Sports Biomechanics

ISSN: 1476-3141 (Print) 1752-6116 (Online) Journal homepage: https://www.tandfonline.com/loi/rspb20

Is there a relationship between back squat depth,

ankle flexibility, and Achilles tendon stiffness?

João Gomes, Tiago Neto, João R. Vaz, Brad Jon Schoenfeld & Sandro R. Freitas

To cite this article: João Gomes, Tiago Neto, João R. Vaz, Brad Jon Schoenfeld & Sandro R.
Freitas (2020): Is there a relationship between back squat depth, ankle flexibility, and Achilles
tendon stiffness?, Sports Biomechanics

To link to this article: https://doi.org/10.1080/14763141.2019.1690569

Published online: 05 Feb 2020.

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SPORTS BIOMECHANICS
https://doi.org/10.1080/14763141.2019.1690569

Is there a relationship between back squat depth, ankle

flexibility, and Achilles tendon stiffness?
João Gomes a, Tiago Netob, João R. Vaz a
, Brad Jon Schoenfeld c

and Sandro R. Freitas a

a
Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of
Lisbon, Lisbon, Portugal; bDepartament of Physiotherapy, LUNEX International University of Health, Exercise
and Sports, Differdange, Luxembourg; cDepartment of Health Sciences, CUNY Lehman College, Bronx,
NY, USA

ABSTRACT ARTICLE HISTORY

This study investigated the relationship between back squat depth Received 6 June 2019
capacity, ankle dorsiflexion resistance to stretch and maximal range of Accepted 4 November 2019
motion (ROM), and Achilles tendon stiffness of healthy individuals KEYWORDS
(n = 20). Squat depth capacity was assessed with 2D kinematic analysis. Biomechanics; technology;
Ankle dorsiflexion maximal ROM was assessed using a smartphone fitness; performance; health;
digital goniometry (lunge test) and isokinetic dynamometry (prone joint range of motion
test). Ankle dorsiflexion resistance to stretch was assessed during the
prone test. Achilles tendon stiffness was estimated at rest [using shear
wave elastography (stiffness-SWE)] and during isometric contraction
through tendon force-length relationship (using B-mode sonography).
Squat depth was associated only with ankle dorsiflexion ROM in the
lunge test (r = 0.69, p = 0.001). Ankle dorsiflexion ROM in the lunge test
was associated with the ankle resistance to stretch (r = 0.46, p = 0.050)
and Achilles tendon stiffness-SWE (r = 0.62, p = 0.005); and it was the
only variable different between individuals with low and high squat
depth capacity (p = 0.014). No other statistically significant associations
were found. In conclusion, back squat depth is associated with ankle
dorsiflexion ROM when the knee is flexed, without evident influence of
global joint and Achilles tendon mechanical properties.

Introduction
The back squat is widely employed to enhance lower limb strength in athletes from
different sports (Escamilla et al., 2001; McCurdy, Langford, Doscher, Wiley, & Mallard,
2005; Senter & Hame, 2006). This exercise has been proposed to be performed at different
depths based on the premise that doing so induces different functional and morpholo-
gical adaptations in the muscle-tendon complex (Bloomquist et al., 2013; Schoenfeld,
2010). For instance, a deeper back squat has been reported to be advantageous in
developing lower limb strength (Bloomquist et al., 2013) and jumping height
(Hartmann et al., 2012). Such strength gain is thought to occur do to a greater increase
in skeletal muscle hypertrophy, as well as changes in the geometry of muscle fascicles, i.e.,
muscle architecture (Bloomquist et al., 2013; Schoenfeld, 2010). However, since back

CONTACT Sandro R. Freitas sfreitas@fmh.ulisboa.pt

© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 J. GOMES ET AL.

