Professional Documents
Culture Documents
Lower Extremity Biomechanics During A Regular And.15
Lower Extremity Biomechanics During A Regular And.15
Lower Extremity Biomechanics During A Regular And.15
ABSTRACT INTRODUCTION
T
Lynn, SK and Noffal, GJ. Lower extremity biomechanics he goal of any exercise training program should
during a regular and counterbalanced squat. J Strength Cond be to improve the overall efficiency of human
Res 26(9): 2417–2425, 2012—If the efficiency of human movement patterns. Whether the training program
movement patterns could be improved using exercise, this is designed to improve athletic performance, to
could lead to more effective musculoskeletal disease-injury
rehabilitate an injury, or simply to improve overall physical
fitness; the goal of performing repeated movements (exercises)
prevention and rehabilitation programs. It has been sug-
should be to make movement patterns more efficient. The
gested that an efficient squat movement pattern emphasizes
concept of efficiency as it relates to human movement has been
the use of the large hip extensors instead of the smaller knee
defined several different ways. In terms of human movement
extensors. The purpose of this study was to determine energetics, mechanical efficiency is defined as the amount
whether a counterbalanced squat (CBS) could produce of mechanical work done divided by the metabolic cost
a more hip-dominant and less knee-dominant squat move- needed to perform that work (39). Although this is the classic
ment pattern as compared with a regular squat (RS). There definition of mechanical efficiency, others have proposed
were 31 recreationally trained college-aged participants more biomechanical definitions of human movement effi-
(15 male, 16 female) who performed 10 squats (5 CBS ciency. These include patterns of movement that fulfill their
and 5 RS), while segment kinematics, ground reaction forces, tasks with minimal strain on the musculoskeletal system (27)
and muscle (gluteus maximus [GM], quadriceps, hamstrings) or as movement that occurs without pain or discomfort and
electromyographic (EMG) activations were recorded. Peak involves proper joint alignment, muscle coordination, and
sagittal plane net joint moments and joint ranges of motion at posture (18). These biomechanical definitions hypothesize
that if we can develop more efficient movement patterns, this
the hip, knee, and ankle joints along with peak and integrated
reduction in strain on the movement components could
EMG activation levels for all 3 muscles were compared using
help in the rehabilitation process and in preventing the
analysis of variance (squat type 3 sex). The results revealed
development of musculoskeletal pain altogether (31). Because
that the CBS increased the hip joint moment and GM musculoskeletal conditions accounted for $849 billion in
activation, while it decreased the knee joint moment and health care costs in the U.S.A. in 2004 (7.7% of the gross
quadriceps activation as compared with the RS. Therefore, domestic product), and with these costs expected to escalate
the CBS produces a more hip-dominant and less knee- as the population ages (16), developing noninvasive strategies
dominant squat movement pattern and could be used in to prevent these conditions is becoming increasingly
exercise programs aimed at producing more hip-dominant important. Therefore, developing exercises aimed at correct-
movement patterns. ing movement inefficiencies could help in delaying and
preventing the onset of some musculoskeletal pathology.
KEY WORDS movement pattern correction, hip-dominant The most common pathologic conditions in the lower
squat, knee-dominant squat, musculoskeletal injury and disease, extremity affect the knee joint (36,37), and women experience
rehabilitation knee pathologic conditions much more commonly than men
(2,13). It can be hypothesized that there may be differences in
muscular activation strategies between men and women that
might be one of several factors leading to these increased rates of
knee injury. Studies that have attempted to determine the causes
of knee pathologies have suggested that hip muscle weakness is
Address correspondence to Scott K. Lynn, slynn@fullerton.edu. associated with the development of knee conditions (5,6,20,26).
26(9)/2417–2425 Therefore, designing exercises aimed at preferentially strength-
Journal of Strength and Conditioning Research ening the hip musculature is warranted, as is examining
Ó 2012 National Strength and Conditioning Association movement pattern differences between men and women.
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
Biomechanics and a Counterbalanced Squat
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
the TM
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
Biomechanics and a Counterbalanced Squat
This involved using a specially designed probe to identify At both the hip and knee joints, negative work corresponded
bony landmarks so that subject-specific segments could be to the eccentric phase of the squat and positive work
created during processing. The subjects also performed 3 corresponded with the concentric phase.
calibrated motions so the joint centers could be calculated.
