TL;DR: You should be able to hold a spine neutral plank position for 2 minutes. Train by a combination of short intervals and longer holds.

We are going to spend a few blogs going over some basic fitness tests to see where you fall on the spectrum and help identify how you can improve. Today’s blog will discuss plank.

There is a lot of debate and discussion regarding the risks and benefits of plank. In order to dive into the topic we first have to have a baseline understanding of what the plank exercise actually is. The basic plank is when your toes and forearms are on the floor and you are supporting your body and head in a neutral spine (straight line) looking down at the floor.

What’s not to like?

I’ve read articles that discuss the pressure put on the lumbar spine (low back) and the risk of costochondritis (inflammation of the cartilage between the ribs). In one article, Dr. Michael Durtnall, a chiropractor in London, was even quoted saying, “Planks are for the super-fit and athletes, not for soft, desk types to go bananas with once a week.” (1) I don’t agree. While I would agree with the sentiment that it is not a good approach to go wild with plank once a week; I would say the same is true for almost any exercise, especially when first starting. The statement implies though that working at a desk is mutually exclusive of being fit or an athlete. I know a lot of people who are active athletes in a variety of sports that work desk jobs. I myself play pickup basketball when I can. I have participated in flag football leagues, kickball leagues, and play tennis regularly when the weather permits. The goal with any exercise is to work up gradually. The risk of injury with plank is substantially lower than with many exercises since there is no motion and there are no additional weights being used. I do agree with the sentiment out there that just trying to exercise to overcome low back pain is not a good approach. Having said that, not doing an exercise because of a current injury doesn’t make the exercise inherently bad. If I had a broken leg I wouldn’t be doing squats, but that doesn’t mean squats are bad (in fact I Love Squats)

What’s the good news then?

The good news is that there is good evidence that planks are pretty beneficial. You see it isn’t actual strength that seems to be important with your core, but rather your core endurance. In the research article, “Core Stability Training for Injury Prevention” by Bliven et al. (2) Planks can help train core endurance which may help reduce certain injury risk. Stuart McGill published in the June 2015 issue of the Journal of Strength and Conditioning Research “…an isometric training approach was superior in terms of enhancing core stiffness. This is important since increased core stiffness enhances load bearing ability, arrests painful vertebral micromovements, and enhances ballistic distal limb movement.” (3) Think of it like this – if you compared it to holding a weight at arm’s length in front of you, it isn’t about how heavy the weight is, but how long you can hold it. Also, one of my favorite things about plank is it is NOT a massive time consuming exercise. This means it is easy to incorporate on a daily basis. Now there is a bit of debate regarding how much is enough/too much. Top End Sports lays out a guide in which they state that excellent core strength is the ability to hold the plank position for over 6 minutes! (4) If you’ve ever tried plank you know that is a LONG time, and fortunately, most exercise experts would disagree. An article published in Women’s Health reads, “Albert Matheny, R.D., C.S.C.S, co-founder of SoHo Strength Lab and advisor to Promix Nutrition, says you can plank daily, but the length you should hold a plank can vary from 10 seconds to one minute.” (5) Men’s Health contributor and strength coach Dan Johns feels strongly that anything over two minutes is a waste of time, but not being able to hold a plank for two minutes is a problem.

The Test

I agree with Johns, the benchmark is two minutes. To perform the test get into the plank position with a time directly in front of your face, or with a partner timing you. If you have appropriate core endurance then you should be able to hold a perfect form plank for 2 minutes. This doesn’t mean it won’t be hard. You might shake, you might hate every second, but if you can hold a neutral spine while in the plank position for 2 minutes then your core endurance should be adequate. If you can’t then you need to get better. Going over 2 minutes doesn’t really indicate anything better in terms of injury prevention or overall fitness.

