Post provided by Barbara Bergin, MD
That’s a good New Year’s Resolution. If a bunch of folks could read this and follow it, I’d see a lot less of you because I can predict that I’ll see 2-3 patients every week this year for knee pain related to starting some kind of a squatting exercise program!
DO NOT DO SQUATS! Let me emphasize the point. DO NOT DO SQUATS!
And learn to recognize deceptive forms of the squat; the deep knee bend, the lunge and its particularly egregious variations, the weighted lunge and especially the forward-moving-weighted-lunge. I don’t know what it is called but I want to put a red circle with a cross hatch on those.
A lot of people are going to hate me, including most trainers, coaches and promoters of video training programs. I’ve got to admit that squats are a good way and maybe the best, most efficient and cheapest way to build gluts, quads and hamstrings. They utilize some of the biggest muscle groups in the body and so you can work up a good sweat and feel the burn. So doing them accomplishes a goal and maybe for football players, it’s the best way. But it’s dangerous for their knees, their cartilages and particularly their knee caps. There are some individuals who are biomechanically sound to do squats but they are rare and there’s really no way to identify those people and predict how long they can tolerate it. So, there are some people who tolerate smoking cigarettes just fine. But more of us can’t and so in general we say, “Don’t smoke.” And in general I like to say, “Don’t do squats!”
Here’s how it works. When you squat you put tremendous pressure on your knee cap since it’s the fulcrum through which you bend and straighten your knee. That puts pressure on the delicate cartilage that lines the knee cap. When you do a deep squat it also put tremendous pressure on the meniscus cartilage (the rubbery shock absorber cartilages between the two bones). Over a period of time (years for some…one squat for others) that can cause wearing of these delicate and important structures in the knee. Once that happens, arthritis begins to develop. And that can even happen at a young age.
For most of us, there are a lot of other exercises we can do to gently strengthen those muscle groups; straight leg raises, quarter squats, leg curls and extensions with low resistance, stationary bike, elliptical trainers, swimming, and the list goes on. I see so many patients with knee pain and in quite a few, particularly those with knee cap pain, I can elicit a history of doing squats…or one of its varieties. So when your personal trainer says he’s going to get your butt into shape…beware of the squat and just say “no.”
That’s a good New Year’s Resolution. If a bunch of folks could read this and follow it, I’d see a lot less of you because I can predict that I’ll see 2-3 patients every week this year for knee pain related to starting some kind of a squatting exercise program!
DO NOT DO SQUATS! Let me emphasize the point. DO NOT DO SQUATS!
And learn to recognize deceptive forms of the squat; the deep knee bend, the lunge and its particularly egregious variations, the weighted lunge and especially the forward-moving-weighted-lunge. I don’t know what it is called but I want to put a red circle with a cross hatch on those.
A lot of people are going to hate me, including most trainers, coaches and promoters of video training programs. I’ve got to admit that squats are a good way and maybe the best, most efficient and cheapest way to build gluts, quads and hamstrings. They utilize some of the biggest muscle groups in the body and so you can work up a good sweat and feel the burn. So doing them accomplishes a goal and maybe for football players, it’s the best way. But it’s dangerous for their knees, their cartilages and particularly their knee caps. There are some individuals who are biomechanically sound to do squats but they are rare and there’s really no way to identify those people and predict how long they can tolerate it. So, there are some people who tolerate smoking cigarettes just fine. But more of us can’t and so in general we say, “Don’t smoke.” And in general I like to say, “Don’t do squats!”
Here’s how it works. When you squat you put tremendous pressure on your knee cap since it’s the fulcrum through which you bend and straighten your knee. That puts pressure on the delicate cartilage that lines the knee cap. When you do a deep squat it also put tremendous pressure on the meniscus cartilage (the rubbery shock absorber cartilages between the two bones). Over a period of time (years for some…one squat for others) that can cause wearing of these delicate and important structures in the knee. Once that happens, arthritis begins to develop. And that can even happen at a young age.
For most of us, there are a lot of other exercises we can do to gently strengthen those muscle groups; straight leg raises, quarter squats, leg curls and extensions with low resistance, stationary bike, elliptical trainers, swimming, and the list goes on. I see so many patients with knee pain and in quite a few, particularly those with knee cap pain, I can elicit a history of doing squats…or one of its varieties. So when your personal trainer says he’s going to get your butt into shape…beware of the squat and just say “no.”