The hip calibrated motion involved performing 3 complete Statistical Analyses
Ôhula-hoopÕ hip rotations in each direction. The knee and Key outcome measures were as follows: (a) the joint ranges
ankle calibrated motion involved performing simple knee of motion (ROMs) for the knee and hip during the entire
flexion and extension and ankle dorsi and plantar flexion squat movement; (b) the peak external net joint moments
movements, respectively. achieved at the bottom during the squat for the knee and hip
joints; (c) total negative (eccentric) and positive (concentric)
Data Processing angular work performed at the knee and the hip; and (d) the
Visual 3D (C-Motion Inc., Rockville, MD, USA) software was peak EMG activity (in %MVIC) achieved during the entire
used to process all squat trial data. This software was used to squat and IEMG during the concentric and eccentric phases
filter raw marker data (fourth-order, low-pass, double-pass of the squat movement for the GM, BF, and RF muscles.
Butterworth filter with a 6-Hz cut-off frequency) (8) and to There were 11 separate 2 3 2 (squat condition 3 sex) factorial
calculate joint angles at the hip and knee during the squat mixed model analyses of variance run on each one of the
trials. These joint kinematics were calculated using the variables, except for the IEMG data. The 6 IEMG variables
Cardan-Euler representation, which finds the orientation were calculated using raw (nonnormalized) EMG data;
of the distal segment with respect to the reference proximal therefore, the between subjects comparison were not
segment using x (flexion/extension), y (ab/adduction), examined on these variables and only the within-subjects
z (axial rotation) sequence of rotations (40). It also combined comparison (squat type) were performed. For all analyses,
motion, force, and anthropometric data using a standard statistical significance was set at p # 0.05.
inverse dynamics link segment model to calculate the net
external moments at the hip and knee. Subject-specific RESULTS
anthropometric information used in these calculations was
estimated from their height and weight (14). All the joint The results for the joint kinetic data (hip, knee) are reported
moments were normalized by body mass (newton meter per in Table 1. It should be noted that there was a main effect
kilogram) and reported in the coordinate system of the distal (p , 0.05) for squat type in both the peak knee (F = 7.9,
segment of the joint. It should be noted that joint angles and p = 0.009, effect size ½h2p ¼ 0:22) and hip (F = 12.5, p = 0.001,
moments were calculated in all 3 dimensions; however, this effect size ½h2p ¼ 0:30) moments. There was a larger
study only examined these angles and moments in the magnitude of hip moment in the CBS, whereasthere was
sagittal plane. Also, the peak knee flexion angle during the a larger magnitude of knee moment in the RS. Also, the hip
squat was used to define the concentric and eccentric phases moment displayed a main effect for sex (F = 7.1, p = 0.013,
of the squat movement for all analyses; and variables effect size ½h2p ¼ 0:20) as the male subjects had an increased
calculated from each of the 5 trials per condition were magnitude of peak hip moment as compared with the female
averaged together for each subject. subjects. There was no main effect for sex (p , 0.05) in
The EMG data were full-wave rectified and filtered using the peak knee moment (F = 0.9, p = 0.348, effect size
a fourth-order, low-pass, double-pass Butterworth filter with ½h2p ¼ 0:03).
a 6-Hz cut-off frequency (39). Integrated EMG (IEMG) was Table 1 also displays the joint work done by the hip and the
then calculated for the concentric and eccentric phases of the knee in both the concentric and eccentric phases. There
3 muscles during the squat using the following equation (17): was a main effect for all of the joint work variables calculated:
eccentric hip work (F = 126.4, p , 0.001, effect size
Zt n
n y i 1 þy i ½h2p ¼ 0:82), concentric hip work (F = 70.2, p , 0.001, effect
yðt Þdt ¼ +i ¼ 1 Dt ; size ½h2p ¼ 0:72), eccentric knee work (F = 22.2, p , 0.001,
2
t1 effect size ½h2p ¼ 0:44), concentric knee work (F = 32.9,
where n is the number of data points for the concentric and p = 0.001, effect size ½h2p ¼ 0:54). It should be noted that for
eccentric phases, yi is the EMG data at time (t), and Dt is the both the concentric and eccentric phases, the knee does
sampling interval (1/2,000 seconds). The IEMG is reported more work during the RS and the hip does more work during
in millivolts. the CBS. There were also main effects for sex in the work
All EMG waveforms were also converted into %MVIC done by the hip in both the eccentric (F = 10.9, p = 0.003,
units by dividing by the peak MVIC activity of each muscle effect size ½h2p ¼ 0:28) and concentric (F = 11.1, p = 0.002,
(BF, RF, GM). effect size ½h2p ¼ 0:28) phases; but no main effect for sex
Angular work was also calculated at the hip and knee joints in the knee work done in either phase (eccentric—F = 6.2,
by multiplying the external joint moment (in newton meter p = 0.145, effect size ½h2p ¼ 0:07, concentric—F = 4.9,
per kilogram) by the joint angular displacement (in radians). p = 0.153, effect size ½h2p ¼ 0:07).
