Deep Sqauts: Personal Trainer vs Physical Therapist

I am having real issues with my knees, and my physio has tried now since 2009 to find ways to help my hyper-mobile kneecaps from going on their own little voyages of discovery.

I have had a couple of flare-ups which my physio believes are the bones grinding where the cartilage has gone, and she has defined a series of ongoing stretches, and imposed certain limits (latest - no running until Feb and then only a minute A MONTH...!).
I've had weeks off, very limited stuff (cycle, swim).
Now gradually adding walking on a treadmill, elliptical, rower ...

My Physio told me the same - no going past parallel - I've discussed this with my Doc (who sent me for an X-ray at the start of the year) and my Personal Trainer.
Doc has tentatively allowed me to ramp up, and the PT took me back through using TRX Straps to take my bodyweight through my arms so I can isolate and focus on form while doing squats and lunges.

My advice is to take the Physio's advice over the PT for the time being... it's not forever... but if it is hurting that much, you really do run the risk of a lot of pain.

If the pain is quite hard to bear, look at maybe doing so low-impact stuff so you are still burning cals, but not knackering your knees...

The medically-qualified person is asking you not to give up squats, but only to change how you're doing them. This person has significant experience and specialist training in how your knees function. Listen to them. Your trainer's knowledge in this area is almost certainly less that that of a medical specialist, and probably focused on those with healthy normal joint function, for whom deep squats may or may not be contraindicated. For someone with impaired joint function, any action that puts extreme pressure or stress on the afflicted joint is going to be problematic - it's common sense. There's really no question here - listen to the medic. Otherwise, I'd suggest you start saving up for knee replacement surgery.

My trainer says there is nothing wrong with it, that there is no actual medical evidence to support that doing a deep squat injures your knees.

"In conclusion, there is scant evidence to show that deep squats are contraindicated in those with healthy knee function. The decision as to how low to squat should therefore be based on an individual's performance-oriented goals and considered in conjunction with any pathological issues that may be apparent. Those with PCL disorders should refrain from squatting below 50 to 60 degrees until the injury is fully healed. Disorders such as chondromalacia, osteoarthritis, and osteochondritis may also contraindicate the performance of deep squats." from http://www.lookgreatnaked.com/articles/archive/are_deep_squats_bad_for_your_knees.htm

This is your situation. You do not currently have healthy knee function. So stop the deep squats and listen to the physiotherapist. You need to first correct the knee function. That is what your therapist is working toward. Then you can work on building the strength/endurance that bootcamp gives.

If you knees are hurting (more than ever) then stop squatting and any other strenuous, knee centric movement until you get that situation resolved

This but to answer your other question squatting deep is good for people with healthy knees and in itself does not cause knee problems. Overly shallow squatting does cause knee problems eventually.

I damaged the cartilage in my knee a couple of years ago in a skiing accident. My personal trainer would always defer to my physical therapist on what I should/shouldn't could/couldn't do. Ask your PT for exercises to strengthen the muscles around your knees that will provide move stability and potentially you could get back to deep squats again.

My knees still act wonky occasionally, but I chalk that up to an active lifestyle and a bit of aging (I'll be 43 on Monday). I usually do squats now using the TRX, and I have no problems--then again, I don't usually do ATG squats...

I agree w/those that said to give your knees a break if you're in pain, and try to resolve any injuries, etc. first.

That said, I have also had knee pain periodically, and learned NOT to do deep knee squats in all my previous training (the whole "Don't go past parallel" thing). I would still have periodic pain, depending on what we were doing, how often, and how much weight we used.

However, I've recently started working with a great CrossFit gym with good trainers who work with us slowly and methodically on form. We do deep squats a lot, BUT, our form is completely different than what I learned in other fitness classes (and even in Group Fitness Instructor training).

When we do deep squats, the toes and knees are pointed slightly OUT to let your hips open up more and your back and chest stay more elevated. You are following your mid-line down to the ground instead of leaning over to accommodate keeping your knees straight on. Because of the levers and angle of your legs, it is actually GENTLER on your knees -- and puts less pressure on them, and relies on your leg muscles -- than the legs parallel squat.

I have not had knee issues doing these deep squats, even with heavy weights. BUT, our trainers also do NOT have us do any squat moves if we are having knee pain. We do other workout movements and lots of therapeutic stuff (rolling things out, working on IT bands, stretching) until the pain resolves.

Hope this helps.

Actually the proper way to squat is lower, it strengthens the knees. watch a baby pay with toys, they squat down, chest up back flat, feet flat butt almost on the floor. ATG squat is a natural position for the body to be in.

I'm not going to disagree with your general premise. You're correct that most trainers recommend deep squats and for good reasons (assuming healthy knee function, etc). But really? Babies do it so it must be "natural" and "correct"? Babies learn almost everything by watching us. They can't even stand till they learn the trick of it, and most of the motions that they attempt while standing result in them falling down. The reasons babies squat the way they do is that they learn it's the most stable way to squat, and they lack the balance and coordination to do anything but the safest and stablest movements without winding up on their butts. It so happens that stability is also very important to weighted squats, so the same motion is also correct for adults doing the exercise version.

If "the way babies do it is the correct and natural way to do it" was a valid argument, the correct way to run would involve hardly bending your knees at all, and winding up on your butt every ten yards.

Sounds like you have a good course of action - follow the advice your PT (and by extension, your coach) wants you to follow right now, see if your knees can't improve a little, and reassess.

In the future, things like this are always a risk-reward analysis. There's always, always, always another (or a series of other) movement(s) or exercise(s) that will work your body in a similar enough manner to the one in question. That's the beauty of the human body, we're so frigging adaptable and capable. So maybe squats past parallel won't hurt your knees, but maybe there's another movement that your coach can come up with that will do something similar, and your PT can agree on.

My example: I have a crappy SI joint. Lunges will leave me unable to walk the next day if I've been lazy and let things go (sadly, not rare). My coach doesn't like that I won't do lunges, but came up with a couple different moves to do instead - surprise, they're the ones I skip usually because I don't like them, because they're really hard and exhausting. But they won't leave me unable to walk, and when I do them regularly and get stronger, I can lunge again.

Another note - I didn't read your knee issue too carefully, but PT isn't the only option before surgery to fix joint issues. I was all set to have my spine fused before I got prolotherapy (google it) on my back - it worked amazingly well. (then again, my husband had a similar issue to me 5 years later and it didn't do anything for him - accupuncture and massage did work for him but not me). Just saying to keep your mind and options open, there are lots of possibilities and specialists and insurers might confuse "outside their purview" with "outside possibility".

Good luck!