squat depth capacity varies across individuals (Kathiresan, Jali, Afiqah, Aznie, & Osop,
2010), it is important to understand the factors underlying back squat depth capacity.
The ankle dorsiflexion maximal range of motion (ROM) has been reported to influ-
ence back squat depth capacity (Escamilla et al., 2001; McCurdy et al., 2005; Senter &
Hame, 2006). For instance, a lower back squat depth was observed when ankle dorsi-
flexion was restricted by dorsiflexing the ankle 12◦ at the starting squat position
(Macrum, Bell, Boling, Lewek, & Padua, 2012). Also, a positive association has been
reported between squat depth capacity and ankle dorsiflexion ROM, with both the knee
flexed and extended (Kim, Kwon, Park, Jeon, & Weon, 2015). A similar observation was
also noted by Kathiresan et al. (2010), where a positive association was observed between
ankle dorsiflexion ROM in the lunge test and squat depth capacity. However, it is
unknown whether the mechanical factors that influence maximal ankle dorsiflexion
ROM is also associated with back squat depth capacity.
Joint resistance to stretch (i.e., passive torque at a given angle) has been asso-
ciated with joint ROM (McHugh, Kremenic, Fox, & Gleim, 1998), and Achilles
tendon stiffness has been reported to correlate with ankle dorsiflexion ROM
(Kawakami, Kanehisa, & Fukunaga, 2008). It is thus possible that the aforemen-
tioned mechanical factors also are associated with back squat depth capacity. It is
important to note that these variables can be assessed using different methodological
approaches, which may produce different outcomes. For instance, ankle dorsiflexion
ROM can be either assessed in closed- or open-chain positions with the knee placed
in different angles. Joint resistance to stretch can be inferred by the passive torque at
a given angle, or through the slope of the angle-torque curve (Freitas, Vaz, Bruno,
Valamatos, & Mil-Homens, 2013). Moreover, Achilles tendon stiffness can be
inferred by different methods. For instance, it can be assessed through (i)
a classical assessment of the tendon force-length relationship during isometric
contraction using dynamometry to quantify joint torque (which is used to estimate
tendon force) and B-mode ultrasonography (which is used to estimate tendon
lengthening) (Kawakami et al., 2008; Seynnes et al., 2015); or (ii) by using a more
recent an ultrasound approach called shear wave elastography (SWE) (Helfenstein-
Didier et al., 2016), which quantifies a shear wave speed after a remote acoustic
perturbation in a passive condition, whose parameter is known to relate to the tissue
shear modulus.
This study sought to examine the relationship between back squat depth capacity
(assessed using a sagittal 2D kinematic analysis), ankle dorsiflexion ROM [assessed in
both closed-chain with knee flexed (lunge test) and open-chain and knee full extended
positions (prone test)], ankle dorsiflexion resistance to stretch, and Achilles tendon stiffness
(assessed with both the classical slope of tendon force-length relationship during isometric
contraction, and using SWE at rest) in young, healthy individuals. We hypothesised that
back squat depth would be i) positively associated with ankle dorsiflexion ROM (in both
tests) and negatively associated with both ii) ankle dorsiflexion resistance to stretch (in the
two methods of analysis) and iii) Achilles tendon stiffness (in both assessment methods).
Secondarily, we sought to examine the relationship between the ankle mechanical proper-
ties (ROM and resistance to stretch) and tendon stiffness variables.
 SPORTS BIOMECHANICS 3

Methods
Participants
Young, physically active individuals (n = 20, 15 men and 5 women; age: 25.9 ± 8.2 years;
height: 169.4 ± 14.5 cm; weight: 65.7 ± 11.7 kg) volunteered to participate in this study.
The repeatability of the back squat depth capacity, Achilles tendon stiffness (for the SWE
assessment), and ankle dorsiflexion ROM in the lunge test was previously determined in
ten of the study participants. The sample size was estimated using G*Power software
(v3.1.9.2) for a minimum correlation coefficient of 0.6, statistical power of 90%, and
significance of 0.05. Only individuals without a current or previous history of injury that
could influence back squat depth capacity, plantar flexors strength, and/or ankle flex-
ibility, were accepted to participate in this study. Prior to participation, all individuals
read and signed an informed consent. This study was approved the Faculty of Human
Kinetic of University of Lisbon Ethics committee (#10/2017).

Procedures
Participants performed two testing sessions, separated by 2 hours. Demographic information
and anthropometric characteristics were obtained at the start of the first session, followed by
the maximal ankle dorsiflexion ROM assessment performed in both lunge and prone tests
(with 5 min rest between tests). Ten minutes afterwards, Achilles tendon stiffness assessment
was performed using SWE (stiffness-SWE). In the second session, participants performed the
back squat depth assessment followed by a maximal voluntary ankle plantar flexors test (2
trials, with 1-min rest between trials), and the Achilles tendon stiffness assessment using the
slope of tendon-force relationship during an isometric contraction (stiffness-CON); 10min
rest was afforded between tests. Immediately before the stiffness-CON assessment, a standard
measuring tape was used to quantify the perpendicular distance between the lateral malleolus
(i.e., estimate of ankle centre of rotation) and the Achilles tendon, and the distance between
the most distal myotendinous junction of the medial gastrocnemius and the Achilles tendon
insertion in the most distal insertion at calcaneus (i.e., to determine tendon length).