the TM
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
the TM
TABLE 1. Hip and knee joint kinetics during the RS and CBS.†*
RS CBS
Hip moment (Nmkg21)‡§ 1.27 (0.51) 0.81 (0.38) 1.04 (0.50) 1.30 (0.51) 0.93 (0.35) 1.11 (0.47)
Knee moment (Nmkg21)‡ 1.39 (0.67) 1.10 (0.38) 1.24 (0.55) 1.33 (0.64) 1.07 (0.36) 1.19 (0.52)
Hip eccentric work (Jkg21)‡§ 21.65 (0.63) 20.98 (0.39) 21.30 (0.61) 22.28 (0.79) 21.53 (0.58) 21.88 (0.77)
21
Hip concentric work (Jkg )‡§ 1.81 (0.74) 1.06 (0.36) 1.41 (0.68) 2.24 (0.80) 1.53 (0.52) 1.86 (0.74)
Knee eccentric work (Jkg21)‡ 22.73 (1.27) 21.99 (1.14) 22.33 (1.24) 22.35 (1.26) 21.80 (1.05) 22.06 (1.16)
Knee concentric work (Jkg21)‡ 2.58 (1.12) 1.96 (1.04) 2.25 (1.11) 2.30 (1.12) 1.78 (1.01) 2.03 (1.08)
*RS = regular squat; CBS = counterbalanced squat.
†All the numbers are presented as mean (SD). Moments represent peak net external flexion moments on the hip and knee joints
during the entire squat movement. Joint work numbers represent the total work performed in the eccentric or concentric phase of the
squat movement.
‡Main effect for squat type (RS vs. CBS).
§Main effect for sex (male vs. female).
Table 2 displays the results of the peak EMG activation both types of squat; however, there was no main effect for
data for the GM, RF, and BF. It should be noted that there sex in the GM (F = 0.49, p = 0.490, effect size ½h2p ¼ 0:02) or
was a main effect for squat type (p , 0.05) in the peak GM the RF (F = 1.7, p = 0.202, effect size ½h2p ¼ 0:06).
(F = 8.0, p = 0.008, effect size ½h2p ¼ 0:22) and RF (F = 13.7, Table 2 also displays the IEMG data for the GM, RF, and
p = 0.001, effect size ½h2p ¼ 0:32) EMG activation data but BF during the concentric and eccentric phases. The IEMG
not in the BF (F = 2.6, p = 0.117, effect size ½h2p ¼ 0:08). The data revealed main effects for squat type in RF activation
CBS squat produced a higher peak activation level of the during both the eccentric (F = 22.6, p , 0.001, effect size
GM, whereas the RS produced a higher peak activation level ½h2p ¼ 0:44) and concentric phases (F = 29.5, p , 0.001,
of the RF. There was also a main effect for sex in the BF peak effect size ½h2p ¼ 0:50). There were also main effect for squat
EMG activation data (F = 5.1, p = 0.03, effect size type in the IEMG data of the concentric phases for the GM
½h2p ¼ 0:15), as the women had an increased peak activation (F = 16.0, p , 0.001, effect size ½h2p ¼ 0:36) and BF (F = 7.7,
of the hamstring muscles as compared with the men across p = 0.010, effect size ½h2p ¼ 0:21). These data revealed
TABLE 2. Electromyographic data for the GM, RF, and BF muscles during both the RS and CBS.*†
RS CBS
Peak GM activation (%MVC)‡ 18.0 (7.7) 21.9 (18.5) 20.0 (14.2) 21.3 (9.5) 24.8 (20.1) 23.1 (15.8)
Peak RF activation (%MVC)‡ 57.1 (35.7) 71.3 (51.5) 64.4 (44.5) 41.9 (19.0) 64.5 (45.0) 53.6 (36.2)
