Squat form to prevent back pain -from Paul Chek:
The squat is what I call a "Primal Pattern"; also known as a "Root Pattern" by some biomechanists. To appreciate the importance of the squat exercise in its raw form, we must first look at why we need to squat. As primitive beings we lived a ground-based life. Virtually everything we did was on the ground, we cooked on the ground, harvested our food on the ground, sat and slept on the ground and since there were no toilets, we did that on the ground! The point is all these activities required squatting and if you couldn't squat, chances are you had a pretty hard time functioning.
Today many trainers choose to use fancy machines to replace the squat. I have always been concerned about this obsession with machines, as it is almost impossible to create a machine exercise that provides as much benefit as performing a primal pattern exercise in its 3-D unstable, free state.
CASE STUDY
I evaluated a woman with back pain who had been seeing a personal trainer for two years. When I asked her to perform a squat with a dowel rod on her back, she stated, "I can't squat, I will fall over if I try." I said "I am sure you can squat, how do you sit on the toilet or in a chair?" She said "I always use the hand rail, or an arm rest to lower myself." When asked how her trainer had been conditioning her legs, she replied, "We use the Smith Machine and the leg press." Interestingly enough, when I told her to squat to the best of her ability, she fell over backward and landed in my arms: it was quite clear that she was unable to keep her center of gravity over her base of support. This was not a surprise, since neither a Smith Machine nor a leg press require that you balance your center of gravity over your base of support either. After teaching her how to squat properly, it dawned on her that the last two years of personal training had only improved her aesthetics, but done nothing to help her back or improve her functional capacity!
TROUBLE SHOOTING
To remove any fear of squatting or teaching the squat, one only need to know how to identify problem areas, or how to "trouble shoot" the squat.
Trouble shooting tip #1 - Sagittal plane evaluation
The most common fault when performing a squat is excessive trunk flexion. This fault is easily identified when the bar goes forward of the base of support . Poor instruction on squat technique is the most common source of this problem, followed by tight hip extensors.
When assessing the squat in the sagittal plane, the trainer should watch to see if the bar is moving forward of the base of support. If the bar is permitted to go forward of the space occupied by the clients feet, excessive loading of the lumbar spine in inevitable!
Solution Progression
Correct squatting form.
ii Cover the classic instructional key points
1. Comfortable stance with toes turned out up to 30°
2. Lordosis is held at neutral throughout the squat
3. Chest is up, shoulder blades together and spinal extensors activated
4. Eyes level with horizon
5. Deeply inhale and hold breath
6. Draw belly button toward spine to activate deep abdominal wall
7. Initiate squat from knees (not the hips, as this accentuates any forward lean)
8. Descend on prescribed tempo as far as possible with good form (maintain lordosis)
9 9. Ascend on prescribed tempo, releasing air through slightly pierced lips as you pass through the sticking point. Repeat for prescribed repetitions
10 10. Rack bar by stepping forward until bar hits rack and lower weight by bending knees, not back!
If your client still fails to maintain an adequate trunk position or loses their lumbar curvature at or near the bottom of the squat, stretch the hamstrings and gluteus maximus.
If this fails to correct the problem, try having them lift their toes in their shoes while squatting. This shortens the foot and stands the trunk more upright.
Should they continue to be unable to hold a natural lumbar lordosis through the squat, I recommend taping the back as a proprioceptive training cue
With your client standing upright, place one strip of high quality athletic (Luco-Bond) tape along both erector spinae muscles. The strips should run from the mid-sacral level to the T12 level of the spine as shown. Be sure the client is holding the lordosis in the position you want maintained during the squat as you tape them.
Trouble shooting tip #2 - Evaluation of frontal & transverse planes
This is best performed by viewing the squat from behind. Prior to initiating the squat, imagine that there is a plumb line hanging between the cheeks of your client's behind. On descending into the squat, there should be no lateral deviation of this imaginary plumb line toward either foot. Any sideways movement generally indicates joint restriction in the ankle, knee or hip of the leg opposite the direction of lean. i.e. if there is a shift to the left, the joint restriction is most probably in the right leg
Joint restriction in the right ankle, knee or hip is likely when your client shifts into the left frontal plane.
As your client squats, pay careful attention to the spine and torso. It is very common to find transverse plane dysfunction coupled with frontal plane dysfunction. This combination can be devastating to the spine under load! A transverse plane dysfunction can be identified as a spinal scoliosis that develops during the squat movement and reduces as the client stands erect in the start position. It may also be seen as a swinging of the bar, one end of the bar being forward of the mid-frontal plane, the other end behind it
If you are able to see the weight plates or bar opposite you, when viewing from the side, a transverse plane dysfunction is likely. Making your client aware of their body position is an important step toward correction.
Solution Progression
Assess the ankle, knee and hip range of motion of the suspected side. If you are not skilled in the use of a goniometer, simply compare joint range of motion between the suspected side and the side the client leans toward
If there is a visual discrepency, stretch the relevant muscles and re-evaluate their squat technique.
Joint restriction Muscles to Stretch
Ankle
Gastrocnemius and Soleus
Knee
Quadriceps
Hip
Gluteus Maximus, Hamstrings, and Hip Rotators
Have your client actively dorsiflex their ankles. There should be symmetry of motion to the end point. Normal ankle dorsiflexion is approximately 20°.
With gentle passive over-pressure, bend your client's knees to passive end range. There should be a symmetrical end point. Normal knee flexion is 135-140°.
With your fingers under your client's spine at the belly button level (L3), passively flex the hip until you feel the spine just begin to move toward your fingers. The range of motion should be symmetrical between sides, normal being 125°.
If the problem has corrected itself, job well done! If your problem persists, I recommend you consult a good physiotherapist to assess joint end feel. If there is a capsular pattern in a lower extremity joint or an irritated spinal joint or disk, the problem is likely to persist, significantly increasing your clients chance of back injury. To remedy the problem, have the physical therapist perform the necessary joint treatment and reevaluate.
Tip #3 - Working with a Motor Moron
If you find that your client just does not seem to have the neurological capacity to perform the squat with good form, (they are what we call a "Motor Moron" in the orthopedic rehabilitation world) you must allow them to cheat! In other words give your client a modification of the squat that is less demanding than the primal standard. For example the first level of descent is to squat while holding a solid support, such as a vertical beam on a squat rack. This should provide enough additional stability to improve squat form and reduce fear of falling over.The next level of descent is to perform the squat with the support of a Swiss Ball, carefully placed between your client and the wallThis will aid them by means of proprioception, reduce the demand to balance their center of gravity over their base of support, yet still require stabilization of their body. Use of a Smith machine would be a third level descent below the primal standard, as it is much more stable than the Swiss Ball, requiring much less stabilizer and neutralizer action from the torso and hip musculature.
Place the Swiss Ball low enough in the start position that it does not travel above the client's shoulders in the bottom position of the squat. As your client improves, bring the feet closer to the wall - encouraging minimal use of the ball for support.
DESCENDING THE PRIMAL SQUAT
Level 3 Level 2 Level 1 PRIMAL PATTERN
Smith Machine Swiss Ball Hand holding FREE BAR
Squat Squat Squat SQUAT
Least stabilization required Most stabilization required
SUMMARY - COURSE OF ACTION
1. Identify your client's specific joint restrictions and technical barriers
2. Determine at which level they need to begin squatting
3. Implement a plan for strengthening them at their appropriate level
Your goal should always be to progress them to at least the primal standard; a good solid, unsupported squat. At least this way you can feel assured they will not fall into the John when you're not around!
Please Scroll Down to See Forums Below 