Silly. Squats as bad as smoking?!? You really want to post that onto the internet for all to see? Before chairs (indeed, long before civilization) human beings often had their meals, conversations, and meetings in a 'squat' (with the knee bent to close the angle to less than 90 degrees) position. Over 3/4 of the Earth population still does. Additionally, try to get off of the ground or out of bed - even out of a chair - without bending your knee to less than a 90 degree angle and forcing an extension. The mechanics of nearly all movement requires a deep flexion of the knee. You are right when you say coaches and trainers will disagree with you. After all, these are the people that develop athletes and elite athletic performance. Medical doctors do not. Nor are they qualified to comment on what CAUSES injuries - they fix them, not prevent them. If you have bad knees it's not the squats - more likely it's the high volume of blunt force trauma from running or similar repetitive movements patterns.
ReplyDeleteBy Mark on Do Not Do Squats! on 1/21/11
where is the data showing the pressure % placed on the knee? Where is the data showing that years of doing squats will result in athritis? Do you also tell people not to run?
ReplyDeleteBy Anonymous on Do Not Do Squats! on 1/21/11
IN 2/3 of the world where people do not have toilets, or chairs, they sit in a squat position, yet they have no knee problems? When we sit, and get up, its essentially a squat. When we go to the can, we squat. In order to lift something we squat down, so we don't lift with out backs. Seems to me squatting is quite functional to every day life. Maybe next time I need to pick up a bag of sand, I leg extension it up! Maybe squatting is not the problem, but flexibility limitations in the hip which cause people to squat improperly is more of the issue.
ReplyDeleteBy Anonymous on Do Not Do Squats! on 1/21/11
So, how do you get up out of a chair? How do you get up off the toilet? How do you pick up anything off the floor? Why then when a knee gets replaced do they work so hard to get back to a range of motion? Why not just hobble around with stiff legs. Squats, when done right, absent any previous injury are completely safe. Sorry to rain on your parade. Most issues are with joint mobility, something tighter on one side of the body causing improper form. More often than not, it is the form itself, people do not know how to squat, most trainers don't even know how. But properly done the knee is actually safe and gets stronger. Unfortunately most doctors only know the above parallel squat. Once the hip crease drops below the top of the knee the hamstrings are the primary mover. If you stop above you will do damage to the knee. If your knees track inside your feet you will do damage. If you relax in the bottom you can do damage. This comment section is far to small to get into the specifics of the squat, do some research, look at Starting Strength by Mark Rippetoe, get some professional training by a olympic coach. I'm sure you studied very hard in school thus the MD. Problem is there are many many many other people out there with far more experience than you on this subject. Perhaps you would better serve Texas by instructing people to get proper instruction on the exercise instead of poo pooing it without knowing all the facts.
ReplyDeleteBy Graham Baynes on Do Not Do Squats! on 1/21/11
Just reading your article I can tell you have no idea what exercising is. If squatting is soo bad then why aren't record-holding power lifters motoring around in wheelchairs by the time they turn 50? Proper technique and form will protect your knees. I would be willing to bet that almost all of your patients have never been shown how to do a weighted squat properly. You are always going to have people who go out and do things with out learning how to do them right. Try learning the right way and you might like it! Good day and happy squatting!
ReplyDeleteBy Anonymous on Do Not Do Squats! on 1/21/11
Whoever told you this is wrong. And you promoting it is even worse. Squats don't just build up the glutes, quads, and hams. they build up the muscles and ligaments of the knees as well. I used to have knee pain all the time until I started to do weighted squats. You just have to have good form for it to not be detrimental to joint health.
ReplyDeleteBy Anonymous on Do Not Do Squats! on 1/21/11
Awesome-I followed your advice and the knee pain is gone. I incorporated other exercises that do not strain the knee joint. Thank you!!!
ReplyDeleteI read your article and I understand why you do not want people to do squats. I had a knee injury from many years ago however recently I have been doing modified squats without pain where my knee is directly over my ankle through out the excercise. I am enjoying the effects. Would you endorse this type of squat where the knee is directly over the ankle?
ReplyDeleteDr. Bergin:
ReplyDeleteCongratulations for stating the obvious. The number of hip and knee replacements in the US is over 1 million per year and over 19 million reported knee injuries per year. Of course those stats are not all "squat" related; however, when the knee extends over the foot, the knee becomes the fulcrum. What else is supporting the weight?
If you can figure out a way to keep the knee over the ankle and do squats, the amount of injuries will dramatically be reduced.
I am also an orthopaedist. When I was in elementary school, "deep knee bends" were outlawed. Years later, I learned why. Sure, we all have to squat. That's living. Do you burn rubber every time you drive? Will your tires last as long if you do? You get one helping of knee cartilage to last a lifetime. Keep your original equipment if you can or you will need to see me and maybe need a patellofemoral replacement. Moderation people. Don't argue with experts who see the inside of the knee every day. Or, on the other hand, go ahead and ignore the data. The doc here is telling the truth.
ReplyDelete