Home Blog The “Don’t Squat” Recommendation

The “Don’t Squat” Recommendation

Written on December 16, 2008 at 7:06 am, by Eric Cressey

I always love it when folks come back from doctors with the “don’t squat” recommendation.  My immediate response is, “So you aren’t allowed to go to the bathroom?”

Obviously, I’m saying this pretty tongue-in-cheek, as I know they’re referring to squatting under significant loads.  However, I wish we’d get more doctors who would appreciate that certain things (e.g., squatting) are important parts of our daily lives, and that those with knee pain need to learn how to squat correctly, not avoid it altogether.

Learning to sit back and hinge at the hip can give a majority of knee pain sufferers relief from symptoms when they do have to do a squatting motion during their daily lives.  Effectively, when one squats this way, it reduces shear stress at the knee and places the load more on the hip extensors: glutes, hamstrings, and adductor magnus.  These muscles have big cross-sectional areas and can easily handle the burden of squatting.

I hate to play devil’s advocate, but it’s a perfect example of a scenario where a doctor only sees pathology and not movements.  It never ceases to amaze me how simply alternating movement patterns can markedly reduce how symptomatic a pathology is – and this is where good physical therapists and trainers/coaches come in.  A lot of doctors are extremely well-schooled in diagnostics, but have little background in terms of mechanisms of injury (particularly for chronic injuries), optimal rehabilitation , and the hugely important role soft tissue restrictions play in the development of pain.  Often, these issues are left unaddressed and an individual still gets healthy simply because the doctor has contraindicated so many exercise modalities that a patient gets better only through resting the irritated tissues.

With respect to the knee, Mike Robertson has put forth some great material on this front in his Bulletproof Knees manual.

bpk

  • Everybody has to be able to execute a squatting motion properly.

    Not everybody needs to get super strong on squats or even increase their strength (for example some women will get too big quads from this), but everybody will benefit from being able to control his/her body and do a proper squat.

    Yavor

  • Bob Parr

    Good post. I’d be about as likely to ask a doctor if it was okay to squat as I would be to ask him if I’m healthy enough for sexual activity. And, if the “do not squat” advice came unsolicited, it would be ignored.

  • Yeah, I get this all the time with new clients. That’s why bought Mike’s Bullet Proof Knees manual. And hired an ART Professional to visit my gym every week as well.

    Rich

  • Your advice about the “hip hinge” is very true. Problem is most people don’t have enough posterior chain strength to really do this. RDL’s accomplish this with a very safe movement progression. One of the many problems with knee pain is a lack of VMO function. Problem here is, it won’t fire completely unless it is in flexion. Kind of makes you go hmmmmmm?

  • jonathan mcgowen

    My wife has been working out and using the book New Rules of Lifting for Women. She has been squatting (and doing pretty well). I have 2 questions though: (1) When she squats down and approaches parallel, her right heel comes off the ground. I’ve pointed it out to her and she tries to correct it, but it happens every single rep. She thinks maybe her right leg is slightly shorter? (2) She can’t do lunges. They hurt her left knee. Any ideas on what the hurt is and how to fix it so she can lunge?

  • Ben Kusin

    Jonathan,

    Assuming there isn’t anything WRONG with her knee, she’s just too quad-dominant. Get her to do bridges on the floor (lie on back, feet on floor, raise body up) Glutes should fire first. Progress to one-legged version and single-leg squats to high box (body weight). That takes care of motor control, then you need to strengthen the glutes.
    Quad dominance, by the way, sometimes is why heels come off the floor in squatting (see: sissy squat)
    Throw in a bunch of mobility work and foam rolling (the one thing everybody skips!), too.

    Of course, if there IS a knee problem, then things get complicated. But bringing up the glutes is still a must in that scenario.

  • jonathan mcgowen

    Ben,

    Thanks for responding. I’ll see if I can convince her to do bridges.

  • Doctors really bother me.

    My father has knee pains due to his job, and his doctor will not recommend him to a physical therapist (we have some pretty serious dudes in town here) — why? Because the doctor feels there is no reason why my father’s ailments cannot be fixed with medicine!

    Sheesh. If that’s supposed to be the safest method, I don’t want to know what UNSAFE is.

    My dad, being smarter than this (and eventually getting over the proximity bias) began doing simple movements to strengthen his legs and voila — knees are better. Oh, some fishoil was added into the mix as well.

  • Great post, Eric!

  • i’m stealing that first part from you to use with people who say that to me! you’re right on the money about moving from the hips. this is why i like the box squat so much- everyone that tells me they can’t squat due to knee pain is able to sit back and squat challenging weights almost immediately.

  • Trish

    What are your feelings on squats/lunges for a client who has knee replacement surgery?

  • Trish,

    It would really be a very individualized situation that would depend on age of the client, any post-surgery complications, functional activities, and the variation of squats/lunges you’re talking about. Some would be appropriate, but others wouldn’t.


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