squatting exercises | knee injuries | spine injuries

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How safe is squatting? Does it injure the knees or even the spine? Here's an exhaustive review of the research

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And it may make you faster
Research also suggests that squatting can improve not just jumping ability but actual running SPEED. In research carried out at the Human Performance Laboratory at the NSW Academy of Sport in Sydney, Australia, subjects were divided into two groups, one of which performed squatting exercises while the other served as a control. At the end of the training period, squatting subjects improved performance during a 40-metre sprint by 2.2 per cent and bolstered power output during an all-out, six-second cycling test by 9 per cent, while control subjects failed to improve at all ('The ability of tests of muscular function to reflect training-induced changes in performance', Journal of Sport Science, Volume 15-2 (April), pp. 191-200, 1997).

So far we have acted as though knee injuries were the only potential problems associated with carrying out squatting exercises, but in truth exercise experts have also been concerned about the effects of squatting on the spinal column. Without a doubt, squatting with resistance placed across the shoulders on the upper back does increase the compressive forces acting on the spine. In fact, research has suggested that forces acting on the lumbar spine during half-squats carried out with a loaded barbell can be equal to six to 10 times body weight. This may increase the risk of a rupture of an intervertebral disc or even a stress fracture of a vertebra.

Of course, one way to get around this is to avoid lifting excessive weight. Squatting should always be carried out initially without added weight (or with an unloaded barbell if a barbell is being utilized), with weight added gradually, cautiously, and progressively as strength and coordination improve.

Stooping in Bristol
Resistance-training experts also generally say that maintaining an erect posture during squatting (instead of bending forward at the hips) helps to evenly distribute the forces on the spine and decreases the incidence of injury. Actual research, however, reveals that things are not quite this simple. In work carried out at the University of Bristol, 21 men and 18 women lifted objects from the ground while either squatting (i.e., significantly bending the knees) or stooping (keeping straighter legs and bending primarily at the hips) to pick up the objects. The researchers also varied the mass of the objects, their bulk, their distance in front of the feet of the subjects, the distance of the objects away from the sagittal plane (an imaginary plane which runs through the middle of the body, dividing it into equal left and right halves), and the speed of movement utilized to pick up the objects. Spinal compressive forces were assessed by measuring the peak extensor moments generated by the back muscles and fascia during the lifts. Extensor moments were calculated from the EMG activity of the erector spinae muscles, using corrections for muscle length, contraction velocity and electro-mechanical delay. The bending forces ('bending torques') acting on the intervertebral discs and ligaments were quantified by comparing dynamic measurements of lumbar flexion with the normalised bending properties of cadaveric lumbar spines ('Bending and compressive stresses acting on the lumbar spine during lifting activities,' Journal of Biomechanics, vol. 27(10, pp. 1237-1248, 1994).

The measurements made by the Bristol scientists showed that stoop lifting actually reduced the compressive forces acting on the spine by about 10%, compared to squat lifting, putting 'stoops' in a slightly favourable light. However, stoop lifting increased the bending torque - the kind of force most likely to cause one vertebra to slip over another and induce spondylolisthesis - by about 75%. Thus, adding a bit of stooping to a squat may actually slightly reduce spinal compression but probably increases the chances of sustaining the kind of injury (vertebral displacement) associating with high bending forces.

In this study, compression force and bending torque both increased substantially as the lifted objects increased in mass, bulk, and distance from the feet. Non-sagittal plane lifts increased the bending torque by about 30% - but not the compression force. The fastest lifts increased compressive forces by 60% but did not increase bending torque. The Bristol researchers concluded that the risk of injury during squatting-type movements depended not just on the mass of the object lifted but also on the speed of movement and the size and position of the hoisted object. Basically, squatting safety increases as movement speed is lessened, resistance is reduced, the centre of mass of the lifted object approaches the sagittal plane, the size of the object decreases, and the resistance is brought closer to the body. Why weightlifters have little back pain

Good abdominal strength probably also helps to protect the spine during squatting. During squats carried out with heavy resistance, holding one's breath increases intra-abdominal pressure and is likely to help stabilize the spine. Wearing a weight belt may also increase intra-abdominal pressure and thus prop up the spine.

Although squatting can place heavy loads on the back, research has shown that squatters and weightlifters in general actually have a relatively low frequency of back pain. This shouldn't be any more surprising than the findings from recent research carried out with endurance runners which showed that runners actually have a fairly small risk of chronic knee pain, compared to the sedentary population. Basically, activities which strengthen muscles and joints - as long as they are not carried out to excess - tend to protect the body from damage, not chip away at its integrity. The study which detected a low risk of back pain for weightlifters also revealed that good spinal flexibility, lifting with a straight back, and strong paravertebral muscles (muscles which run between the vertebrae) protect strength trainers from back troubles. In former lifters, the incidence of back pain is less than in the general population ('Safety of the Squat Exercise', Current Comment from the American College of Sports Medicine, pp. 1-3, March 2000).

