Squatting below parallel and knee health

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ell_v131
ell_v131 Posts: 349 Member
in Fitness and Exercise
Hi there,

I am looking for some reliable information about deep squats and knee health, preferably peer reviewed studies and medical journal articles. I am doing my research too but was hoping to get some more input from the enthusiasts here. Back story below for those that want to know why I'm looking for this :)

I have been seeing a physiotherapist after my hamstring injury, which has now healed and I'm getting back to lifting (although still spending a lot of time with specific exercises to prevent future injury)

The clinic I go to specializes in muscle injuries, inflammation and recovery after these events and treats top athletes from my country. I am therefore using my physiotherapist to help me develop proper form and core strength (something I neglected before) for my lifting, which I am still a beginner at.

Anyways, I want to get back to squatting and I have previously done a fair amount of research on this as I have a small birth defect in both my patellas which is causing a reduction in the surrounding cartilage. Nothing dramatic thought so I have concluded that with proper form I should be safe to squat once or twice a week, especially since I have no ambition to do hundreds of pounds and I have only gotten to like 15lbs pre-injury. I believe I have suffered the injury during some mobility exercises rather than actual lifting but I guess I will never know as it wasn't a big tear and for days I thought the pain was just DOMS :)

My issue is my physiotherapist doesn't want me doing squats below parallel, which is not an opinion based on my specific patella issues, she is convinced it is not good for anyone. She has me doing what I would call quarter squats with narrow stance, toes forward and back a lot more horizontal than I'm used to. She claims to have attended several seminars in the past year dedicated to knee health and squatting/lifting and read multiple recent studies on the topic and that the most recent conclusion is that there is just too much strain on the knees for it to be healthy for anyone.

I will ask her for the studies as I want to read through it and understand her point better. But I would also like to find studies that support my belief (if any) so that we can discuss and find the best way for me to proceed safely.

Thanks guys!

Replies

  • jlclabo
    jlclabo Posts: 588 Member
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    i would have to read these studies too, being that squats are one of the best compound movements you can do for overall fitness. i, myself, have slight pain on the outside of my knee if im not paying attention and dont set up correctly. i would say play around with your stance and see if that helps. if i go too wide its when it really feels uncomfortable, so normally i squat "olympic" style. feet closer together and my knees definitely extend beyond my feet, but with no pain, and at enough depth to not red light at my meets.
  • rejectuf
    rejectuf Posts: 487 Member
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    My issue is my physiotherapist doesn't want me doing squats below parallel, which is not an opinion based on my specific patella issues, she is convinced it is not good for anyone. She has me doing what I would call quarter squats with narrow stance, toes forward and back a lot more horizontal than I'm used to. She claims to have attended several seminars in the past year dedicated to knee health and squatting/lifting and read multiple recent studies on the topic and that the most recent conclusion is that there is just too much strain on the knees for it to be healthy for anyone.

    I will ask her for the studies as I want to read through it and understand her point better. But I would also like to find studies that support my belief (if any) so that we can discuss and find the best way for me to proceed safely.

    Thanks guys!

    I really don't like the idea of giving advice contrary to what a medical professional is telling you. If you have doubts, seek a second opinion from another physio.

    A more narrow stance, toes forward, and back further up are all things that can actually help some people. Super wide stances and toes out can help people squat more, but may not be the best mechanics in the long run. There's a lot of room for debate and individual ability/preference there. Back further up, we'd have to see what you were doing vs what she is recommending. Keeping your chest up is generally a good cue. If you let your back go really far forward you're basically doing a good morning.
  • Shawshankcan
    Shawshankcan Posts: 900 Member
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    http://www.biomechfit.com/2012/02/09/3-squatting-myths-that-refuse-to-die
    http://www.liftbigeatbig.com/2012/01/squatting-below-parallel.html
    http://www.tonygentilcore.com/blog/let-me-know-if-youve-heard-this-one-before-a-personal-trainer-walks-into-a-bar-and-says-squatting-below-parallel-is-bad-for-the-knees/
    http://www.examiner.com/article/are-deep-squats-good-for-your-knees (Quote from this article: Last month, the final nail was driven into the coffin of the "deep squats are bad" myth with a study published in the journal Sports Medicine. Researchers Hagen Hartmann, et. al. of the Department of Human Movement Science and Athletic Training, Institute of Sports Sciences, Goethe University in Frankfurt released their findings that, rather than causing destructive degeneration of the knee, deep squatting in fact was a major element in stabilizing the joint (2).)

