InFORM Your Squat Form:  The evidence behind the rules of the squat

December 21, 2017 in News by Horizon Physical Therapy  |  Comments Off on InFORM Your Squat Form:  The evidence behind the rules of the squat

Whether you’re a gym rat with years of experience squatting under a barbell, or a novice who occasionally performs a workout in the comfort of your own home, you most likely share some of the same questions. Most of those questions are likely met with a different answer each time you’ve asked: “Should my knees ever pass my toes when I squat?” … “How wide should my stance be when I squat?”…“Is a front squat or back squat better for my knees?”  There is no better resource than evidence-based research articles to separate the anecdotal opinion from scientific outcome.  Our goal is to direct you to evidence-based answers to each of these questions.

Let’s start with understanding that the sum amount of force through your body during a squat – whether weighted or not – is going to be distributed throughout the joints of your body.  Squat form determines whether those forces will be shared evenly throughout the knees, hips and spine, or if one segment of the body will take the brunt of that force.

The cue that we have all heard and have even voiced to our clients and patients when squatting is “don’t ever let your knees pass your toes”.   Upon review of the article Effect of Knee Position on Hip and Knee Torques During the Barbell Squat; findings reveal that a restricted motion of the knees tracking beyond the athlete’s toe position does in fact decrease stress to the knee joints, but results in an increase of forward trunk lean causing increased lumbar and hip stress.  Understanding that decreasing the force from the knees causes a direct increase in force through the hips and lumbar spine gives us the advantage of choosing which is best for each individual athlete. In an athlete with a history of knee pain or surgery, we may want to restrict forward knee position. Whereas with an athlete with a history of hip or lumbar injury, we need to open up the travel of the knees over the toes. The final analysis of this evidence based study states, “To optimize the forces at all involved joints, it may be advantageous to permit the knees to move slightly past the toes when in a parallel squat position.”

When determining how wide our squat stance should be, the answer we all like to hear is actually acceptable this time – do what feels good.  Though, theoretically, we all have the same anatomy, each of us has a unique makeup of bone lengths and joint angle differences that ultimately lead to a tailored approach of stance width.  Since getting stronger is the goal for both the trained power lifter as well as the novice squatter under the barbell for the first time, the most important measure of stance position throughout the squat is the effectiveness of muscle activation.  The article The Effect of Stance Width on the Electromyographical Activity of Eight Superficial Thigh Muscles during Back Squat with Different Bar Loads, reveals the evidence of an increase in Gluteus Maximus activation with a wider stance, while all anterior thigh muscle activation remains the same with both narrow and wide stance width.  The variable of increased weight on the bar resulted in increased activation of all muscles of the thigh.

Last, but not least, is the debate of when and why to choose the front squat versus the back squat.  Again, we point to the evidence based research for the best answer here.  The article, A Biomechanical Comparison of Back and Front Squats in Healthy Trained Individuals gives us the breakdown of muscle recruitment, as well as the comparison of compression forces on the knee joints for both lifts.  The findings from this study reveal the front squat to be the best in show.  Why?  According to their research, during the front squat, electromyography of thigh muscle recruitment was equal to that of the back squat with significantly decreased compressive forces through the knee joint.  The study concludes by stating “The results suggest that front squats may be advantageous compared with back squats for individuals with knee problems such as meniscus tears, and for long-term joint health”.

In summary, the squat is an approachable, functional way to get stronger.  Now that we have the answers from evidence-based studies to know both how to squat and how to teach others to squat, we have no limits to seeing the best strength gains in our fitness journey.  Knowledge is power.  Here’s to using it to get stronger!

Physical therapy is a conservative form of treatment for multiple pelvic health issues

December 6, 2017 in News by Horizon Physical Therapy  |  Comments Off on Physical therapy is a conservative form of treatment for multiple pelvic health issues

Did you know that physical therapy is a conservative form of treatment for multiple pelvic health issues that lead to symptoms involving urinary incontinence, pelvic organ prolapse, and sexual dysfunction? Urinary incontinence is reported in up to 45% of women (Hay-Smith 2012) and affects over 200 million people worldwide (Knorst 2013). Approximately 41% of women between the ages of 50-79 experience some degree of pelvic organ prolapse (Hendrix 2002). Pelvic floor muscles have multiple functions including continence control, support to pelvic organs, core stability/postural control, and sexual function.

Pelvic floor muscle disorders are classified in two general categories: underactive pelvic floor and overactive pelvic floor. Underactive pelvic floor is typically caused by childbirth, advanced age, obesity, and heavy lifting or straining. Underactivity of the pelvic floor results in weakness of the pelvic floor muscles and contributes to symptoms of urinary incontinence and pelvic organ prolapse. Overactive pelvic floor is often multifactorial and caused by childbirth/surgical trauma, anxiety/stress disorders, bowel and bladder disorders, and orthopedic joint malalignments. Overactivity of the pelvic floor results in tightness of pelvic floor muscles and may contribute to a variety of pelvic pain disorders.