How to Train

McGill recommends training in repetitions of 10 seconds (6), while Matheny recommends simply holding the position until your form breaks down. I recommend both. To give an analogy to running, if you’re training for a marathon, don’t only run sprints. If you’re trying to make your body as fit as possible, don’t only run long distances. All of the exercises we discuss are designed to promote healthy and normal function. Our goal isn’t just to be able to hold a plank for two minutes but to actually improve the function of our core so that we reduce injury risk and promote wellness. If you alternate days between training intervals and longer holds, or want to mix both together on the same day, you will make positive steps with either approach. If you really want to maximize your training though try using plank variations like side bridge or one foot planks. Your body is dynamic and your training should reflect that by challenging your body in a controlled manner to improve overall fitness.

1. http://www.dailymail.co.uk/femail/article-3030983/The-ultra-competitive-exercise-fad-ruin-health-called-planking-suddenly-sweeping-gyms-Pilates-classes.html

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/

3. http://journals.lww.com/nsca-jscr/Abstract/2015/06000/Effect_of_Long_term_Isometric_Training_on.8.aspx

4. http://www.topendsports.com/testing/tests/plank.htm

5. https://www.womenshealthmag.com/fitness/how-long-to-hold-plank

6. https://www.menshealth.com/fitness/truth-about-extreme-planking

My wife is amazing. No questions, no debates. While there are a plethora of reasons why I say this, I am currently referring specifically to her giving birth to both of our wonderful children. I will avoid straying too far down memory lane, but I want to take a minute to discuss my wife’s experience with pregnancy. For our first child, our daughter, my wife had an uneventful (relatively speaking) pregnancy. She had a lot of the norms – nausea, fatigue, etc, but on the whole things marched along pretty smoothly.

For our son, pregnancy marched along fairly smoothly until we found out that at 38 weeks our son was in the breech position. We had a conversation with our OB that included her telling us that my wife would need a cesarean section, and me informing the OB that before we just agreed to that, there was some structural chiropractic work that I wanted to do with my wife. While the OB agreed, she clearly didn’t understand the purpose or even the goal. For the next week my wife and I employed a rigorous structural correction plan. I addressed shifts in the bony structures and spent a lot of time working on the soft tissues as well. The goal of the neuro-structural care was focused on allowing my wife’s pelvis to achieve a normal position which would remove a secondary condition known as intrauterine constraint, and allow our son to achieve the normal position for delivery. At our follow-up appointment ultrasound confirmed that our son was no longer breech, and could be delivered without a cesarean section, which for us was terrific news.

Now let me make a few quick, but essential, points here. First, I did not, do not, will not ever treat to turn a breech baby. There is a medical maneuver for that called an External Cephalic Version (ECV). It is where a medical doctor attempts to turn the baby manually into a head down position.(1) The goal of structural care is to create normal structure which facilitates normal function. Second, I am in no way criticizing or disparaging any woman who has had, or will have, a cesarean section. The procedure can be a life saving intervention for the mother, for the baby, or for both. For my wife, she wanted to avoid a cesarean section if possible and was happy to be able to do that.

So now that you have our backstory, let me dive further into why neuro-structural chiropractic care during pregnancy is so effective.

Ultimately the main reason we chose to utilize neuro-structural chiropractic care for my wife’s scenario is that the Webster Technique has been shown to be much more successful than ECV. With neuro-structural chiropractic care demonstrating an 82% effective rate in research (2) and ECV showing less than a 56% success rate in 2016 according to statistics from the CDC. Additionally, there are some drawbacks to ECV which made my wife uncomfortable. While the risk associated with ECV is small, 1 in 286 results in the need for emergency delivery, typically via cesarean section. Other complications such as cord prolapse, vaginal bleeding, and water breaking are infrequent, but associated with the maneuver. (3)

Using neuro-structural care during pregnancy is not just for a breech presentation of the baby either. Common complaints like low back pain and sciatica are also associated with the neuro-structural shifts that naturally occur during pregnancy. The mechanism of neuro-structural shifts is pretty simple. In basic terms the fetus grows in the woman’s uterus it expands, which in turn pushes and strains everything in that area. These shifts result in changes to normal movements – think of things like the late pregnancy “waddle”. All of this is occurring while the woman is carrying the additional weight of pregnancy. This is why neuro-structural focused care during pregnancy can be so helpful – it helps to compensate for the inevitable changes of pregnancy. Research also supports that chiropractic care is very safe during pregnancy. (4) In fact evidence exists which shows that getting manipulative therapy during pregnancy is associated with improved labor and delivery outcomes. (5) This indicates that neuro-structural care can be beneficial during pregnancy even without a secondary complaint.