Peak BF activation (%MVC)§ 11.7 (9.2) 28.9 (27.0) 20.6 (21.9) 13.6 (9.9) 30.5 (28.9) 22.4 (23.2)
IEMG eccentric GM (mVs) 60.2 (40.4) 64.7 (44.5)
IEMG Eccentric RF (mVs)‡ 323.7 (196.8) 233.1 (126.0)
IEMG eccentric BF (mVs) 118.1 (97.1) 123.9 (114.0)
IEMG concentric GM (mVs)‡ 99.3 (59.0) 124.0 (74.7)
IEMG Concentric RF (mVs)‡ 300.0 (177.7) 226.2 (133.1)
IEMG concentric BF (mVs)‡ 122.8 (69.8) 139.4 (80.4)
*EMG = electromyographic; IEMG = integrated EMG; GM = gluteus maximus; RF = rectus femoris; BF = biceps femoris; RS =
regular squat; CBS = counterbalanced squat; MVC = maximum voluntary contraction.
†All numbers are presented as mean (SD).
‡Main effect for squat type (RS vs. CBS).
§Main effect for sex (male vs. female).
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
Biomechanics and a Counterbalanced Squat
TABLE 3. Mean joint ROM for the hip and knee during both the RS and CBS*†.
RS CBS
Hip joint‡ 93.8 (15.8) 90.0 (11.9) 91.9 (13.8) 91.3 (14.9) 85.6 (12.0) 88.4 (13.6)
Knee joint‡ 119.9 (13.9) 110.1 (18.9) 114.8 (17.1) 120.5 (14.1) 112.5 (17.7) 116.4 (16.3)
*ROM = range of motion; RS = regular squat; CBS = counterbalanced squat.
†All numbers are presented as mean (SD) and are in degrees.
‡Main effect for squat type (RS vs. CBS).
§There were no main effects for sex (male vs. female).
increased activation of the hip extensors (GM and BF) during Based on these results, it can be suggested that the CBS
the CBS in the concentric phase, whereas the knee extensors produces a more hip-dominant pattern of movement as
(RF) were more active in the RS during both the eccentric compared with the RS, which produces a more knee-
and concentric phases. There was no main effect for the dominant pattern of movement. However, even though there
IEMG data in the eccentric phases of the GM (F = 3.3, are large effect sizes for most of the comparisons, the
p = 0.082, effect size ½h2p ¼ 0:10) or the BF (F = 1.3, magnitude of these changes in external loading and muscular
p = 0.260, effect size ½h2p ¼ 0:04). activation levels are small. It is unknown as to how these small
The hip and knee joint ROM data are reported in Table 3. alterations in muscle activation levels could change the
There was a main effect for squat type (p , 0.05) in both overall patterns of movement if the CBS is performed as part
the hip (F = 47.9, p , 0.001, effect size ½h2p ¼ 0:62) and knee of a long-term corrective exercise program. Future research
(F = 5.5, p = 0.026, effect size ½h2p ¼ 0:16) ROM data. The should investigate both the acute and long-term effects of
hip displayed a greater ROM during the RS, whereas using a CBS in a training program to see if this can produce
the knee displayed a great ROM during the CBS. However, a more hip-dominant and less knee-dominant patterns of
there was no main effect for sex in either the hip (F = 0.9, movement.