Variables and equipment

Back squat depth
A 2D kinematic capturing system (recorded at 25Hz) was used to assess the performance of
the back squat in the sagittal plane. A digital camera (Sony Handycam HDR-CX210) with
a built-in lighting system was placed 3.8 m from the individual sagittal plane (Figure 1).
Reflective markers were placed on the greater trochanter, fibular head, and lateral mal-
leolus. Participants performed 2 sets of 3 repetitions each, with 30s rest between sets.
Participants positioned their feet at a bi-acromial distance, and held a bar (218g) against
their upper back in alignment with the shoulders to simulate the back squat. Participants
were instructed to perform the back squat using a slow and constant speed, in accordance
with the technique previously described (Comfort, McMahon, & Suchomel, 2018), until
achieving their maximum depth without raising their heels off the ground and maintaining
their lumbar natural lordotic curve. When a local examiner confirmed that the heels rose
from the floor, additional trials were performed.
4 J. GOMES ET AL.

Figure 1. Back squat depth capacity assessed during the back squat performance (left), defined as the
distance between the great trochanter (GT) and the lateral malleolus (LM) at the deepest back squat
end position (b) normalised to the same distance at the starting position (a); and, the ankle
dorsiflexion maximal range of motion obtained during the lunge test (right), which was determined
by the difference of the tibia slope between the upright and maximal ankle dorsiflexion range of
motion positions.
Legend: FH, fibula head reflective marker.

Ankle dorsiflexion maximal ROM

Two tests were used to assess the ankle ROM (Figure 1): the lunge test, (i.e., closed
kinetic chain test carried out with the knee flexed); and the prone test (i.e., open
kinetic chain test carried out with the knee in full extension). The lunge test was
performed according to procedures described by Cejudo, Sainz de Baranda, Ayala,
and Santonja (2014). From an orthostatic position, and after placing the foot of the
tested limb 50 cm forward from the other foot, participants moved the knee of the
tested limb forward with a slow velocity until achieving the maximum ankle dorsi-
flexion possible without raising the heel from the floor. The ankle dorsiflexion ROM
was quantified using the The Clinometer application (Version 2.4, Plaincode;
Stephanskirchen, Germany) installed on a Huawei P9-Lite smartphone. The smart-
phone was placed (2 cm) below the tibial tuberosity. The slopes of the tibia at the
orthostatic and at the maximal ankle dorsiflexed positions were quantified and used
to determine the ankle dorsiflexion ROM (i.e., tibia slope difference between posi-
tions). Two measurement trials were performed for each limb, with the measure-
ments of the limbs performed interchangeably (i.e., 30s rest between trials). In each
trial, individuals maintained the maximal ankle dorsiflexed position for 3s to allow
accurate ankle dorsiflexion ROM measurement by the local examiner.
For the prone test, the ankle angle was assessed (at 50Hz) using an isokinetic
dynamometer (Biodex system 3 Pro, Shirley, New York, USA). The individuals were
placed in ventral decubitus position on a table, with the foot fixed against the dynam-
ometer platform (Figure 2(a)). Before ankle ROM testing, participants performed 5 ankle
rotations from 40º of plantarflexion to 10º of ankle dorsiflexion position at 4º/s for
conditioning purposes. The test started with the foot at 40º of plantarflexion, and it was
rotated (at 4◦/s) until a maximal tolerated plantar flexors stretch was achieved without
 SPORTS BIOMECHANICS 5

Figure 2. Experimental setting used to assess: (a) ankle dorsiflexion maximal range of motion and
resistance to stretch in a closed-chain with full knee extension position, performed in the isokinetic
dynamometer, where the participant holds a hand-held stop button; (b) achilles tendon shear wave
velocity (i.e., as an index of stiffness) with the ankle at 40º of plantar flexion position in a resting
condition, showing sonogram replicated with both B-mode (below) and shear wave elastography
(above) ultrasound modes; and (c) slope of tendon force-length relationship obtained during a plantar
flexors isometric contraction, where force was estimated based on ankle torque measurements while
tendon lengthening was based on medial gastrocnemius muscle-tendon junction displacement (as
observed in right and inferior corner of the image).

perceived pain. Maximal ankle dorsiflexion ROM was determined by each participant by
pressing a button that ceased the joint motion. Participants were instructed to remain as
relaxed as possible during the stretching protocol. Three trials were performed with a 60s
rest period between trials.
6 J. GOMES ET AL.