The bottom line?
Squatting is basically a safe activity (when carried out in the proper fashion) which can have a tremendously positive impact on leg-muscle strength. The following tips should help you reduce your risk of injury when you carry out squat training:

1. Initially, squat only to the point at which the tops of your thighs are parallel with the floor. Over time, as your strength and coordination improve and you remain injury-free, you can increase the depth of your squats. As squatting depth increases, quadriceps-muscle activation also increases, and thus expanding the depth of squatting should be associated with augmented gains in quad strength. To be fair, though, we should mention that few sports (except for weightlifting) actually require you to perform from a deep-squat position. Since gains in strength are partially a neural phenomenon, utilization of very deep squats may have a smaller than expected effect on your leg strength during your sporting activity (i.e., your nervous system may improve its ability to organize muscular force production during deep squatting, but this organizing will never come into play during competition, where deep squats are rare).

2. Don't squat when you are fatigued, and try to avoid training to failure when you are squatting. If you are exhausted, you may lose control of the squat, and - if you are utilizing a loaded barbell - you may end up twisting a knee, increasing your risk of knee-cartilage damage.

3. For two-legged squats, use a shoulder-width foot stance.

4. Always descend and ascend in a controlled and coordinated manner; don't jerk or rock back and forth. Avoid twisting movements in the bottom position.

5. Back pain and knee pain are indicators that you are progressing too fast with your squat training. If either type of pain occurs, you should rest until the pain disappears and then decrease your resistance and the number of squat repetitions you are completing.

Keep it specific
While we have so far approached squatting as a two-legged activity, you should bear in mind that optimal strength training should produce the best-possible adaptations of the muscular AND nervous systems. For this to occur, strength-training movements should attempt to duplicate the movements associated with your sporting activity as much as possible. If this is not the case, muscular strength may be developed, but it will not necessarily be the strength needed to perform at a high level in your sport. True, neural coordination of movement may be enhanced, but the enhancements may be strictly associated with movements which are dissimilar to those used in your sport.

For these reasons, individuals engaged in sports which involve running should prefer - for reasons related both to performance and injury prevention - the one-leg squat over the two-leg version. During running full body weight is supported by one leg at a time, not by both legs simultaneously. Thus, it makes sense for athletes who run to choose an exercise which will enhance leg-muscle force production when the left and right leg are working 'solo' - not together. When you squat with full body weight supported by only one leg at a time, rather than two, forces acting on your supporting leg roughly double, requiring greater muscular force production and - eventually - the development of greater strength. Similarly, when you squat with complete body weight on just one leg, your nervous system must learn to control and coordinate flexion at the hip, knee, and ankle during a movement which replicates running - not during two-footed jumping, which is a fairly rare action in many sports.

If this isn't completely clear, think about that popular open-chain exercise called knee extensions just one more time. To carry out this exercise, athletes are usually in a seated position, their hips are relatively immobile, and their ankles are locked in place. The quadriceps muscles - the ones really being trained - may be extremely challenged as the leg extensions are carried out, but they work in total isolation from the rest of the leg, since the hip and ankle are locked in place and the hamstrings are not required to furnish support for the body since it is in a seated position. This is the exact opposite of what happens during squatting and running, when the quadriceps muscles must coordinate their activities with the synchronously working hamstrings, glutes, calf, and shin muscles. Small wonder that research has shown that rigorous knee-extension training does not improve squatting strength, even though the quadriceps muscles are the prime movers for both activities. And small wonder that no research has ever linked knee extensions with enhanced force production while running. The only time that leg extensions could help you move faster would be if you were able to run in a seated position!

The right way to squat on one leg
Two-leg squatting is not as bad for running athletes as knee extending, but - as mentioned - two-leg squatting does have some problems. Basically, you don't move around on the football field, the rugby pitch, or the 10-kilometre running course by jumping from position to position with both feet on the ground simultaneously and both legs working together to produce movement. You bound from one foot to the other, and each time a foot makes contact with the ground full body weight is supported by the leg attached to that foot, and all the force needed to produce movement is generated by that leg alone. The same can be said for one-leg - but not two-leg - squats, and therefore one-leg squatting should do a superior job of improving running prowess.

To carry out one-leg squats properly, simply stand with your left foot forward and your right foot back, with your feet about one shin-length apart (they should be hip-width apart from side to side). Place the toes of your right foot on a block or step which is six to eight inches high (this is crucial; if you fail to put your trailing foot in an elevated position, you will often unconsciously support some body weight with the rear foot, reducing the strengthening effect for the support leg). Most of your weight should be directed through the heel of your left foot. Now, bend the left leg and lower your body until your left knee reaches an angle of 90 degrees between the thigh and lower leg. Then, return to the starting position, maintaining upright posture with your trunk and holding your hands at your sides. Complete your prescribed number of reps, and then do the same thing with your right foot forward and your left foot back.

As you do one-leg squatting, you will quickly realize that it is both a strengthening and COORDINATION exercise. You'll feel the ankle muscles of your support leg work overtime to keep your leg stable, and you'll feel your hip, ab, and low-back muscles go into full alert to keep your upper body under control. Of course, this is a good thing, because it means that while you are strengthening your legs you are also improving the efficiency with which your legs - and indeed whole body - work. Better efficiency (economy) automatically makes it possible for you to attain higher running speeds as you engage in your sport.