p = 0.342, effect size ½h2p ¼ 0:03) or knee (F = 2.3, p = 0.137, The use of a CBS as part of a training program could have
effect size ½h2p ¼ 0:08) ROM. a wide range of uses clinically. It has been shown that those
with a torn anterior cruciate ligament (ACL) adopt a gait
DISCUSSION pattern where they attempt to reduce the contraction of the
This study found that the CBS increased the sagittal plane quadriceps (3) during gait. This is believed to be an attempt to
loading of the hip joint while decreasing the sagittal plane decrease the anterior shear force produced on the proximal
loading on the knee as compared with the RS. This is most tibia when the quadriceps contracts. Therefore, performing
likely because of the increased mass placed anteriorly during a CBS exercise to decrease the recruitment of the quadriceps
the CBS when the dumbbells and arms are moved anteriorly and increase the recruitment of the hip extensors may be
with shoulder flexion. This coincides with the findings of advisable. This may allow for the subjects to begin re-
previous work that has suggested that forward trunk lean habilitation exercise much sooner after ACL replacement
during a drop jump task increases the demand on the hip surgery, because the graft could be spared some of the stresses
while decreasing the demand on the knee as compared with of the anteriorly directed forces applied on the tibia with
landing with a more erect trunk (29), as forward leaning of excessive quadriceps contraction. The CBS may also be useful
trunk would also shift more mass anteriorly. This shift in in prevention of ACL injury as the decreased quadriceps
external loading that increases the loading of the hip and activation could potentially help in reducing quadriceps to
decreases the loading of the knee during the CBS also led to hamstring ratio and decreasing the ‘‘quad dominance’’ that has
a shift in muscular activation levels by increasing the peak been shown to increase ACL injury risk (24).
activity of the larger proximal hip extensor (GM) and Training a movement pattern that can reduce external knee
decreasing the peak activity of the relatively smaller distal moments and the resultant quadriceps activation may also
knee extensors (RF). This coincides with the results of have implications in the treatment and prevention of several
Blackburn and Padua (4), because they found that increasing other knee pathologic conditions. For example, it has been
the mass placed anteriorly during jump landing (i.e., forward shown that increased quadriceps strength (force) increases
trunk lean) caused decreased quadriceps activation; however, the rate of cartilage wear over an 18-month period in those
hip extensor muscle activity was not measured in this study. with malaligned knees and laxity in the knee joint (32). This
the TM
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
the TM
may be because of the combination of compressive and shear increase in hip flexion but would most likely also increase the
forces placed on the knee with quadriceps contraction when lordotic curvature in the lumbar spine. Because increased
the knee is misaligned (33), as it has been shown that shear lordosis (or spinal extension) has been shown to increase the
stresses are highly detrimental to cartilage health (19,38). contact forces in the facet joints at L4-5 (34), it can be
Also, training a movement pattern that decreases quadriceps hypothesized that reinforcing a movement pattern with
force could also lead to smaller patellofemoral compressive increased RSF activation may increase the loading of the
forces, especially at larger angles of knee flexion, because this facet joints. In those with greatly reduced neural drive to the
would decrease the forces in the quadriceps and patellar hip extensors, this could lead to facet joint arthritis and
tendons (7,8). Therefore, using the CBS to train a pattern of perhaps even spondilolisis and spondylolisthesis. However,
movement that reduces the external knee moment and the this is strictly speculation because the curvature of the lumbar
resultant quadriceps activation may also be beneficial in spine was not measured in this work. Therefore, future
prevention and treatment of knee osteoarthritis (OA) and research should examine the effect of a CBS technique on the
patellofemoral joint pain. sagittal plane stability of the pelvis and lumbar spine during
It has been suggested that increased GM activation during the squat.
any hip extension movement would lead to more precise Although it has been suggested that a more hip-dominant
control of the femur and less stress on the hip joint (21,22). and less knee-dominant pattern of movement is beneficial, it
More specifically, a weakness in the GM results in increased should be noted that there are still relatively large quadriceps
anterior hip joint forces during hip extension (21), which contractions even during the CBS (.50% MVIC). Therefore,
could lead to clinical conditions such as acetabular labrum the CBS does not completely unload the knee extensors, it
tears and eventually hip OA. Because it has been discovered simply shifts some of the loading onto the much larger hip
that the majority of hip OA cases have the cartilage wear extensors. The results of this study also suggest that if the goal
occurring on the anterior surface of the acetabulum (25), it of training is to strengthen the knee extensors in a weight-
can be suggested that the CBS could be useful in increasing bearing closed chain exercise, positioning the mass more
the activation of the GM during concentric hip extension posteriorly (as was done in the RS) would be beneficial.