Ankle dorsiflexion resistance to stretch

During the prone test (previously described; Figure 2(a)), the passive ankle torque was
quantified (at 50Hz) along the ankle rotation. Prior to the testing, the torque generated by
the empty ankle footplate was recorded to correct for gravity.

Achilles tendon stiffness

Two types of tests were used to estimate tendon stiffness: through quantification of the
shear wave speed (i.e., an index of stiffness) using ultrasound-based SWE (stiffness-SWE);
and, through the quantification of the slope of tendon force-length relationship during
a plantar flexors isometric ramp contraction (stiffness-CON). It is important to note that
while stiffness-SWE estimates the localised Achilles tendon stiffness in a passive condi-
tion, the stiffness-CON estimates Achilles tendon stiffness based on global joint torque
and muscle-tendon junction displacement during plantarflexor isometric contractions.
Due to time constraints, only the right limb was assessed in both tests.
For the stiffness-SWE, an ultrasound machine (Supersonic Imagine v11, Aix-en-
Provence, France) was used in shear wave elastography mode (musculoskeletal preset,
penetrate mode, smoothing level 5, persistence off; scale: 0–800 kPa), coupled with
a linear array transducer (4–15MHz. Super Linear 15–4, Vermon, Tours, France) to
determine the shear wave speed within the Achilles tendon stiffness at rest. Individuals
were situated in ventral decubitus, with the ankle attached to the dynamometer platform
and positioned at 40º of plantarflexion. This angle is known to be slightly above of where
the tendon falls slack but before achieving saturation in the elastogram window (Hug,
Lacourpaille, Maïsetti, & Nordez, 2013). The angle was chosen since most participants
could not achieve a higher ankle angle without reporting pain, which in turn could
increase muscle activation and affect the shear wave measurements. The ultrasound
transducer was placed on the largest tendon thickness, while avoiding the distal tendon
region that was compressed by the plantarflexion of the foot (Figure 2(b)). Minimal
pressure was applied against the skin surface during testing. A minimum of three
consecutive elastograms each were obtained, with the probe removed between trials.
The stiffness-CON was measured as previously described (Kawakami et al., 2008). An
ultrasound machine (EUB-7500; Hitachi Medical Corporation, Chiyoda-ku, Tokyo,
Japan), coupled with a 8-cm linear probe operating at a 10 MHz frequency was used in
B-mode to quantify muscle-tendon junction displacement; while the ankle torque was
quantified using an isokinetic dynamometer (Biodex system 3 Pro, Shirley, New York,
USA). The individuals remained seated with the hip flexed at 80º, the knee in full
extension, and the ankle in a neutral position (i.e., 0º) (Figure 2(c)). The ultrasound
probe was affixed to the skin by a custom-cast secured with velcro tape and using bi-
adhesive tape (between the cast and the skin) in the most distal myotendinous junction of
the medial gastrocnemius. Prior to the assessments, we confirmed by conducting a pilot
test in several individuals and found that no motion occurred between the ultrasound
probe and the skin. Participants were instructed to produce isometric force in their
plantar flexors against a static platform at a rate of 10% of their maximum voluntary
isometric contraction per second, aided by visual feedback of their strength performance.
Two trials were performed with 1 min rest afforded between trials (trials repeatability:
ICC = 0.72).
 SPORTS BIOMECHANICS 7