At Align Chiropractic, we have specialized equipment to help pregnant women – tables with drop away abdominal pieces, tables that raise and lower to make getting on and off the table easier, gentle adjusting equipment for women that do not want or cannot physically handle manual adjustments, soft tissue tools used to address tight ligaments and muscles. If you have questions, I would be happy to sit down and have a consultation with you. As always, at our office a consultation is a conversation, not a commitment.

1. https://www.acog.org/Patients/FAQs/If-Your-Baby-Is-Breech

2. https://www.ncbi.nlm.nih.gov/pubmed/12183701

3. https://evidencebasedbirth.com/what-is-the-evidence-for-using-an-external-cephalic-version-to-turn-a-breech-baby/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647084/

5. King H.H., Tettambel M.A., Lockwood M.D., Johnson K.H., Arsenault D.A., Quist R. Osteopathic manipulative treatment in prenatal care: a retrospective case control design study. J Am Osteopath Assoc. 2003;103(12):577–582.

People are continuing to experience low back pain at an incredibly high rate. Current statistics show that 8 out of 10 Americans will experience low back pain at some point. (1) If that weren’t bad enough, low back pain doesn’t seem to really have a preference regarding who it affects. The CDC reports that of people who have experienced low back pain in the past three months there is less than a 4% difference between males and females. A common misconception is that low back pain is a problem that develops as we get older, but 1 in 5 people aged 18-24 reported having low back pain. (2) So it isn’t surprising that people are looking for an answer.

So what are the options? Over-the-counter drugs? Prescription drugs? Surgery? Physical therapy? Chiropractic? Something else? Each approach has pros and cons. Let’s dive a bit deeper into each and see what might be the right choice for you.

Medication – Short term prescription pain medication demonstrated modest relief of pain, and limited improvement in disability. Long term use of opioids can actually be associated with an increase in disability. Also, most prescription medications did fare any better in relieving low back pain than simple over-the-counter ones. (3) What we can take from this is that while the medications might help for a little while, they don’t seem to provide a good long term solution. With growing concerns regarding addiction and side effects caution has to be used when treating low back pain with narcotics.

Physical Therapy and Traditional Chiropractic – A little over half (54%) of people who saw a chiropractor for their low back pain reported getting effective results. Physical therapists did similarly although slightly worse with 48% reporting their care as fairly or very effective. (1) Unfortunately that still leaves a lot of people still suffering. The initial thought might be that those patients just had more severe cases that needed surgery. Let’s take a look.

Surgery – University of California, Irvine, School of Medicine clinical professor of orthopedic surgery, Charles Rosen, M.D., was quoted saying “An enormous number of back surgeries don’t give patients long-term relief.” He even went as far as to say, “”Maybe 5 percent of patients with back pain need surgery.” Another study drew the conclusion that, “This Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor [Return To Work] status.” This conclusion came after the study showed that only 26% of people returned to work 2 years following a spinal fusion whereas 67% were able to return to work if they did not have surgery. (4)

So what’s left? Well at Align Chiropractic we feel a different approach, the neuro-structural approach, is our best chance for a positive outcome. We address the underlying neuro-structural issues that cause the cascade of events that lead to low back pain, disc herniations and/or degeneration, or symptoms down the leg. We take an in-depth analysis of the patient before us, and then address the neuro-structural shifts to create our best outcomes. Research shows that neuro-structural rehabilitation of the spine has more evidence supporting it than traditional chiropractic. (5) By incorporating treatments designed to not only improve the objective measurements of the spinal column, but also to facilitate healing and restructuring of the associated soft tissues (discs, muscles etc) we see success in much higher numbers than the reported 54%. We have invested heavily into the techniques and equipment that have been shown to have the best outcomes. We offer spinal decompression therapy, which is backed by studies showing resolution of symptoms in 86% of patients who completed decompression therapy, while improvement was shown in 92% of patients. (6). We don’t stop there. We also incorporate Class IV Laser Treatments which have been shown to improve blood flow, improve tissue healing, reduce inflammation, and ultimately reduce pain. (7)(8 )

Our goal is to restore normal structure. With normal structure your body is set up for success allowing your brain to coordinate normal, pain-free, function.

