One of the first things you learn to do when you enter a weight room, is “How to squat”. I still remember when I was taught to squat. I was told to stand infront of a wall, with my toes nearly touching the wall. I then was walked through how to squat. I was taught how to sit back, keep my back flat, head looking straight ahead etc etc. But one thing was stressed more than anything else. “KEEP YOUR KNEES BEHIND YOUR TOES” This became even more important when I suffered my 2 ACL ruptures and subsequent ACL reconstructions. I never questioned this “HOLY GRAIL” Heck! Even the National Strength and Conditioning Associations (NSCA) guideline’s for how to teach a proper squat, states the importance of keeping your knees behind your toes.
As I entered Physical Therapy school, I learned we must learn balance and optimize biomechanics with preparing individuals for the demands of life and sport.
In the video below, it does a great job demonstrating the biomechanics of the squats, and how the body works as a system.
As we can see as the knee begins to move over the toes, greater amounts of stress is placed on the patella femoral joint(knee)
As we move into a deep squat(which requires knees to anteriorly translate) it causes
- Increased quad requirements
- Increased strain on ACL MCL and LCL(*Not enough to cause any damage)
- Increased Patella Femoral compression’
Requirements in life and sport:
What do you notice in all of these pictures?
Knees are over the toes!
Knees going over our toes, is a normal and an absolutely necessary part of our life. Whether that comes from standing up from the toilet, walking down stairs, or competing in a sport. As a profession we have failed our patients and clients by not preparing them for these demands.
Squats are not an exercises but instead are a movement patterns. When we dive deeper into the squat,;the Biomechanics are correct. When we move our knees over our toes, the forces at our knees increase. This can be explained by simple math. However, a 2001 study showed that the shear force at the patella femoral joining onlyincreased by 28%. Which for people who have pathological injuries, can cause pain. However, for the majority of the population, this will not damage their knees, but instead strengthen them and help prevent future pain. In that same study, they found shear forces at the hip to increase close to 1000% when subjects knees were restricted from moving anteriorly. Now this may seem excessive, but due to the strong powerful muscles at the hip, they are much better adapted at being able to handle this increase in load.
When should we avoid our knees going over our toes?
- In the treatment of patients suffering from knee pain or recovering from some type of knee pathology, such as Patella Femoral Pain syndrome.
- When we want to bias and focus on strengthening our glutes
- When we are looking to trying to maximize the amount we are lifting. By biasing the more powerful glute muscle we wll be able to lift more
Allowing your knees to go over your toes is a completely normal and healthy movement pattern. Training your knees to do this and becoming strong in these positions will have more long term benefits than negative. This will also be a great way to build some really strong quads in positions that are necessary for both everyday life and in athletics.
PS: This is not me arguing that squatting with proper form isn’t an important thing. However, Just saying knees over our toes(assuming we are keeping good balance in our feet and doing this movement in a controlled manner) is probably the least of our concern