Data acquisition and processing

Angle and torque obtained by dynamometer were synchronised and recorded using the
Biopac MP100 acquisition system and the AcqKnowledge software (Biopac Systems Inc,
Santa Barbara, USA). A pedal switch was used to simultaneously activate the dynam-
ometer and ultrasound acquisition, thus ensuring that sonographic and mechanical data
were synchronised. The back squat depth and the tendon displacement data were
analysed using the Kinovea software (0.8.15, Kinovea organisation, France), while the
remaining data were processed using routines created in the Matlab software (v9.4,
Mathworks, Natick, Massachusetts, USA).
For back squat depth quantification, the coordinates of the greater trochanter and
lateral malleolus reflexive markers were automatically tracked using the marker and
follow path tools. Visual inspection was performed to ensure correct automatic tracking.
The lowest vertical distance between the greater trochanter and the lateral malleolus
normalised to the greater trochanter-lateral malleolus distance at the starting position
observed across trials was defined as the back squat depth capacity and used for analysis.
For the ankle dorsiflexion ROM in the lunge test, the tibia slope between the upright
position and the maximal ankle dorsiflexion angle was determined for each trial, and the
average was used for analysis. After checking inter-limb symmetry (see results section),
data from the right ankle was used for the association analysis. In the prone test, the
average ankle angle across trials observed at the maximal dorsiflexion ROM (i.e., when
the participant pressed the hand-stop button), as well as the resistance to stretch variables
(i.e., passive torque at 15º of dorsiflexion, the torque slope between 0 and 15º of
dorsiflexion, and the passive torque at 80% of individual’s maximal dorsiflexion ROM),
were determined and used for analysis. The dorsiflexion angle of 15º corresponded to the
maximal ROM of the lowest flexible individual. For Achilles tendon stiffness-SWE, shear
wave velocity at 40º of ankle plantar flexion was determined using a Matlab routine and
by selecting the largest area within the tendon in the elastogram window (Figure 2(b)).
Care was taken to avoid regions of saturation (i.e., values higher than the ones supported
by the ultrasound device), since they are considered as artefacts. Shear wave velocity
values were calculated by converting the colour pixels (in accordance with the scale) and
averaged. The average of 3 trials was used for analysis.
The Achilles tendon stiffness-CON was processed as previously described (Kubo,
2014). Briefly, the medial gastrocnemius myotendinous junction displacement during
the plantar flexors isometric contraction was quantified using the automated tracking
tools function of the Kinovea software (0.8.15, Kinovea organisation, France), and
visually inspected to ensure correct tracking. The displacement of the myotendinous
junction was summed to the tendon length (assessed with the ankle in neutral position)
and used to quantify the tendon lengthening. The medial gastrocnemius force (Fm)
applied to the Achilles tendon was estimated using the following Equation (1):

Fm ¼ k  TQ  MA (1)

where k represents relative contribution (i.e., 18%) of the physiological cross-

sectional area of the medial gastrocnemius muscle within plantar flexor muscles
(Fukunaga, Roy, Shellock, Hodgson, & Edgerton, 1996), TQ represents the ankle
torque, and MA represents moment arm length of the triceps surae muscles with the
8 J. GOMES ET AL.

ankle at neutral position (i.e., perpendicular distance measured between Achilles

tendon and the lateral malleolus). To estimate tendon stiffness, Fm and tendon
lengthening were fitted to a linear regression equation, and the slope above 50% of
maximum voluntary isometric contraction was adopted as an index of tendon
stiffness (Kubo, 2014; Kubo, Kanehisa, & Fukunaga, 2001). The average of 2 trials
was used for analysis.

Statistical procedures
Data analysis was performed using IBM SPSS Statistics software (v22, IBM Corporation,
New York, USA). The assessment repeatability of back squat depth, lunge test ankle
dorsiflexion ROM, and Achilles tendon stiffness-SWE was determined by calculating the
intraclass coefficient correlation (ICC3,1) and the standard error of measurement (SEM,
i.e., standard deviation of the difference scores divided by √2). Normality was confirmed
using the Shapiro-Wilk test. The inter-limb symmetry for ankle dorsiflexion ROM in the
lunge test was determined using a paired t-test. The association between the back squat
depth, ankle dorsiflexion ROM (in both tests) and resistance to stretch (of both para-
meters), and the Achilles tendon stiffness (of both methods), was determined by calculat-
ing the Pearson correlation coefficient (r), as well as the linear regression equation
constants. K-means cluster was used to differentiate individuals in two clusters with
low and high back squat depth capacity. The quality of clusters was confirmed via
silhouette plot when most of the values were higher than 0.6 (Burney & Tariq, 2014).
An unpaired t-test for independent samples was applied to compare outcomes between
cluster groups Both ICC and r were classified as: ‘minimal’ (0.00–0.25), ‘low’ (0.26–0.49),
‘moderate’ (0.50–0.69), ‘high’ (0.70–0.89), and ‘very high’ (0.90–1.00) (Domholdt, 2000).
Significance was set at p ≤ 0.05.