    Happy reading.
  • cerixon
    cerixon Posts: 17 Member
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    Following. I have always done deep squats.
  • ell_v131
    ell_v131 Posts: 349 Member
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    Thanks for the sources Shawshankcan, I'm getting right to it!

    Just to clarify, I am not looking for advice contrary to what my therapist says so I can say ha, you're wrong! I just want to be able to read through both sides of the coin and discuss it with her, so we can arrive at a conclusion together.
  • Cherimoose
    Cherimoose Posts: 5,209 Member
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    I'm pretty sure the studies don't prove that deep squatting is safe for people with reduced cartilage due to a birth defect. You would need a study specifically looking at that subset of the population.
  • DavPul
    DavPul Posts: 61,406 Member
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    general studies won't apply to specific situations like yours, so good luck convincing your physio by handing them a ream of paper. that said, what your physio said about quarter squats vs regular squats is total poppycock (that's a scientific term i read in a study but i can't remember which one) so take his/her advice with a grain of salt.

    in my experience medical professionals that don't work primarily with athletes (or wanna be athletes) tend to give advice mostly along the lines of "don't do that. or that either". if you person works primarily with the general population you might seek a second opinion at a sports clinic sorta place.
  • dixiewhiskey
    dixiewhiskey Posts: 3,333 Member
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    Get a second opinion...
  • neandermagnon
    neandermagnon Posts: 7,436 Member
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    it's not inherently bad for the knees but it's difficult to get good form, you need to be sure that you're knees are not caving inwards (i.e. going knock-kneed) mid squat. That's bad for the knees, if you can't keep your knees in the right position, deload to a weight where you can and work up again.

    Note that this is advice for people who don't already have knee issues... for people with injuries or other issues with the knee joint, the advice may be very different.
  • ell_v131
    ell_v131 Posts: 349 Member
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    I'm pretty sure the studies don't prove that deep squatting is safe for people with reduced cartilage due to a birth defect. You would need a study specifically looking at that subset of the population.

    you're right, but if you take it to that extreme then the studies would not be indicative for anyone, since everybody's situation is different, with pretty much nobody being the perfect average Joe with no (even unknown) issues. Since she made a broad statement about deep squats being bad for everyone, that is the topic I want to discuss with her.

    It's entirely possible I will come out of this discussion convinced that it is not for me and look for alternative movements to strengthen my lower body, but it's a topic I find interesting enough to engage in a discussion about it.
  • SunofaBeach14
    SunofaBeach14 Posts: 4,932 Member
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    http://www.biomechfit.com/2012/02/09/3-squatting-myths-that-refuse-to-die
    http://www.liftbigeatbig.com/2012/01/squatting-below-parallel.html
    http://www.tonygentilcore.com/blog/let-me-know-if-youve-heard-this-one-before-a-personal-trainer-walks-into-a-bar-and-says-squatting-below-parallel-is-bad-for-the-knees/
    http://www.examiner.com/article/are-deep-squats-good-for-your-knees (Quote from this article: Last month, the final nail was driven into the coffin of the "deep squats are bad" myth with a study published in the journal Sports Medicine. Researchers Hagen Hartmann, et. al. of the Department of Human Movement Science and Athletic Training, Institute of Sports Sciences, Goethe University in Frankfurt released their findings that, rather than causing destructive degeneration of the knee, deep squatting in fact was a major element in stabilizing the joint (2).)

    Happy reading.

    ^ Thank you. I got very suspicious of the various claims about squatting not being good for the knees while living in Asia and seeing a large segment of the population regularly sitting back on their haunches in a deep squat, and continuing to do so into their 70s.
  • trojan_bb
    trojan_bb Posts: 699 Member
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    Pretty sure I've seen a number of scientific papers showing tremendous shearing force on the knee when stopping AT parallel.

