Be Careful What You Ask For: Q&A with Paul

Be Careful What you ask for...

Most questions I get come in through email or text, which is great for ensuring the specificity of my answer, but it also means all other readers miss out on the information. So, today will be the first post in my Careful What You Ask For series.

Question:

“What are the safety considerations for performing squats? Specifically, what application does the squat have for runners? And what concerns exist for individuals with arthritis?”

Answer:

Wow – applications and concerns for the squat, known as “the king of all movements!” This could be a pretty involved topic but I’ll do my best to stay on point.  

First off, let’s cover the basics:

The human body is meant to squat.

baby-squat

As soon as we can stand on two legs, we frequently sit in a deep squat position. Whenever we sit down and stand up from a chair, we are squatting. The legs and hips are some of the biggest and strongest muscles in the body not only to carry us long distances, but to offer a safe and powerful base for when we come to a rest and lower into a seated position.

However, like any other movement, the squat can be risky if performed incorrectly.

So, the best place to start is with proper “squat mechanics”

squat

  1. Stand with feet shoulder width apart, toes turned slightly out, weight evenly distributed through the ball of your feet, the pinky toe, and the heel.
  2. Reach hands out in front for counterbalance and push your hips / butt back, keeping your lower back arched in, and shoulders / chest up.
  3. As hips are lowering behind you, actively push knees out to the sides. Keeping the knees wide, and preventing them from caving in, will reduce any load on the knee and ACL.
  4. Keep sitting back and down, almost between your legs, until you reach depth. This is dependent upon specific hip structure, mobility, and experience. Stop descending if your lower back loses its arch and starts to round, if you start to tip / lose your balance, or if any part of your foot leaves the ground.
  5. The squat back up should be identical – knees wide, back arched, chest high and wide – until you are standing up straight, squeezing the butt and keeping the knees “soft” (not forcibly pushing the knees back, creating hyperextension a the knee joint).

A common training wheel of sorts would be to elevate the heels about 1 inch. This will allow you to sit deeper down, without feeling like you’re going to tip over or the extending the knees too far forward.

Next, let’s look at the specific application for runners.


Running is a sport that involves the body moving in one direction, often for many miles, with a great deal of impact. This will develop some muscles while leaving others completely passive and underdeveloped. The most concerning would be the glutes and the hamstrings.

Four-Steps-to-Good-Running-FormAny exercise moving the knee and leg away from the midline of the body will target the glutes and hips…but the squat may be the most effective option because it requires balance and postural awareness, while also engaging the rest of the muscles throughout the body.

My recommendation for a runner would be to become proficient in a bodyweight squat. Once 2 or 3 sets of 20 repetitions can be completed without breaking a sweat, add an elastic band around the knees, hold a dumbbell in front of the chest, or place a bar on the shoulders.

Progressing to barbell squats or a single-leg version would be a perfect goal for runners! If you want to run 26.2 miles without injury, it’s a good idea to first develop the balance, strength, and endurance to perform 20 squats on one leg.  

Remember my favorite quote from Tim Gould, Doctor of Physical Therapy: “Train to run, don’t run to train.”

And finally, does the presence of arthritis contraindicate squats?

Just to clarify, the form of arthritis determines the risks.

Degenerative arthritis is caused by a breaking down of the “padding” between bones. Rheumatoid arthritis is an autoimmune condition where, simply put, offending foods have broken through the stomach lining and are wreaking havoc elsewhere in the body.

I’m going to assume we’re talking about degenerative arthritis since this is affected by activity and movement.

As always, you should consult your doctor first. No matter how cautious and properly a movement is performed, if your body doesn’t have enough cartilage to protect bones from grinding against one another, pain and further deterioration can occur.

Let’s assume that you can load and bend your knee without any pain. If so, performing a controlled squat may actually strengthen the muscles around the joints!

I have had quite a few clients with arthritis, and we usually make the following modifications:

  1. Progress slower, only adding 2 repetitions per set every week.  
  2. Don’t hold any one position too long. Normally, doing a pause squat, where you sit Squat-2and stay tight in the bottom for a count, improves mobility and strength. But the longer you “hang out” in one position, the more likely your muscles will get tired, transferring the load to the bones and joints.
  3. Allow for more recovery and emphasize diet. Degenerative arthritis cannot be cured through diet like rheumatoid, but consuming enough vitamin D & K, magnesium, iron, and collagen (found in gelatin), can help improve bone health.
  4. And finally, never allow one bad repetition! If your knee joint is lacking its natural cushion, we don’t want even a millisecond to be spent in a suboptimal position.

