Squatting is a key developmental movement that we do in order to stand up and walk as little ones. The thing we often ignore in our squat training is that we learn to squat from the ground up. This is a fundamental movement that can not only help with our squat form but also with pain from a nagging problem or when recovering from an injury.
In clinical practice, I often see an individual with a nagging lower extremity problem that aggravates them when squatting. This could be a pinch in their hip or a lack of mobility from an old ankle sprain. Barring any internal damage to these structures the goal is to get them moving the way they want as soon as possible.
We cannot address the lower extremity without addressing the lumbo-pelvic complex or “core”. You can think of the core as a conduit for movement-producing forces traveling through the torso to and from the extremities. It is a stable base. Imagine you were an outfielder throwing a baseball to the infield. You would have to plant the front foot for stability and drive the pelvis over the femur at the hip joint producing force that is translated through the core and torso to the shoulder and then onto the hand to release the ball. This is an oversimplification but you get the idea of that relationship. If you were to only move the shoulder and arm that baseball would most likely not hit its target and the shoulder would suffer for it.
With a nagging hip problem or a dodgy ankle the first thing is to rule out an any damage to the joint that would contraindicate treatment and then see how the joints themselves move. After this I want to see how the patient balances on one leg, how they squat, and how they engage their core.
Most of the time, all these things need some improvement. An ideal place to start is by working with our core, the stable base, through a fundamental movement – the squat. I would start the patient on hands and knees in the quadruped position and make sure they can engage their core muscles to be stable. If they can then I have them rock back into the hips with a straight back. Then the fun starts – the “low bear” position. The same idea as the quadruped but they are now on their toes. From here we can do what we all learned to do to stand up – crawl back into a squat. This developmental movement loads the whole body while keeping the core strong. It uses the hips to drive the movement and helps the ankle get into the appropriate position so as not to be overloaded. How far apart the feet are or which direction they turn does not matter as much so long as it feels natural. Our hips and pelvis are unique to us and we all work within our own anatomy.
From this position, we can start progressing the movement. We can then load this with a kettlebell exercise called “The Backhoe.” This requires coordination of movement and helps with body awareness. We can groove these movements and then incorporate full squat motion. This not only improves the form of the squat but properly loads the structures used therein.
In the video, you can see these corrective movements. It is important to remember that if you are having pain it is necessary to consult a healthcare professional first to diagnose the problem and rule out any internal injury to the joints. These exercises should not cause pain or an increase in pain but should help increase stability. So, if it hurts, avoid doing them until you can see your healthcare professional to take a closer look at the problem and how you are moving. Results are optimized with the combination of both corrective exercise and manual therapy that is customized to you by an appropriate healthcare professional.
Dr. Chase Waldrup, DC is a board-certified Chiropractor at Vida Integrated Health in Kirkland, WA
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