    Maybe it's in those links above, I didn't click them.
  • Shawshankcan
    Shawshankcan Posts: 900 Member
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    Pretty sure I've seen a number of scientific papers showing tremendous shearing force on the knee when stopping AT parallel.

    Maybe it's in those links above, I didn't click them.

    I've read that too, but couldn't find the article I wanted to show evidence of that.
  • tootoop224
    tootoop224 Posts: 281 Member
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    Have always heard parallel or below is best. Beach, thanks for links. OP please post links from your doctor when you get them.
  • SunofaBeach14
    SunofaBeach14 Posts: 4,932 Member
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    Have always heard parallel or below is best. Beach, thanks for links. OP please post links from your doctor when you get them.

    Thanks but that wasn't me. That was Shawshankcan.
  • Shawshankcan
    Shawshankcan Posts: 900 Member
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    Have always heard parallel or below is best. Beach, thanks for links. OP please post links from your doctor when you get them.

    Thanks but that wasn't me. That was Shawshankcan.

    Story of my life, I do the work, someone else gets the credit. Lol
  • SunofaBeach14
    SunofaBeach14 Posts: 4,932 Member
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    Have always heard parallel or below is best. Beach, thanks for links. OP please post links from your doctor when you get them.

    Thanks but that wasn't me. That was Shawshankcan.

    Story of my life, I do the work, someone else gets the credit. Lol

    Hey, if I could credit like this at work, I'd be set! :grumble:
  • HappyStack
    HappyStack Posts: 802 Member
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    I would recommend having a look at Kelly Starrett's technique for proper squat mechanics ("the squat magically cures knee pain if you squat correctly") either through transcripts/videos of his seminars or through one of his books.

    He advocates a more foot-forward, vertical-shin, deep/parallel squat as opposed to the feet-to-45 degrees and mental-cue-for-knees-out approach. That's sort of hard to explain in words so here's a picture of his squat technique:

    kelley-starett-squat-e1383978190965.jpg

    Unfortunately with a condition like you have, it's hard to say what will/won't work for you in the long run in terms of technique... but partial squats create more jarring and shearing forces on the ligaments in the knee, whereas a proper deep squat that stresses the muscles and stretches the ligaments [in a good way] will create more stability in the knee joint, and as long as you can squat to a certain depth without pain most physios would be fine with you doing that. It's bone-on-bone they worry about, and that causes pain - which is a good cue to stop what you're doing immediately.

    I can't offer any better links than the ones that have been posted already.
  • ell_v131
    ell_v131 Posts: 349 Member
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    I would recommend having a look at Kelly Starrett's technique for proper squat mechanics ("the squat magically cures knee pain if you squat correctly") either through transcripts/videos of his seminars or through one of his books.

    He advocates a more foot-forward, vertical-shin, deep/parallel squat as opposed to the feet-to-45 degrees and mental-cue-for-knees-out approach. That's sort of hard to explain in words so here's a picture of his squat technique:

    kelley-starett-squat-e1383978190965.jpg

    Unfortunately with a condition like you have, it's hard to say what will/won't work for you in the long run in terms of technique... but partial squats create more jarring and shearing forces on the ligaments in the knee, whereas a proper deep squat that stresses the muscles and stretches the ligaments [in a good way] will create more stability in the knee joint, and as long as you can squat to a certain depth without pain most physios would be fine with you doing that. It's bone-on-bone they worry about, and that causes pain - which is a good cue to stop what you're doing immediately.

    I can't offer any better links than the ones that have been posted already.

    Thanks for that, I love Kelly Starrett! I watched a lot of his videos, but I'm not at that level of flexibility to perform his way correctly just yet. It is something I'd like my physio to help me with if we agree that this would be ok for me.

    I have never experienced knee pain while squatting deep, which I take as a good sign but understand that it doesn't all happen instantly.

    Thanks guys for all the info, if you find more studies/links i'd appreciate it. I will post here when I get anything from my physio, I'm going away for a couple of weeks so it will be only then.

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