Making it harder
At first, you'll want to employ just your own body weight for resistance during your one-leg squatting. As you gain strength and skill, however, you can hold dumbbells in your hands as you carry out the exercise, place a progressively loaded barbell on your shoulders, or even wear a weighted vest while squatting. Start small (five-pound dumbbells in each hand, a four-pound vest, etc.), and gradually increase the resistance over time.

To increase the difficulty of the exercise and also include an upper-body strengthening effect, you can over time progress to one-leg squat and dumbbell presses. To do these, simply perform the one-leg squats described above, but hold dumbbells in your hands - directly in front of your shoulders. Your hands should be turned inward, so that the palm sides of your hands are facing each other (the grip on each dumbbell will make a straight line directly forward from your shoulder). Squat as you usually do, but once you have returned to the standing position from the squat, 'press' the dumbbells directly overhead, straightening your arms in the process. After you return the dumbbells to shoulder position, you have completed one rep.

Although one-leg squats and one-leg squats with dumbbell presses are wonderful exercises, they do have one deficiency: they are not really dynamic in nature. That is, although they replicate the hip, knee, and ankle flexion associated with running and dramatically strengthen the quadriceps and gluteal muscles while also helping the hamstrings, the two exercises do not call for a key component of successful running - generating propulsive force AND GETTING THE FOOT OFF THE GROUND AS QUICKLY AS POSSIBLE. Thus, there is a need to include a more dynamic form of squatting - 'one-leg hops in place' - in one's strengthening and injury-prevention programme and to also progress from standard one-leg squats to 'one-leg squats with lateral hops' over time.

One-leg hops in place...
To carry out the one-leg hops in place, start from the same position you used for the one-leg squat, with the toes of your right foot supported by a six- to eight-inch block or aerobics step. Then, hop rapidly on your left foot at a cadence of 2.5 to three hops per second (25 to 30 foot contacts per 10 seconds) for the prescribed time period. As you do so, your left knee should rise by about four to six inches with each upward hop, while your right leg and foot should remain stationary. Your left foot should strike the ground in the area of the mid-foot and spring upwards rapidly, as though it were contacting a very hot burner on a stove. Your hips should remain level and virtually motionless throughout the exercise, with very little vertical displacement. After hopping for 30 to 40 seconds on your left foot, shift over to your right. Over time, you can increase the duration and number of sets of hopping.

...and squats with lateral hops
To complete the one-leg squats with lateral hops, bear in mind that they are just like the one-leg squats, except that once your left knee reaches an angle of 90 degrees between the thigh and lower leg, you should hop laterally (with your left foot; the right foot stays in place) about six to 10 inches, squat, hop back to 'centre', squat, and then hop medially (to the right when your left leg is forward) for six to 10 inches, squat, and then come back to the centre - and then starting positions. To begin, you can try six reps with your left leg forward (a rep has an initial central squat and both a lateral and medial hop with squat, followed by the return to the starting position), and then six reps with your right leg forward. Over time, you can increase your speed of movement, the number of reps and sets, and the resistance (with a weighted vest, dumbbells, or a barbell).

Trying to pick up your speed of squatting movement - without losing control and coordination - is important, as evidenced by a recent study carried out at the Department of Health Sciences in the Sargent College of Allied Health Professions at Boston University. In this research, two groups of young women squatted repeatedly with either a slow tempo (two seconds for ascending, two seconds for descending) or a fast cadence (one second up, one second down). Both groups completed three warm-up sets and three eight-repetition maximum sets, three times per week for seven weeks ('Early phase differential effects of slow and fast barbell squat training,' American Journal of Sports Medicine, vol. 26(2), pp. 221-230,1998). The women were tested at the beginning and end of the study using force-platform and video analysis of their vertical jumping, long jumping, and maximum squatting; they also underwent isometric and isokinetic quadriceps-muscle testing at speeds from 25 to 125 deg/sec. As it turned out, in the long jump the fast group was superior in numerous variables, including knee peak velocity and total-body vertical and absolute power. As the researchers put it, faster training 'showed some advantages in the quantity and magnitude of training effects'. Basically, in sporting activities a premium is placed on not only the magnitude of force production (strength) but also on the rate with which the force is developed (power or speed). One can't hope to become as powerful as possible simply by exercising the muscles at slow rates of speed; power doesn't magically descend on an athlete but must be developed through the use of intense training involving quick movements. From an injury-prevention standpoint, sudden, extremely fast and forceful movements which arise during competition are less likely to cause injury if an athlete has developed strength and control at those rates of movement during training.

So what's the final word? There is little evidence to support the idea that squatting is an unsafe activity which decreases knee-joint stability and/or increases the risk of low-back injury. Although incorrect utilization of the squat exercise during training can certainly heighten one's chances of getting hurt, correctly performed squats are not only safe, they also can dramatically improve functional leg-muscle strength, jumping ability, and running speed.

Owen Anderson

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