movements. This could help in decreasing the anteriorly There were also sex differences in squat biomechanics
directed hip joint force and reduce the stress on the diseased across both conditions. The female subjects had decreased
part of the hip joint in those with hip OA on the anterior external hip loading (peak hip moment and concentric and
surface of the acetabulum. However, finding other ways to eccentric hip joint work) and increased peak hamstring
increase the activation of the GM during eccentric activity. It appears that the female subjects in this study adopt
contraction is warranted, because the CBS did not increase a less hip-dominant movement pattern that preferentially
total eccentric GM activity during the squat. activates the 2 joint hamstrings rather than the 1 joint GM
The CBS also altered the joint ROM at the knee and the hip to overcome the much smaller (as compared with the male
as compared with the RS. The differences in the joint ROM subjects) external hip moment created during the squat. This
between the 2 squat conditions were small as there was result is supported by the increased rate of noncontact ACL
approximately 3.5° less flexion at the hip and 1.6° more injury in female athletes (2,13). It can be hypothesized that
flexion at the knee in the CBS. Although this is a small this squat pattern observed in the female subjects may lack
absolute change in angles, the effect sizes for these 2 com- the frontal and transverse plane control of the femur that
parisons were relatively strong, especially at the hip joint comes with activation of the large, proximally located gluteal
(effect size of 0.62). This is because all the subjects had same muscles because this muscle is not needed to control the
small changes in joint angles with the 2 different squat smaller external hip moment. This also results in a compen-
conditions, and this may be related to the fact that the CBS satory increase in hamstring activity, which could help
also had decreased peak (%MVIC) and total (IEMG) RSF decrease the anterior translation of the tibia and help relieve
activation. During the squat movement, the RSF eccentrically some of the stress on the ACL. However, if this were true,
lengthens by an extremely small amount (,2%); therefore, one would also expect decreased GM activation in the female
one could characterize its role as being isometric in the subjects as compared with the male subjects, which we did
dissipation of knee extensor torque (30). Because neural drive not find. These results also contradict those of Youdas et al.
to the muscle is smaller in the CBS as compared with that in (41), where it was found that female subjects had more
the RS, the RSF muscle would be less ‘‘stiff’’ in the CBS, quadriceps activation and less hamstring activation than did
which would produce less hip flexion and allow for more male subjects during single-limb squatting. These conflicting
knee flexion in the CBS as compared with the RS. The origin results indicate that the sex differences in movement pattern
of the RSF muscle on the anterior-inferior iliac spine could biomechanics are complex and require a much more
also result in an anterior pelvic tilt during the squat thorough investigation.
movement if this muscle has an increased neural drive and The drawback of the CBS is that the amount of mass that
was not allowed to eccentrically lengthen (as would be the can be used to counterbalance is limited by the amount of
case in the RS). This anterior pelvic tilt would appear as an weight the shoulders can support through the 90° of flexion.
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
Biomechanics and a Counterbalanced Squat
This would also limit the ability to overload the squat pattern 8. Escamilla, RF, Fleisig, GS, Lowry, TM, Barrentine, SW, and
using the CBS and future research should examine whether Andrews, JR. A three-dimensional biomechanical analysis of the
squat during varying stance widths. Med Sci Sports Exerc 33: 984–998,
it is possible to produce a training effect using the CBS. A CBS 2001.
may also be contraindicated for those with certain shoulder or 9. Escamilla, RF, Fleisig, GS, Zheng, N, Barrentine, SW, Wilk, KE,
spine pathologic conditions. For example, placing more mass and Andrews, JR. Biomechanics of the knee during closed kinetic
anteriorly could increase the moment on the lumbar spine chain and open kinetic chain exercises. Med Sci Sports Exerc 30:
556–569, 1998.
and therefore, examining the ‘‘costs’’ of this exercise on other
10. Flanagan, SP and Salem, GJ. Lower extremity joint kinetic responses
joints is warranted. to external resistance variations. J Appl Biomech 24: 58–68, 2008.
Perhaps the best use of a CBS technique would be in the 11. Gans, C. Fiber architecture and muscle function. Exerc Sport Sci Rev
initial stages of a training program to establish a more hip- 10: 160–207, 1982.
dominant and less knee-dominant pattern of movement 12. Gullett, JC, Tillman, MD, Gutierrez, GM, and Chow, JW. A
before progressing to more complicated movements. It could biomechanical comparison of back and front squats in healthy
trained individuals. J Strength Cond Res 23: 284–292, 2009.
also be used as a warm-up or movement preparation routine
to help establish a more hip-dominant pattern before 13. Gwinn, DE, Wilckens, JH, McDevitt, ER, Ross, G, and Kao, TC. The
relative incidence of anterior cruciate ligament injury in men and
performing other movements. It should also be pointed out women at the United States Naval Academy. Am J Sports Med 28:
that this study simply investigated the differences between 98–102, 2000.