1. https://medlineplus.gov/backpain.html

2. https://www.cdc.gov/nchs/data/hus/2014/046.pdf

3. http://www.goodhousekeeping.com/health/a18687/back-pain-surgery/

4. https://www.ncbi.nlm.nih.gov/pubmed/20736894

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1840024/

6. Gionis, Thomas MD; Groteke, Eric DC. Surgical Alternatives: Spinal Decompression. Orthopedic Technology Review. 2003; 6

7. http://www.litecure.com/medical/2014/07/2-studies-that-will-make-you-rethink-laser-therapy/

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418129/

Everything we do at Align Chiropractic has a purpose and reason. Today we want to shed some light on why we always analyze the entire spine for neuro-structural shifts, and address the shifts wherever they occur, even if some regions of the spine are pain-free.

Anterior Head Syndrome (AHS) is a growing problem in the modern world. A syndrome is classified as “a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms.” (1) AHS is a set of symptoms associated with anterior or “forward” displacement of the head relative to the rest of the spinal column. This is a common result of a neuro-structural shift in the cervical spine (the neck). While there are many aspects of this syndrome that we could explore today we are going to explore a less commonly explored aspect, which is LOW back pain.

The average head weighs between 8-12 pounds. (2) When the structure of the cervical spine is altered, and there is a reduction or reversal of the cervical lordosis (normal curve), the weight of the head gets shifted. This leads to a number of biomechanical changes in the spine. These changes actually compound dysfunction in the low back. Correction of the neuro-structural shifts which cause AHS have been shown to actually improve low back pain and lumbosacral radiculopathy (radiating leg pain). Research indicates that addressing AHS, when present, in conjunction with lumbar spine correction leads to improved outcomes.(3)

As you can see, it isn’t always just the low back that is neuro-structurally shifted, when you are suffering from low back pain. Maybe if you have unresolved low back pain, it is because you haven’t address the entire issue.

TL;DR – Having a neuro-structural neck issue can be a factor in low back pain, even if your neck is pain free.

1) https://www.google.com/search?q=definition+of+a+syndrome&ie=utf-8&oe=utf-8

2) Goldstein, Jonathan P. Goldstein Helmet Study. Biker’s Rights. May-June 2006.

3) http://www.ncbi.nlm.nih.gov/m/pubmed/25704221/?i=4&from=lumbar+lordosis+nerve+root

TL;DR – Fish oil supplements have been shown to be effective in reducing pain from chronic arthritis.

Fish oil supplements are very popular and for good reason, but a lot of people still don’t know why. We will explore some of the better known aspects of fish oil, and touch on some of the less well established claims as well. To be clear this is not intended to be a comprehensive review of all the benefits of fish oil, but rather we will focus on why arthritis sufferers should care about fish oil.

In order to get started we need to know what exactly is arthritis. Arthritis as a term can be broken down into two parts: 1) Arthro – a prefix that simply means joint. So anywhere two bones come together, and 2) Itis – a suffix that mean inflammation. Arthritis is a major problem in the US. In fact over 8 million working age adults report restricted work abilities due to arthritis. Unfortunately, arthritis is also on the rise – the CDC predicts that by 2030 the number of adults diagnosed with arthritis will rise to 67 million people.

So, why do we even care about fish oil? The answer is long chain omega-3 fatty acids – specifically EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) help reduce inflammation – the “itis” part of arthritis. This is achieved in two major ways – by blocking inflammatory substances called cytokines and prostaglandins, and by converting into anti-inflammatory chemicals called resolvins. If we reduce the amount of inflammation in the joint we reduce the amount of pain caused by arthritis.