Results
Due to data corruption, data from one individual was excluded from analysis. Individuals
showed similar ankle dorsiflexion ROM in the lunge test between limbs (right=40.4±9.5º,
left=42.0±10.5º; p=0.07). A high to very high intra-day repeatability was found for back
squat depth (ICC=0.93, SEM=3.4%), ankle dorsiflexion ROM in the lunge test
(ICC=0.98, SEM=1.6º), and tendon stiffness-SWE (ICC=0.76, SEM=0.81m/s).
A moderate and positive association was found between back squat capacity and ankle
dorsiflexion ROM in the lunge test (r = 0.69, p = 0.001), but not for the prone test
(r = 0.11, p = 0.660) (Figure 3). No association was found between back squat depth and
ankle dorsiflexion resistance to stretch (torque at 15º: r = 0.397, p = 0.880; torque slope:
r = 0.266, p = 0.270; torque at 80% of maximal ROM: r = 0.428, p = 0.067), nor between
the back squat depth and Achilles tendon stiffness-CON (r = 0.315, p = 0.190) or
stiffness-SWE (r = 0.424, p = 0.070).
Individuals divided into low (n = 10, back squat depth = 35.9 ± 8.4%) and high (n = 9,
back squat depth = 74.8 ± 6.8%) back squat depth clusters showed silhouette values
greater than 0.6 (low squat depth: mean = 0.73, median = 0.80, min = 0.23, max = 0.82;
high back squat depth: mean = 0.79, median = 0.80, min = 0.63, max = 0.83), except for
one individual in the low back squat depth cluster (i.e., silhouette = 0.23). Among the
 SPORTS BIOMECHANICS 9

Figure 3. Plot between back squat depth capacity (y-axis) and the ankle dorsiflexion maximal range of
motion in the lunge test (a) and prone test (b), as well as their linear regression equation parameters.

Table 1. Individual ś ankle dorsiflexion maximal range of motion, ankle dorsiflexion resistance to
stretch, and achilles tendon stiffness parameters in the low and high back squat depth groups (values
are shown as average ± standard deviation).
Variable Low Back Squat Depth High Back Squat Depth p-value
Lunge test (º) # 35.6 ± 8.4 45.8 ± 7.9 0.014
Prone test (º) 40.5 ± 11.2 40.7 ± 11.8 0.976
Torque at 15º (Nm) 11.2 ± 6.4 13.2 ± 10.5 0.605
Torque 0–15º slope (Nm/º) 0.66 ± 0.19 0.59 ± 0.27 0.528
Torque at 80% of maximal ROM (Nm) 37.4 ± 9.5 29.0 ± 13.2 0.127
Stiffness-CON (N/mm) 36.3 ± 21.8 46.3 ± 19.0 0.305
Stiffness-SWE (m/s) 1.86 ± 1.20 1.29 ± 0.55 0.210
Legend: Stiffness-CON: active tendon stiffness assessment using plantar flexors isometric ramp contraction;
Stiffness-SWE: passive tendon stiffness using ultrasound-based shear wave elastography technique.
#—Statistical difference between low and high back squat depth groups (p < 0.05).

different ankle and tendon variables (Table 1), only the ankle dorsiflexion ROM in the
lunge test was statistically different between the low and high back squat depth groups
(p = 0.014).
Ankle dorsiflexion ROM in the lunge test was moderately and negatively associated
with the resistance to stretch for the torque slope (r = 0.456, p = 0.050; y = −0.011x+1.071,
where ankle ROM corresponds to x-axis), but not for the torque at 15º (r = 0.397,
p = 0.091) and for torque at 80% of maximal ROM (r = 0.001, p = 0.939); alternatively,
no significant association was found for the prone test. Ankle dorsiflexion ROM in the
lunge test was moderately and negatively associated with Achilles tendon stiffness-SWE
(r = 0.62, p = 0.005; y = −0.059x+3.895), where ankle ROM corresponds to x-axis), but
not for the stiffness-CON (r = 0.01, p = 0.655); no significant association was found
between ankle dorsiflexion ROM in the prone test for either stiffness-SWE (r = 0.32,
p = 0.165) or stiffness-CON (r = 0.10, p = 0.684). In addition, no association was found
between Achilles tendon stiffness-CON and stiffness-SWE (r = 0.429; p = 0.067).

