Dr. Squat - Dr. Fred Hatfield

Your PT doesn't know what they are talking about. They were told that in school, believed it as if it was in the Bible, and never looked back.

$20 bucks says he/she can't explain why.

They'll mutter something about sheering forces when the sheering forces are virtually zero when knee if in full flexion.

I seriously (regretfully) don't have a count of the people in real life, via this message board, and via email who have come to me with knee issues, and as soon as I can get them to doing full squats, Peterson step ups, Full ROM split squats and/or lunges, step ups, etc. in which the knee goes over the toes........ they're knee issues disappear.

Had Kinesiology in grad school and an athletic trainer was in my class. He wanted to bring this up in class one day after I did a presentation of a kinesiological analysis of the snatch.

The snatch to him was dangerous because the knees went over the toes.

Forget the data I provided about weightlifters having lower incidence of knee injury than any other sport including Chess.

Forget the reasoning that in EVERY single sport that requires dynamic movement the knee stays ahead of the toes (football, baseball, basketball, hockey, soccer, etc...)

Forget the good research that does not in anyway find it to be in the least bit dangerous and in certain studies much more effective in training the knee extensors, etc......

Anyway, this guy played intramural rugby.... didn't look like much of an athlete, but was in the weight room all the time. Well, after a few weeks he blew his knee out. Good thing he didn't do full squats, his knee may have really been screwed up. Wasn't a collision injury either, he was trying to stop..... classic weak VMO/hamstring cause for tearing the ACL and MCL.

I've never had any athlete I've worked with have a knee injury, even a collision injury. Sure, you can't prevent or predict collisions, and some of that is certainly dumb luck, but a strong knee is less likely to be injured even in collision type injuries. Not that you can for certain prevent them, but you can minimize the damage and maximize and expedite the recovery by having strong and balanced muscle development in the muscles that act upon the knee.

Movements in which the knee stays behind the toes doesn't develop the VMO properly. The VMO is dynamic and particulary explosive and sudden movements is the first muscle of the quads to fire, and therefore is critical to the joints stability not to mention proper patellae tracking.

Charles Poliquin has told the story a bunch of when he was hired to coach the Canadian women's volleyball team virtually the entire team had tendonitis. After a few weeks of full squats only 3-4 had it and a few weeks after that they were all fine.

My dad coached at a high school in Louisiana his last year coaching. There was a linebacker there that was a beast, who was recruited by and last year finished up an outstanding career with LSU. Towards the end of the football season he had developed tendonitis in both knees.

The football coaches were against him playing basketball for fear the condition would worsen, but the kid had played since junior high.

My dad called me, I made a trip down one afternoon, taught him split squats and full squats, after 3 weeks he had no pain despite the fact that the football coaches shit their pants when they walked into the weight room one day and saw what my dad had him doing. My dad had to politely tell the to kindly F-off. They didn't bitch much the next season when he was completely healthy and took them to the state semifinals though.

My sophomore year in high school I had really just started lifting and I caught the worst case of tendonitis at a basketball camp that summer. Walking hurt, stairs made me nauseous. Through wrapping them I made it through camp, but I had just bought a flex magazine that had an article by none other than Bill Starr in it (God bless Bill Starr!). He detailed the history and mythology of the full squats and knee over the toes myth. Keith Klein came up with a BS study that has never been duplicated, but has persisted the mythology behind knee training, especially in rehab circles.

The day after I read that article I immediately made full squats a staple of my routine, and have not had the slightest knee twinge ever since. That was 15+ some odd years ago.

One of the schools I played ball at in college... we had a strength coach who constantly bitched, told my coach, threatened to throw me out if "his" weight room etc. because I did full squat when he would say up when I had lowered myself to about parallel.....

Well, I did it anyway..... but when I went into the training room to get my ankles tape, I never had to join the half to a dozen athletes that were perpetually in there after just coming off of ACL surgery. I mean, it was very few athlete who played 4 years there that didn't end up tearing their ACL, but everyone assumed it was just dumb luck.

I could go on, but you get the picture. I don't care who they are, what their accomplishments are, how many letters come after their name, don't assume they know what in the world they are talking about. Be critical of everything! Doubt everything. Be doubting Thomas! Verify everything via your experience, others experience, research, people's theoretical opinions, etc.

But again, your PT doesn't know what they're talking about.

I've never seen an injury or an injury develop from using full ROM knee movements, but the majority of people I have know that have had knee injuries have never done any significant amount full ROM knee movements.

Todd had a long but very good post. I just want to make sure this part is reinterated from his post:

"I don't care who they are, what their accomplishments are, how many letters come after their name, don't assume they know what in the world they are talking about. Be critical of everything! Doubt everything. Be doubting Thomas! Verify everything via your experience, others experience, research, people's theoretical opinions, etc.

But again, your PT doesn't know what they're talking about."

Now, I have a few brief comments, besides your PT not knowing what the hell they are talking about. The idea that knees progressing over the toes is bad came from some studies near 30 years ago using 2D methods and a poor way of modeling the knee during open-chain isokinetic exercises (in the late 70s and 80s it seems all anyone did was isokinetic studies because it was new technology and everyone wanted to use it). They fear for ACL injuries because of the progression of the tibia forward in relation to the femur in open-chain knee extensions, stressing the ACL. So, it was widely concluded that the knee going past the toes is bad for the ACL and can lead to said injuries. Unfortunately, this is still taught in too many PT programs, and is believed by nearly every PT who graduated more than 5 years ago.

More recently, using squats and 3D videography and inverse dynamics, it has been shown the PCL is actually at risk (Escamilla did several of these types of studies while at Duke) with increased squat depth, with ACL force being practically zero. But, the PCL forces (and resulting strains) are not enough to cause injury during squats. There are some instrumentation problems with his studies (mean residual errors of up to 1.0 cm using the video technique he used), but the resutls are the best we have as of now. Hopefully that will change soon, if you know what I mean.

Also, the glutes and quads don't need to fire equally. Again, your PT is an idiot. The posterior muscle groups are larger, and we have more of them (quads vs hammys/glueal complex), thus they actually should contribute more. Most EMG studies have looked at quad/hamstring activation magnitudes (I can think of two, Zazulak 2005 and Zeller 2003, that have done glute max and a few other muscles during single leg landing and squatting, respectively). I know the literature pretty well regarding ACL injury, but not so much other knee injury literature (the vast majority is with ACL, though). But for ACL sutff, the problems have been encountered when the quads have fired: 1) more strongly, or 2) prior to, the hamstrings. This seems to be something that can be remedied (at least partially) by just having people sit back more when doing a squatting movement (during squats of various types, or more dynamic movements like landings from jumps). This was actually supported more by a dissertation defense I saw this afternoon.

Anyway, I'm going on a tangent. The point is they don't have to contract equally. Timing is more important than magnitude, actually (posterior first). I guess I'm done now...

Thanks Brian and Todd. That's what I needed.