shear force to the sacrospinal muscles in the L4-L5 area is produced(source).
But, Joe Lim, how can we make sure this does not happen? Stretch the hips?
“The best way to delay lumbar flexion in a squat to full range is to increase dorsiflexion of ankles.It is not a hip-flexor tightness issue.”
Unbelievable! Everyone with whom I have spoken about leaning forward in the squat seemed to think it was a hip-flexor tightness issue. Now here I come to learn that it is ankle mobility! And this makes sense, because what do you sometimes see athletes use while performing a back squat? some kind of ankle elevation device. They place their heels upon a small plate or board in order to elevate the ankle and increase mobility. This helps to keep the back from bending forward.
So what do I have so far?
 The full squat is considered safe according to these experts if:
1-  The spine remains in the upright position( less posterior shear force to the erector muscles). NO LEANING FORWARD.
2- To create this upright position through the full range of motion, it is necessary to be mobile through the ankles(dorsiflexion). Use of an elevating device for the heals helps until mobility can be achieved.
3- Lordosis(low back arch) is maintained untill thighs become parallel to the floor.
4- A slight posterior tilt of the pelvis is okay once past the thighs parallel position.
5-Intra abdominal pressure relieves compressive force on the spine by up to 40%
So what about the knees?
What we were taught in personal training school:
What we were taught in personal training school about the knees also differs from what is seen in this video. We are taught that there is unnessesary force placed on the knee if the knee is allowed to travel past the big toe in the down part of the squat. Common reasoning is this:
 “During the descent phase of any type of squat, do not allow the knees to extend beyond your feet. The further your knees travel over your feet, the greater the shearing forces on the patella tendon and ligament.”(This is a direct quote from bodybuilding dot com)
If this is mostly true, why  is the motion initiated at the knee in the video? Why not at the hip? Wouldn’t initiating the motion at the hip help to prevent the knee from traveling to far forward?
The answer goes back to what was said earlier about Vastus Lateralis Oblique(VMO).

” this is real squat, but you you guys do probably only half squat or power-squats, in strength training and training for athletes we only do full squat, begining with knees, not hip, begining with knee put much more involvement of VMO, but begining with hip there is way to much lower back involvment and probably soner or later, pain and your VMO will remain weak. And if you would know any basics of human anathomy, you wouldnt make such a stupid statement….”

 

Joe clarifies this statement:

“The VMO  is recruited maximally from Full knee flexion to thights parallel position…
Muscles need to be pre-stretch for maximum [ motor unit activation], and this requires complete knee flexion to pre-stretch the VMO.

If you stop at parallel, the VMO doesn’t get the required stimulation,
the glute max is not at full stretch either.

The quads in general never get trained thru full ROM, leading to chronically shortned quads, which pre-disposes to lateral deviation of patella — leading to anterior knee pain that is the most common knee injury presentation to sports clinics.”

 

So the safety of the knee is actually dependant upon maximal VMO recruitment, which happens from the very bottom of the range of motion up to the thighs parallel position.

 

It’s important that the knees travel directly forward over the big and second toe and do not collapse inward nor outward as you drive through the quads to come up.

 

So what I take away from this education about  the knee is:

1- VMO is a crucial stabilizer of the knee

2- Weakness of VMO is the reason for the most common knee pain treated in clinics.

3- Beginning the squat with movement at the knees produces more VMO involvment.

4- VMO is most active between the bottom range of the full squat and the thighs parallel position because,

5- VMO goes to a full stretch position at the bottom of the motion and therefor can be recruited maximally

 

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It’s now almost three months since I have re-incorporated the full squat into my splits. I must admit that at first, I sure was weak. Even now my squats are about half of what they were.

But they are improving with every passing leg day. And what is more, I feel stronger than ever on all my other lifts. There is zero back pain and my knees feel like they are bulletproof!

I’ve even managed to apply these principles to clients with knee pain(while working with a physiotherapist), and wouldn’t you know, their knee pain and back pain is a thing of the past now too!

There are still ques one has to watch for while attempting the full back squat. One assumes risk of themselves, there is just no way around it. Really what I have learned here is that, given all the concern about the full squat, it can present less of a risk than the half squat.

I still think everyone has to make up their own mind about this. And certainly one should not just attempt it without consultation by a qualified fitness professional. Hopefully these points will help you to make a more informed decision.

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*UPDATE*

 

I have been reading up on Stewart McGill. He is a professor of spine bio-mechanics at the university of Waterloo. I spoke about him briefly earlier. He is the gold standard in spine research. Everyone sites him.

In an interview he gave for the website Tnation, he expressly states that the posterior pelvic tilt at the bottom of a full squat is NOT okay.

He says: ” I see too many ruined backs from those who believed they were immune from    spine flexion during the deep squat or clean, including some of the trainers and    coaches themselves… Of course, the safest choice over the long term is to not go deeper than the break    point of where the neutral spine is lost.”

They do not mention the degree to which there is risk if the spine is upright. However he talks about spine flexion as risk to the collagen in the disks annulus. The  fibers on the outside of the disk delaminate causing a disk bulge. That is bad.

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When you flex your spine you use less hip strength and create more force upon the posterior part of the disk. How much force can this structure tolerate? And how much force does one put on the disk when one performs the squat in a very upright position? And how much force is placed upon this structure when only a slight posterior pelvic tilt is performed( and not full L-spine flexion)?

 

Since I do not have answers to these questions, and Stewart McGill says maintain a neutral spine… I’m gonna go with Stu.

 

 

 

 

 

 



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