Improving Your Squat Form With Physical Therapy

by Vida Integrated Health | Jun 4, 2020 | Uncategorized

Squat Form Case Study

I am coming at you with a squat case study, hopefully it will give insight into the physical therapy evaluation and treatment process! With physical therapy the goal is always to keep you moving and doing what you love to do as efficiently as possible. The subject of the study is my wife, Bethany. Bethany has been having low level left hip pain for the past 2-3 months. We have been doing more home workouts lately, and that is when I noticed her form was suffering with squatting movements. I thought this was the perfect case study to demonstrate how physical therapy can minimize pain while optimizing athletic performance!

The first part of the evaluation starts with the “subjective” portion – this is where we gather pertinent information about the site of pain, past medical history, goals, and get to know the subject (well, I know her pretty well already!)

Subjective

Chief complaint: left glute soreness, mostly after working out and trying to go to sleep, over the last 2-3 months.

Personal: Bethany is extremely active, she cycles 4+ days a week, as well as going to crossfit classes 5x week.

Past medical history: multiple right ankle sprains growing up, right hamstring tendon strain last year.

Treatment to date: massage (shout out to Kim Singletary, LMT at Vida Seattle).

Goals: reduce hip soreness, keep working out at a high level .

Now that we have some good background info, the next step is the “objective” portion. This is where we observe movements pertinent to Bethany’s issue, take strength and range of motion measurements of areas that could contribute to her pain. It is useful to see if we can reproduce the pain, so we can better understand what does / does not irritate it. To simplify things, I will share a condensed version of what we found.

Objective

Range of motion: ankle, knee, hip mobility were normal – except tightness of hip flexors and quads. Bringing the left knee across the chest caused mild discomfort in the front of the left hip.

Strength: left glute max muscle is limited in stability as noted by bridge march test. Left glute med muscle is limited in strength by manual muscle testing.

Movement quality:

Lunge: excellent form, pain free .

Air squat: good form, pain free.

Squat loaded in 35# thruster/overhead squat form – right foot travels and rotates externally as squat is initiated, large weight shift to right side while twisting to the left, weight in toes, right knee falls inwards.

Assessment / Plan

Now that we have enough information we have to take it all into account and make up a plan! We made up an exercise plan based off of the biggest issues we observed and measured – quad/hip flexor flexibility, glute max and glute med strength/stability, and squat form. At this point in time, it appears that Bethany’s lack of left glute stability and control is leading to a breakdown of her squat form, causing a shift to the right away from the effected leg. Her high volume exercise routine could also place undue stress and strain on that left hip, especially with the underlying strength/control issues. We talked about training volume and what proper recovery should look like. With working out so much, the body needs the right recovery to build up what was broken down during training.

Results

Flash forward after two weeks of performing super-secret home exercises: Bethany is feeling 95% better, no longer having soreness after workouts, no longer having uncomfortable feelings at night, getting up and down from the chair doesn’t bother her anymore. Her overall form looks a lot more efficient and she feels stronger with squat dominant exercises. Take a look!

Bethany Before

Bethany After

Now, a disclaimer, not all cases are as quickly resolved as two weeks. It is important to take into account how long the issue has been going on, the severity of pain/irritability, what actual body part is at play (joint, tendon, muscle, ligament) as those all have differing healing time frames. In general, the earlier the better when you are having pain or an issue. What starts as avoiding/modifying one little thing due to pain can sometimes snowball into a bunch of things as time goes on. As always, seek out a physical therapist who can assess and get to the root of the issue, don’t waste time guessing!

If you are experiencing any issues with your form and workouts, come in and see us!

Ashley Henriques, PT, DPT
Physical Therapist at Vida Seattle

Vida Integrated Health – THINKVIDA.COM/CONTACT

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Ashley Henriques, DPT

Physical Therapist