This past weekend at the Optim COMT course, we were discussing squats as a form of treatment. While the squat is an excellent exercise for a variety of ailments, it is an exercise that is prone to many compensations. Combine that with pain in the knees or elsewhere, and form may be compromised even more. There are several reasons why the pain may impact the ability to squat, but tissue tension may play a role.
One of the common variations that is seen during squats is the "buttwink," otherwise known as posterior pelvic tilt and lumbar flexion. Typically we see this occur as the client nears their bottom depth of the squat. There are many possibilities as to why this may occur: lack of hip flexion, poor motor control, decreased spinal mobility/strength and more. Another possible explanation for lumbar flexion is poor quadriceps strength. As an individual with poor quad strength descends into a squat, they typically either stop early in the depth or display a compensation like lumbar flexion and forward trunk lean. To try and control the movement that the quads are insufficient to support, the body tries to rely on the passive tissue tension of the posterior chain and a shift in center of gravity anteriorly. As the "buttwink" occurs and the trunk shifts forward, the muscles, tendons, and ligaments become taut and provide a form of passive support to control the body during the motion. Over time, this may lead to injury.
So how do we fix this? There are many avenues to address this client, but strengthening the lower quarter should absolutely be considered. There are many ways to strengthen the quadriceps, and it may be tempting to avoid squats due to the client's poor form; however, the exercise can be modified to the appropriate level. Using an assistive device like a TRX or leg press can simulate the motion at less than body weight to allow proper form. There are some cases where adding a load to the individual actually improves form! Regardless, improving an individuals functional squat may be as simple as improving their strength.
-Dr. Chris Fox, PT, DPT, OCS
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