Discussion and implications

This study investigated the relationship between back squat depth capacity, ankle dorsi-
flexion mechanical properties, and Achilles tendon stiffness, using different ankle and
Achilles tendon tests/parameters. Globally, the variables assessed showed high to very
10 J. GOMES ET AL.

high repeatability, based on present test- retest findings and previous study outcomes
(Freitas et al., 2013; Kawakami et al., 2008); this provides confidence in the veracity of
the study results. The main relationships found were: i) back squat depth was moderately
and positively associated with ankle dorsiflexion ROM in the lunge test and Achilles tendon
stiffness-SWE, but not with ankle dorsiflexion resistance to stretch or Achilles tendon
stiffness-CON; and ii) ankle dorsiflexion ROM in the lunge test was moderately and
negatively associated with both ankle dorsiflexion resistance to stretch (in the torque
slope) and Achilles tendon stiffness-SWE. No other significant relationships were observed.
Previous studies have suggested that ankle dorsiflexion ROM is associated with back
squat depth performance, as a lower degree of dorsiflexion during the squat potentially
could hinder centre of gravity positioning in a mechanically advantageous condition (Bell,
Padua, & Clark, 2008; Hemmerich, Brown, Smith, Marthandam, & Wyss, 2006; Kathiresan
et al., 2010; Kim et al., 2015; Kritz, Cronin, & Hume, 2009; Macrum et al., 2012; Schoenfeld,
2010). However, we only found such a relationship when ankle dorsiflexion ROM was
assessed with the knee flexed in a closed-chain condition, as no relationship was noted with
the knee fully extended and in open-chain condition. This contradicts the findings of Kim
et al. (2015), who reported an association between back squat depth with ankle dorsiflexion
ROM in both knee flexed or extended conditions. To our knowledge, this is the only
previous study to have compared these two conditions. The reason for this discrepancy may
be related to the nature of the ROM measurement (i.e., active vs. passive). In addition, we
speculate that dorsiflexion ROM with the knee flexed might have greater importance for
achieving increased back squat depth (compared to full knee extension), since both the
gastrocnemius and sciatic nerve tract become slack allowing a greater ankle ROM (Andrade
et al., 2018; Maïsetti, Hug, Bouillard, & Nordez, 2012). The closed-chain condition may also
affect ankle dorsiflexion ROM, as it allows a greater ankle dorsiflexion ROM compared to
open-chain condition (Dill, Begalle, Frank, Zinder, & Padua, 2014; Krause, Cloud, Forster,
Schrank, & Hollman, 2011). Thus, the relation of back squat depth and ankle dorsiflexion
ROM should be test-specific.
Two additional aspects of the present study deserve highlighting. First, we observed
that each additional 6.5º of ankle dorsiflexion ROM in the lunge test allows for 10% more
back squat depth (Figure 3(a)). Future study is needed to determine if such alterations in
back squat depth occur with a longitudinal intervention design targeting the increase of
ankle dorsiflexion ROM in a lunge movement. Second, assessment of ankle dorsiflexion
ROM during the lunge test was carried out using a goniometer smartphone app. This
assessment has been recently been validated when the methodological procedures of
application are met (Milani et al., 2014).
As previous studies have reported a relationship between joint ROM and resistance to
stretch (McHugh et al., 1998), and between ankle dorsiflexion ROM and Achilles tendon
stiffness (Chino & Takahashi, 2015; Kawakami et al., 2008), we hypothesised that such
mechanical factors could be associated with back squat depth. However, back squat depth
tended to correlate negatively only with Achilles tendon stiffness-SWE (r = 0.424,
p = 0.07), but not with stiffness-CON (r = 0.315, p = 0.190). It is important to note
that tendon thickness has been suggested to influence shear wave speed measurement, as
the shear wavelength is reported to be larger than the mean Achilles tendon thickness
(Brum, Bernal, Gennisson, & Tanter, 2014; Helfenstein-Didier et al., 2016). This is
thought to guide the wave propagation to along the tendon due to the successive
 SPORTS BIOMECHANICS 11