2 different squat techniques. Future research is needed to 14. Hanavan, EP. A mathematical model of the human body. Aero
examine both the long-term and short-term training effects Medical Research Laboratory Technical Report. Air Force Base, Ohio,
1964.
of using CBS movements to determine whether they have
15. Ito, J, Moriyama, H, Inokuchi, S, and Goto, N. Human lower limb
the ability to alter the mechanics of a subject’s natural muscles: An evaluation of weight and fiber size. Okajimas Folia Anat
movement patterns. Jpn 80: 47–55, 2003.
16. Jacobs, JJ and King, T. US bone and joint decade prepares for the
PRACTICAL APPLICATIONS future. Arth Care Res 61: 1470–1471, 2009.
17. Kamen, G and Gabriel, DA. Essential of Electromyography.
If the goal of a squat training program is to increase the Champaign, IL: Human Kinetics, 2010.
dominance of the hip extensors in producing a squat move- 18. Kritz, M, Cronin, J, and Hume, P. The bodyweight squat: A movement
ment, there should be an attempt to increase the mass placed screen for the squat pattern. Strength Cond J 31: 76–85, 2009.
anteriorly. However, if the goal of a squat training program is 19. Lee, MS, Trindade, MCD, Ikenoue, T, Schurman, DJ, Goodman, SB,
to strengthen the knee extensors, there should be an attempt and Smith, RL. Effects of shear stress on nitric oxide and matrix
protein gene expression in human osteoarthritic chondrocytes
to increase the mass placed posteriorly. in vitro. J Orthop Res 20: 556–561, 2002.
20. Leetun, DT, Ireland, ML, Willson, JD, Ballantyne, BT, and Davis,
ACKNOWLEDGMENTS IM. Core stability measures as risk factors for lower extremity injury
in athletes. Med Sci Sports Exerc 36: 926–934, 2004.
The authors would like to thank their graduate students
21. Lewis, CL, Sahrmann, SA, and Moran, DW. Anterior hip joint force
(Melinda Pittman, Yasuo Sakurai, and Lisa Wilson) for all of increases with hip extension, decreased gluteal force, or decreased
their help with data collection, processing, and organization. iliopsoas force. J Biomech 40: 3725–3731, 2007.
There was no funding received for this work. 22. Lewis, CL, Sahrmann, SA, and Moran, DW. Effect of position and
alteration in synergist muscle force contribution on hip forces when
performing hip strengthening exercises. Clin Biomech 24: 35–42,
REFERENCES 2009.
1. Abelbeck, KG. Biomechanical model and evaluation of a linear 23. McKean, MR, Dunn, PK, and Burkett, BJ. Quantifying the
motion squat type exercise. J Strength Cond Res 16: 516–524, 2002. movement and the influence of load in the back squat exercise.
2. Arendt, E and Dick, R. Knee injury patterns among men and women J Strength Cond Res 24: 1671–1679, 2010.
in collegiate basketball and soccer—NCAA data and review of 24. Myer, GD, Brent, JL, Ford, KR, and Hewett, TE. Real-time
literature. Am J Sports Med 23: 694–701, 1995. assessment and neuromuscular training feedback techniques to
3. Berchuck, M, Andriacchi, TP, Bach, BR, and Reider, B. Gait prevent anterior cruciate ligament injury in female athletes. Strength
adaptations by patients who have a deficient anterior cruciate Cond J 33: 21–35, 2011.
ligament. J Bone Joint Surg Am 72A: 871–877, 1990. 25. Neumann, G, Mendicuti, AD, Zou, KH, Minas, T, Coblyn, J,
4. Blackburn, JT and Padua, DA. Sagittal-plane trunk position, landing Winalski, CS, and Lang, P. Prevalence of labral tears and cartilage
forces, and quadriceps electromyographic activity. J Athl Train 44: loss in patients with mechanical symptoms of the hip: Evaluation
174–179, 2009. using MR arthrography. Osteoarthritis Cartilage 15: 909–917, 2007.