So why supplement, why not just eat fish? I am actually a major supporter of trying to get our appropriate nutrition from the source rather than supplementation, but I also know that most of us fail to eat a diet that fully satisfies our all of our nutritional needs. Therefore, I am also a supporter of supplements. In order to get the 2.6 grams of omega-3 fatty acids per day that have been shown to have therapeutic effects, we would need to eat between 6 oz of fish like wild caught mackerel or salmon and 2.4 pounds of fish like tilapia, crab, lobster, shrimp – keep in mind that 3 oz is a standard serving of fish. Basically, you need fish at nearly every meal to do that, and that is a lot of fish to have everyday. Most people aren’t going to do that. A word of warning though – not all supplements are created equally. Higher quality supplements which have at least 30% EPA and DHA by volume and utilize better processing are more effective than other lower quality (and unfortunately lower priced) supplements.

But wait I heard… Like I mentioned at the beginning there is a lot of information out there, and some recent studies have shown some possible negative effects of elevated EPA/DHA levels in the blood. At this point more research needs to be conducted. The current studies have limited use because they did not do a great job of eliminating confounding factors (other reasons people might have had the negative effect). This among a few other problems with the studies leave us with our best science showing that fish oils benefits are real and the risk nearly non-existent. The most common side effect of fish oil is fishy tasting burps.

The bottom line. Research indicates that fish oil can actually replace the use of non-steroidal anti-inflammatory drugs (things like acetaminophen and ibuprofen) for chronic arthritis pain suffers.

TL;DR – A basic exercise program (BEP) is a better way to get into (or back into) exercise, while short term high intensity programs (STHIPs) are better suited as a way to change up an already consistent exercise routine.

As with many of us, athletics are where I learned how to exercise, learned how to set fitness goals, and how to achieve them. My high school football team had a weightlifting program with attendance and performance goals. At the end of each summer we were able to determine if we had met our goals heading into the season. When I transitioned from high school to college, I no longer had these clear cut goals for exercise. My experience was that without the organization of a sport I was constantly falling short of the new goals I tried to set. If I did manage to reach a goal, I would then be thrown off track while deciding on a new goal.

As I’ve grown through my own health and wellness journey, I realized that I needed to totally re-orient my approach to exercise if I ever wanted to make it a truly consistent life-long pursuit. I learned that for most people the worst way to get back into exercise is with what I call a Short Term-High Intensity Program, or STHIP. These are programs like a 90 day fitness regime or 21 days to get shredded, or whatever other plan you’ve heard about. Now, before I delve any further into this topic, I can already hear the rants, “Well I did the 30 Day Furious Fat-Blaster 9000 and I lost 60 pounds, and now I work out every day!” If it worked for you, that is great! For most people that didn’t happen. If it did, there wouldn’t be a new program, a new piece of home exercise equipment, or a new diet coming out seemingly daily. I’m going to take a bit and examine the pitfalls of STHIPs, and why I strongly recommend NOT using them to get back into exercise.

Pitfall #1 – Most people don’t follow the program all the way through.

Pitfall #2 – These types of programs increase the risk of injury.

Pitfall #3 – These types of programs cause significant muscle soreness

Pitfall #4 – These types of programs have a designated stopping point.

To go from couch potato to gym hero, regardless of the time frame, is a challenging task. People who are typically drawn to STHIPs do not already have the habit of exercise. Using a STHIP allows people to convince themselves that in a limited time frame they can achieve their desired physical results, while ignoring the need for ongoing exercise. For sustained results we need to have integrated exercise into our NORMAL routine. With an STHIP, we are setting aside a short time frame to be ABNORMAL, so when life gets busy (which it always does), exercise is going to be the first thing we drop. Also, if we have been lax on performing vigorous exercise for months, or even years, we won’t have the strength, flexibility, or joint stability to perform intense exercise without a significant risk for injury. Injuries not only delay our short term goals, but they also lead to misconceptions about what exercises are safe to perform. This leads can have life-long ramifications. Even without major injury, STHIPs cause a LOT of muscle soreness. The type of soreness that interferes with daily life activities, like getting out of bed!