reflections at the tendon boundaries, which favours the underestimation of the shear
wave velocity and, consequently, might have affected the accuracy of shear wave velocity
measurement. Nevertheless, both the stiffness-SWE and stiffness-CON were not able to
differentiate individuals with low vs. high back squat depth capacity, suggesting that
tendon stiffness is not a factor underlying back squat depth performance. Also, despite
the moderate and negative association between ankle resistance to stretch and the ankle
dorsiflexion ROM for the lunge test, no association was found with back squat perfor-
mance. This may be due to differences in knee angle performance during the back squat
among individuals (Schoenfeld, 2010). As none of these aforementioned mechanical
variables differentiated individuals with low vs. high back squat depth, other structural
(e.g., morphology of talocrural joint) (Nägerl et al., 2016) or functional (e.g., contribution
from subtalar and midtarsal joints to ankle dorsiflexion ROM during the back squat due
to greater foot pronation) (Johanson et al., 2014) factors may be more important for back
squat depth.
Contrary to our expectation, no association was found between the two proposed
methods to assess Achilles tendon stiffness. This inconsistency might be explained by
several methodological assumptions underlying these methods [for more detailed under-
standing please see references (Bercoff, Tanter, & Fink, 2004) and (Seynnes et al., 2015)],
but also by the fact that: i) the SWE technique targeted the Achilles tendon (free)
component derived from the mid-region of both the lateral and medial gastrocnemius
heads, while the stiffness-CON was determined based on the estimation of force gener-
ated by the medial gastrocnemius and its muscle-tendon junction displacement; and ii)
assessment was performed with different conditions of muscle activity (i.e., rest vs.
contraction) and tendon lengths. Future studies should endeavour to examine the
relationship between these methods in assessing tendon stiffness.
The study had some limitations that should be considered when attempting to draw
practical implications. (i) Tendon stiffness-CON was assessed based on indirect mea-
surements of variables used to estimate stiffness (e.g., tendon moment arm and medial
gastrocnemius physiological cross sectional areas); however, this procedure was similar
to those employed in previous studies (Kawakami et al., 2008; Kubo, 2014; Kubo et al.,
2001). (ii) Although we made considerable effort to affix participants’ foot against the
dynamometer platform during assessment of tendon stiffness-CON, and despite the fact
that a researcher monitored heel position at all times during performance, we cannot rule
out the possibility that a small heel displacement took place, which in turn could
potentially have affected the stiffness calculation. (iii) For ankle dorsiflexion ROM
assessment in the prone test, as well as for Achilles tendon stiffness-SWE assessment,
the plantar flexors muscular activation was not monitored to ensure a passive condition,
for instance by the use of surface electromyography. Data collection issues rendered it
infeasible to assess muscular electromyographic activation; nonetheless, individuals were
instructed to remain as relaxed as possible during testing, and had prior familiarisation to
the experimental setup. (iv) Finally, only the right limb was tested for ankle resistance to
stretch and Achilles tendon stiffness; that said, because a similar ankle dorsiflexion ROM
in the lunge test was found between limbs, it is reasonable to assume that this was not
a confounding issue.
12 J. GOMES ET AL.

Conclusion
The present study indicates that the capacity of achieving a higher depth during the back
squat is associated with maximal ankle dorsiflexion range of motion when the knee is flexed
and in a closed-chain condition (i.e., lunge test), but not when the knee is fully extended
and in an open-chain condition. The assessment of ankle dorsiflexion angle in the lunge test
can be performed with very high reliability using a digital goniometer smartphone app. The
ankle dorsiflexion resistance to stretch and Achilles tendon stiffness do not correlate with
back squat depth, suggesting that other structural and/or functional factors may explain the
variance in this outcome. Professionals should consider other factors underlying a low back
squat depth capacity (e.g., functional/motor control), when the ankle dorsiflexion maximal
range of motion in the lunge test is high.

Acknowledgments
Authors thank the study participants for their contribution.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This work was supported by the Fundação para a Ciência e a Tecnologia [PTDC/SAU-DES/31497/
2017].

ORCID
João Gomes http://orcid.org/0000-0001-9691-5456
João R. Vaz http://orcid.org/0000-0001-9691-5456
Brad Jon Schoenfeld http://orcid.org/0000-0003-4979-5783
Sandro R. Freitas http://orcid.org/0000-0002-9760-5350

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