Infinity Spine Center Blog

Part 1: Build a Better Squat

One assessment that we perform on virtually every patient is a bodyweight squat.  Whether you are an elite athlete at the professional level or a 94 year old recreational athlete, you should know how to squat with proper mechanics.  One of the common findings at our center as well as in the gym is a toe out (forefoot deviates laterally) stance—especially when the patient or athlete reaches their maximum range of motion at the bottom of the squat.  When toes deviate outward  it commonly coexists with a host of other biomechanical faults.  These faults include hyperpronation (collapsing) of the medial longitudinal arch of the foot, genu valgus (knee moving inward), and hip adduction (check out Arnold in the photo below to see a perfect example of what we are talking about). When these improper mechanics take place during the squat, the athlete increases their risk for injury at the foot, ankle, knee, and hip due to lack of joint stability and centration.  These improper biomechanics then lead to suboptimal neurological positioning of the pelvis and spine.  Overtime the suboptimal neuromuscular firing patterns lead to destruction of joint cartilage and ligaments that finally leave you with arthritis an a consultation with an orthopedic doctor that will likely recommend a knee replacement.

 

squat

Domino effect with Arnold.

In this article we will discuss possible causes of the toes moving outward as a result of hyperfacilitation of certain muscles.  In a later article we will discuss common muscles that are inhibited causing the outward movement of the toes during the squat.

 

It is important for you to understand that this article is in no way a substitution for an assessment and treatment with a knowledgeable clinician of biomechanics, specifically knowledgeable about squatting.

 

Hyperfacilitated and inhibited muscles are muscles that have increased and decreased rate of neuromuscular activity, respectively.  Hyperfacilitation causes an increase in muscular tone and inhibition causes decreased muscular tone.  This over or under firing of the muscle may be as a result of peripheral nervous system (muscle spindle, golgi tendon organ, lower motor neuron) or central nervous system (frontal lobe, basal ganglia, cerebellum, upper motor neuron) dysfunction.

 

Again, in this article we will discuss muscles that may be over firing leading to the toes moving outward during the squat and in a later article we will discuss inhibited muscles that may lead to the outward movement of the toes.  Humans move as a system of integrated part controlled by the nervous system.  There are many more parts of the system that we could discuss, but we will first discuss two often overlooked muscles when assessing the squatting pattern.  Due to the lack of attention relative to other commonly looked at muscles (gastrocnemius, soleus, hip adductors), we begin our correction of the squat with peroneus longus and brevis and bicep femoris.

Hyperfacilitated muscles that may cause toes to move outward during a squat:

1. Peroneus longus and brevis

2. Bicep femoris

 

Peroneus longus and brevis

 

The peronei group is made up of three muscles including peroneus longus, brevis, and tertius.  Peroneus longus runs from the top part of the fibula and courses down to the inside bottom of the foot. Peroneus brevis orginates on the lower part of the fibula and connects on the outside of the foot.  Peroneus tertius runs from the bottom part of the fibula to connect on the top part of the outside of the foot.  Peroneus longus and brevis play a role in plantar flexion and evertion of the foot and rather than plantar flexing, peroneus tertius plays a role in dorsiflexion of the ankle.   In order to keep the toes from moving outward while squatting, peroneus longs and brevis must not be hyperfacilitated.  The toe-out stance especially during a squat is a common finding in the gym–go there and you will see what we are talking about.   A couple studies have found an association of glute inhibition which may lead to hyperfacilitation of peroneus longus (see references below).  We will discuss this in a future article.

 

squat bicep femoris

Overly active bicep femoris may cause duck feet during your squat or gait

 

Second, hyperfacilitation of bicep femoris may cause your toes to move outward during squat especially at the bottom range of motion of the squat due to the fact that it crosses the hip and ankle joints .  The bicep femoris originates at the ischial tuberosity and femur then courses to attach to the head of the fibula.  As you descend in the squat the hip flexes which causes lengthening of the bicep femoris, therefore increasing tension (unless there is decreased hip flexion relative to knee flexion which is not common in our center or our observations in the gym).  This increased tension may lead to external rotation of the tibia and fibula resulting in the toes moving outward.

There are many different treatments that can be used to help with these neurological dysfunctions.  Here are two exercises that you can do at the office or at home to help.  In our center, we have seen great results with implementing these two exercises before performing any squatting exercise.

Peroneus longus and brevis exercise:

1. Stand with your feet about 2-3 times shoulder width apart.

2. Turn your toes (forefoot) inward.

3. Keeping your feet planted, externally rotate your hip by driving your knees outward as you bring your knees forward over the foot.  You should be aiming to take the knee forward and to the outside of the foot.

You should feel a stretch along the outside of foot and ankle and/or outside of the leg.

Hold the position for 20-30 seconds and repeat throughout the day or at the beginning of your workout.

 

Bicep femoris exercise:

1. Stand with your feet touching each other side-by-side.

2. Turn your knees outward (external rotation of the hip).

3.  Keeping a neutral spine, flex at the hip as if you were going to touch your toes, but remember to keep your spine in a neutral position.

You should feel this on the outer part of your lower thigh.

As you perform these exercises you’ll start to feel the muscles decrease tone and the exercise will become easier.

Squats do not cause injury.  The way that you squat causes injury.

Rule: Never move in pain.  If you have pain call your chiropractor or physical therapist that knows about optimal squatting mechanics to help correct your movement dysfunction.

Sources:

http://www.ncbi.nlm.nih.gov/pubmed/24373699

http://www.ncbi.nlm.nih.gov/pubmed/23642515

 


What is Really Causing Your Low Back Pain?

One of the more common low back injuries that we see is disc injury.   Studies show that close to 80% of us will experience one episode of low back pain including disc pain.  If you’ve ever had low back pain before you know that it decreases your productivity and kills your mood.

From my clinical experience, I find that low back pain is a lot of times the result of another joint not functioning well.   One of the more common stories of low back pain that I hear from people is, “I just bent down to pick something up and instantly had back pain.”

In order to pick something up from the ground we must bend forward.  Bending forward to pick something up is a compellation of many joints flexing, or bending so you can reach down and pick the object up.  Some of the joints that work to make this happen include the ankle, knee, hip, and spine.  Breakdown in any of these regions leads to compensation in another.

The hip joint is one of the most common areas for dysfunction that I see leads to back pain, including disc injury.  If the hip is not bending and/or muscles that support normal hip function are not working the back must compensate by increasing its movement.  This increased movement over and over eventually leads to disc injury or another type of back injury.

Due to increased popularity of workouts like Insanity, P90x, and Crossfit, we are seeing more injuries.  Most of those doing the workouts lack proper range of motion and muscle activation, especially in the hip.  These workout programs are great due to the fact that they focus on more complex movements that increase demand on your body.  However, the downfall of an exercise program like this, the “one-size fit all” type of program is that there is a lack of individuality to meet the needs of the person exercising.  It is essential that you optimize joint function before using that joint(s) under a loaded condition (squat, snatch, clean, etc.).

Call Dr. Thoma today to see if we can help you restore your health and help you get rid of your back pain.


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