Even completing the program creates a problem – a designated stopping point. You then have to decide whether to re-do the same program again (boring), spend time looking for a new program (a new period of inactivity), or the worst yet, be satisfied with your accomplishment and go back to doing nothing The common theme between all of these pitfalls is they all MOTIVATE YOU TO STOP EXERCISING. Rather than using a STHIP which will likely end up demoralizing you, and reinforcing the idea of NOT exercising; I would prefer that when starting to exercise we shift our focus away from short term goals and towards a long term goal of health and fitness.

I personally think that the best way to motivate someone to become consistent with exercise over a lifetime is to create a Basic Exercise Program, or BEP. A BEP is a program which focuses on functional movement and strength – exercises like deep squats, lunges, planks, pushups, dips, dead lift, and/or pull-ups. I’m not actually too picky on what exact exercises you decide are right for your BEP, but it is important that the exercises work a variety of muscles throughout the entire body, especially core muscles, and utilize functional movement. The better your BEP, the easier all your other fitness goals will be to achieve. At this point I’m going to plug a program that I think is a great way to get into weight lifting and is a solid version of a BEP and that is StrongLifts 5×5. The website gives a great explanation of the program and even offers a free app for your mobile device to help get you started and keep you on track. I use this program as my BEP, and when I start to get bored, I will switch out and do a new program. Once my alternate program ends though, I know that I can jump right back into my BEP to keep consistently going to the gym. Having a BEP provides 3 major benefits.

1) You can build SLOWLY. When I am going through a structural correction with a patient we incorporate a VERY gradual exercise program to make sure that we achieve joint stability and avoid re-injury. You will also develop better form and maximize your exercise benefit this way.

2) A BEP will allow you to always have a workout ready to go. A BEP is composed of exercises that can be easily modified based on the time and equipment you have available. Even if it means doing body weight squats and push ups in a hotel room while traveling for work. This eliminates a commonly used excuse for not working out.

3) The biggest benefit though is, there is no set stopping point. With a focus on gaining functional strength and increased mobility through a BEP, you gain a long term goal of health and wellness. Health is not something we can achieve and then move on to the next thing. We have to consistently work to maintain our health.

Once you have used a BEP to gain some muscle strength, flexibility, and joint stability, then STHIPs become a great way to mix things up. You will have the lifestyle and physical ability to avoid the pitfalls, and the variety will keep it from being boring. Another great way to get variety in your exercise routine is by doing a physical activity that you simply enjoy. Love golf? Skip the cart and you just got a great low impact cardiovascular workout in by walking the course. If you don’t know what you would enjoy, join a slow pitch softball league, or take a tennis lesson. Your BEP will help you engage in these activities more successfully, and if you find you don’t love them, you can move onto the next idea. Sometimes they provide motivation to push yourself a bit harder in your normal exercise regimen because you want to improve your skills. Asking a friend to join you on your fitness journey is another great way to get, and stay, motivated while making exercise more fun.

In sum, having a BEP, is safer and easier when trying to form the habit of exercise. You will be able to achieve a level of fitness where challenging yourself with a STHIP is safe and fun versus demoralizing. Incorporating fun physical activities will also help you achieve the long term goal of being happier and healthier for life.

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TL; DR – Deep squats are awesome, but you need to have good technique.

Like many people my first experience with weight lifting had mixed results. I was a respectable 6’0” tall, but weighed all of 140 pounds soaking wet with a pocket full of coins. I lifted hard and often, but never seemed to make the gains I had always imagined I would. Years later I learned that basically everything I was ever taught about weight lifting was wrong. I was taught numerous technique errors that resulted in reduced range of motion, limited muscle gains, and more significantly left me more at risk for injury. I want to spend a little time talking about my favorite lift – the squat. Hopefully we can dispel some myths to avoid some of these pitfalls for others.

Today we are going to address squatting past parallel. I was taught that to squat past 90° of knee flexion put too much strain on the knee and could cause knee injuries. While I doubt my coaches knew the root of this myth when they passed it on to me, this was based off a study in 1961, which determined the ligaments in people who had weight lifted using a deep squat technique were more lax than in people who had never done a deep squat. (1) To date, the results of this study have not been reproduced, and there is no indicator that the deep squat is the cause of ligament laxity. A full and complete deep squat is indicative of full and normal range of motion in the hips, the knees, and ankles.