Physical therapy interventions can be utilized to address weakness and/or tightness of pelvic floor muscles to reduce symptoms of incontinence, pelvic organ prolapse, and pelvic pain disorders. We are pleased to offer services at Horizon Physical Therapy to assist you in reducing symptoms associated with pelvic floor muscle dysfunction and to help you return to a functional and active lifestyle. Examinations include internal and external pelvic assessment as well as musculoskeletal assessment to determine dysfunction of the pelvic floor. Interventions for pelvic floor muscle dysfunction often involves pelvic floor strength, endurance, and coordination training; behavioral training, including urge control/suppression techniques; musculoskeletal intervention; and diaphragmatic breathing techniques. For a comprehensive assessment and individualized treatment interventions to address your pelvic health issues, call today! ☺

Your Leg Raises Aren’t Doing Squat

October 30, 2017 in News by Horizon Physical Therapy  |  Comments Off on Your Leg Raises Aren’t Doing Squat

The underbelly of many lower extremity injuries

Pick up a copy of any popular running magazine. Page after page, your eyes gravitate toward gear you don’t need at prices you can’t afford. Your eyes scan over a cross-training regimen that promises to prevent injury and propel performance. The most common muscle groups addressed in these articles are, and always will be, core and hip exercises.

From our clinical experience and well-published research, these types of exercise regimens have a significant positive impact on performance and injury prevention. A strong core and strong hips are essential to a healthy and well- balanced exercise regimen.

Then why are you thinking, “I’ve done those clamshells and leg raises every day, but my runner’s knee still pops up every year during AthHalf training”? You’re right; you’re doing your homework, and you’re still getting hurt. So how can you correctly train your hips?

The misconception we see most often isn’t in which muscles our patients choose to cross train, but how. And this is true for more than just runners. In fact, sports which require any amount of rotation or agility (tennis, baseball, football, soccer, basketball, golf, gymnastics, etc…) each have a high demand for hip strength in order to diminish stress to the knees and ankles.

The problem is that the hip and core muscles are most often trained concentrically in an open-chain environment. However, these muscles typically function eccentrically in a closed-chain environment, which is when the hips work to control the legs and torso while your foot is in contact with the ground. The hips are highly adaptable muscles, which means they are very easy to train correctly, or incorrectly.

The commonly prescribed straight leg raise creates an open chain environment because your feet are not touching the ground. This type of exercise trains the hips but not in a functional pattern.

Long story short, your straight leg raises aren’t as productive as a squat for injury prevention and increasing performance. A squat, in comparison to a straight leg raise, requires additional core and hip control with your feet in contact with the ground. Below are videos demonstrating four closed-chain exercises intended to help with injury prevention and increasing performance. For those who are looking for a more technical explanation, I encourage you to watch Michael Griffith’s lecture from the 2016 NCSA National Conference.


  1. Single Leg Deadlift Reach
  2. Squat and Chop
  3. Monster Walks
  4. Alternating Lunges With a Twist

Common injuries linked to inadequately trained hips

Low back pain
Hip impingement
Piriformis syndrome
Hamstring strain
Runner’s knee
ACL Tears
Shin splints
Achilles tendonitis

Runners, listen to your feet

October 11, 2017 in News by Horizon Physical Therapy  |  Comments Off on Runners, listen to your feet

Having worked with runners of all ages, shapes, sizes, and ability levels through the years, we are always looking for ways to improve our approach to diagnosing and treating running injuries. We’ve done this long enough to realize that the prescription commonly given in most health care facilities that sounds something like “if it hurts when you run, just stop running” simply doesn’t work. Rest simply doesn’t change mechanics, and runners who are told that stopping running is their only option normally are going to terminate their care with you ASAP.

Most running injuries are based, to some degree, on a biomechanical flaw that must be diagnosed and corrected in order for the pain to go away. One common biomechanical flaw, and one of the first things that we commonly assess in our runners, is their cadence. Cadence is the average number of times your feet strike the ground in a minute and ideally should be ~180 strikes/minute for shorter-statured runners and ~170 strikes/minute for taller runners. The idea is that most runners have a cadence that is too low, and they cover too much ground with every stride. This increases the load of each stride on their lower body. When a runner is diagnosed with a low cadence, our first intervention is to equip them with a metronome to help their body keep the rhythm of their newer, faster turnover. Many of you have entered our facility to the rhythmic, sometimes maddening tune of incessant beeping of the metronome with a runner trying to keep pace on the treadmill. A 2008 presentation by Willy et al revealed that cadence re-training lowered peak impact in runners by ~18-19%. This reduction often makes a significant improvement in the runner’s pain with running.

I give you all that information as a backdrop to say that I was very interested to read a research article in the August 2017 edition of The Journal of Orthopaedic and Sports Physical Therapy (JOSPT) entitled “Sound-Intensity Feedback During Running Reduces Loading Rates and Impact Peak”. Now I won’t bore you with all the specifics here, and I encourage those of you who are interested to find the article online and give it a read, but I found the results of the study to be very compelling. Basically runners were given a decibel meter (a free app that had been downloaded on an iPad) and told to try to decrease the sound intensity of their foot striking the treadmill using the decibel meter as instantaneous feedback. After 15 minutes of sound intensity feedback training with running, most runners (~80%) showed a 20% reduction in the peak impact on their lower body. This is a greater reduction than we would expect with cadence re-training.

Based on this research, we now have another, possibly improved, tool to reduce impact forces on a runner’s lower body and may eventually be able to step away from the incessant beeping of the metronome as our go-to tool for one of the most common mechanical flaws in our ailing runners.

Personalized Physical Therapy

November 28, 2016 in News by Horizon Physical Therapy  |  Comments Off on Personalized Physical Therapy

We were recently featured in an article, Personalized Physical Therapy on the Horizon for Athens Area.

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