In summary, the inclusion of properly executed squats can help improve running performance, as well as prevent injuries. Squats can also build the strength and stability of soft-tissues around the joints and improve bone density, thereby benefiting those with arthritis.

How you structure your squat training is up to you – some like to heavy barbell squats once a week, while others prefer to complete 20 repetitions of bodyweight squats at random on a daily basis.

If you need any hands-on guidance learning how to squat or developing a safe and effective program, just let me know!

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Enjoy Your Exercise!

In previous posts, I’ve talked about the importance of picking exercise that is enjoyable and not boring.

A new study showed that individuals ended up feeling unhappy and over consuming calories after activity that was defined as “exercise”. Study participants that were told they were walking for “pleasure” ended up feeling more positive about their time spent active, and made healthier nutritional choices for the remainder of the day.

For the complete article that discusses this study, please visit this link to The New York Times.

One interesting aspect that the study did not discuss was the role of cortisol, or stress levels, in the body. Sure, telling someone to “go out and exercise” may make their experience less enjoyable than telling them to “listen to music, stroll around, and sight-see”, but ultimately, we need to examine the mechanisms behind the difference.

As one of the last paragraphs of the article states:

“Just how, physiologically, our feelings about physical activity influence our food intake is not yet known, she said, and likely to be bogglingly complex, involving hormones, genetics, and the neurological circuitry of appetite and reward processing. But in the simplest terms, Dr. Werle said, this new data shows that most of us require recompense of some kind for working out. That reward can take the form of subjective enjoyment. If exercise is fun, no additional gratification is needed. If not, there’s chocolate pudding.”

I don’t know if it’s necessarily a compensation that’s required, but rather, more about finding the activity that is right for you.

I have clients that perform bodyweight exercises for 15 minutes a day in their office. I have clients that walk leisurely outdoors then perform a few movements with elastic bands. I have clients that prefer loading up a barbell and pushing their strength limits. I have clients that go through a one-hour session, spending the first 3rd on an aerobic machine, the second 3rd on exercises to improve strength and balance, and the last 3rd on flexibility and recovery work.

All these people experience incremental progress on a daily basis, and major improvements month-to-month. But, more importantly, they leave each session feeling like they accomplished something important that day, and not that they were simply “forced to exercise”.

To go back to my point about cortisol – if an activity is not enjoyable, it’s going to feel like a chore or a stressor. When our stress levels increase, our body does a few things.

First, it will hold onto body fat because the body wants to prepare itself for enduring “hard times” and sustaining life. Second, the body’s hunger-signaling will be altered to allow for additional calories to come in, to once again be stored as fat to ensure our survival through the stressful period.

Cortisol has many other functions but is better saved for a later post.

One last thing I can’t keep myself from drawing attention to, are the studies parameters for healthy and unhealthy food. They list a “chocolate bar and pudding” as unhealthy and a “cereal bar and applesauce” as healthy.

Certainly a cereal bar and applesauce can be healthier than a chocolate bar and pudding, but this is like saying that driving 75 MPH on a small side-road is safer than driving 100 MPH on the same road. Sure, one is marginally safer, but they both have very high likelihoods of a tragic outcome.

These are all refined, processed, and packaged foods that are not found in nature. Also, they are all sources of carbohydrates with next to no essential proteins or fats. All carbohydrates have 4 calories per gram and will turn to sugar in the blood. It doesn’t matter if we’re looking at applesauce or pudding…we’re still focusing on non-essential, man-made products.

If the two groups had truly healthy options, such as a large salad with salmon and avocado, topped with olive oil and red wine vinegar, it would be almost impossible for either group to overeat. The body needs proteins and fats, and while carbs are useful to boost athletic performance, they result in insulin spikes that interfere with leptin, causing abnormal hunger-signaling.

Ok, sorry, got a little side-tracked there!

The final takeaway from this post is: find an enjoyable and sustainable activity to improve your health!