So how do we do one? There are many schools of thought on what the “perfect” squat looks like. We are going to break it down into a few categories

Stance – Since I want to focus on functional motion versus lifting the most weight humanly possible, I am going to recommend that you go with a more natural stance. This means that whatever position feels comfortable to squat in, is the right one for you. For some people this means a slightly wider stance with the toes slightly out, for others it may mean a narrower stance with the toes straight ahead. The key is to make sure that your knees track along the same path as your toes to avoid putting irregular stress on the joint. This means that you need to point your knees directly at your toes. So your knees should flare out slightly as you squat if your toes are out, or stay straight if your toes are straight ahead. The degree we bend has less to do with injury rate than the tracking of our knee directly over our toes (2)

Motion – The next step is to squat down. There are lots of opinions on whether you should let your hips fold or your knees bend first. I prefer a fluid motion. That means both of those things should be occurring simultaneously. Once we have dropped down to as deep of a squat as we can comfortably achieve, then we want to drive up with the weight pushing through our heels as make a fluid upward motion to standing. (3) Throughout your entire trip (down and up) you should work to keep your chest up and preserve the curve in your low back. This is going to give you more balance and keep you from irregularly loading the discs between the bones in your back.

Barbell Position – ***This is only if you are doing a back squat*** If you are planning on doing a back squat, where there is a barbell across your shoulders, then we need to cover the position of the bar. There are, again, multiple schools of thought on what is the “ideal” bar position. I prefer the bar to be slightly lower on my back – think across my shoulder blades versus on top of my trapezius muscle. I think that this forces the lifter to keep his/her chest up, because you will feel the bar begin to roll up if you start to breakdown in your form and lean forward. It will also give you some room to recover before you recruit your neck to hold the weight up, which can lead to injury. This is not the rule, just my preference. The key is to make sure the bar is loaded over your back versus jamming into your neck and forcing your head forward, whether you are in a “high bar” or “low bar” position.

My last tip on the performance of squats is to build slowly. This article is not directed at those who are looking to lift 10,000,000 pounds and defy the limits of the human body. This article is designed to help a typical person improve their functional motion, while improving overall health and wellness. Perfect your technique before you add weight, and add weight very slowly.

Squats are wonderful compound exercises that engage a lot more muscles than just your legs. Squats also help to build core strength when performed correctly because of the muscular involvement to keep your trunk in an upright position. There are a plethora of benefits to adding squats to your regular activities. Squats translate well into real world movements. Think of simple things like checking your tire pressure, picking up your kids toys, or lifting a laundry basket off the ground. All of these activities incorporate muscles that will be strengthened by squatting. In addition to the muscular help, weighted squats help to improve bone density. This can help to prevent injury as we age. Also, despite the very commonly held myth that deep squats cause knee instability a review of literature performed by the NSCA indicated that squats actually improve knee stability when performed correctly and help to strengthen connective tissue. (4) Basically squats are awesome!

This is not to say that anyone and everyone can perform a deep squat. While sparing you some of the anatomical details, people with compromise to the structural integrity of their back, hips, knees, and ankles would need to build up even more slowly to a deep squat, and some injuries may restrict a person from ever completing a full deep squat. In any case it is important to contact a healthcare professional to be cleared for a new exercise program.

1. Klein, K. (1961). The deep squat exercise as utilized in weight training for athletics and its effect on the ligaments of the knee. Journal of the Association of Physical and Mental Rehabilitation, 15(1), 6-11, 23.

2. Markolf K.L., J.L. Slauterbeck, K.L. Armstrong, M.M. Shapiro. and G.A. Finerman. 1996. Effects of Combined Knee Loadings on Posterior Cruciate Ligament Force Generation. Journal of Orthopaedic Research 14: 633-8.

3. Contreras, Bret. https://www.t-nation.com/training/7-squat-dilemmas-solved

4. McManus, Matt. http://www.axissport.com/Debunking-a-Myth–Squatting-Deep-is-Bad-for-Your-Knees.html

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