5. Boling, MC, Padua, DA, and Creighton, RA. Concentric and 26. Niemuth, PE, Johnson, RJ, Myers, MJ, and Thieman, TJ. Hip muscle
eccentric torque of the hip musculature in individuals with and weakness and overuse injuries in recreational runners. Clin J Sport
without patellofemoral pain. J Athl Train 44: 7–13, 2009. Med 15: 14–21, 2005.
6. Chang, A, Hayes, K, Dunlop, D, Song, J, Hurwitz, D, Cahue, S, 27. Pitt-Brooke, J, Reid, A, Lockwood, J, and Kerr, K. Rehabilitation of
and Sharma, L. Hip abduction moment and protection against Movement: Theoretical Basis of Clinical Practice. London, United
medial tibiofemoral osteoarthritis progression. Arthritis Rheum Kingdom: WB Saunders, 1998.
52: 3515–3519, 2005. 28. Pollard, CD, Sigward, SM, and Powers, CM. Limited hip and knee
7. Escamilla, RF. Knee biomechanics of the dynamic squat exercise. flexion during landing is associated with increased frontal plane knee
Med Sci Sports Exerc 33: 127–141, 2001. motion and moments. Clin Biomech 25: 142–146, 2010.
the TM
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
the TM
29. Powers, CM. The influence of abnormal hip mechanics on knee 36. Taanila, H, Suni, J, Pihlajamäki, H, Mattila, VM, Ohrankämmen, O,
injury: A biomechanical perspective. J Orthop Sports Phys Ther 40: Vuorinen, P, and Parkkari, J. Musculoskeletal disorders in physically
42–51, 2010. active conscripts: A one-year follow-up study in the Finnish Defence
30. Robertson, DGE, Wilson, JJ, and Pierre, TAS. Lower extremity Forces. BMC Musculoskelet Disord 10: 89, 2009.
muscle functions during full squats. J Appl Biomech 24: 333–339, 2008. 37. Taunton, JE, Ryan, MB, Clement, DB, McKenzie, DC, Lloyd-Smith,
31. Sahrmann, SA. Diagnosis and Treatment of Movement Impairment DR, and Zumbo, BD. A retrospective case-control injuries analysis of
Syndromes. St. Louis, MO: Mosby, Inc., 2002. 2002 running. Br J Sports Med 36: 95–101, 2002.
32. Sharma, L, Dunlop, DD, Song, J, and Hayes, KW. Quadriceps 38. Tomatsu, T, Imai, N, Takeuchi, N, Takahashi, K, and Kimura, N.
strength and osteoarthritis progression in maligned and lax knees. Experimentally produced fractures of articular-cartilage and
Ann Intern Med 138: 613–619, 2003. bone–the effects of shear forces on the pig knee. J Bone Joint
Surg Br 74: 457–462, 1992.
33. Shin, CS, Chaudhari, AA, Dyrby, CO, and Andriacchi, TP. Influence
of patellar ligament insertion angle on quadriceps usage during 39. Winter, DA. Biomechanics and Motor Control of Human Movement
walking in anterior cruciate ligament reconstructed subjects. (2nd ed.): John Wiley and Sons, Inc., New York 205, 1990.
J Orthop Res 27: 730–735, 2009. 40. Woltring, HJ.3-D attitude representation of human joints—A
34. Shirazi-Adl, A and Drouin, G. Load-bearing role of facets in standardization proposal. J Biomech 27: 1399–1414, 1994.
a lumbar segment under sagittal plane loadings. J Biomech 20: 601– 41. Youdas, JW, Hollman, JH, Hitchcock, JR, Hoyme, GJ, and Johnsen,
613, 1987. JJ. Comparison of hamstring and quadriceps femoris electromyo-
35. Simonsen, EB, DyhrePoulsen, P, Voigt, M, Aagaard, P, and Fallentin, graphic activity between men and women during a single-limb
N. Mechanisms contributing to different joint moments observed squat on both a stable and labile surface. J Strength Cond Res 21:
during human walking. Scand J Med Sci Sports 7: 1–13, 1997. 105–111, 2007.
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.