Fine Tuning Your Home Care Patient's Squat

Fine Tuning Your Home Care Patient's Squat

 

 

The previous post discussed the techniques and benefits of both the Box Squat and the Face the Wall Squat.  Both types of squats are performed using body weight, and they are very helpful in providing external cues for performing a correct squat.  In the Home Care setting, I have the majority of my patients (most of which are elderly) perform squats while holding onto their kitchen sink.  The kitchen sink is a great place to perform standing exercises at home because it is stable enough to support you if you lose your balance (unlike holding onto the back of a chair which may tip over).  I include squats in almost all of my home treatments because of its functional everyday value.  However, most of my patients require verbal and tactile cues to perform the squat correctly.  Incorrect performance may cause more harm than good, so it is extremely important to cue your patients as needed.

 

 

I first have my patient stand comfortably facing the sink with their feet shoulder width apart.

 

As they squat, I make sure that their knees are in proper alignment in reference to their feet, their lower back remain straight (not vertical), and their body weight shifts posteriorly onto their heels as they hinge at the hips.

 

Many patients squat vertically.  They keep a straight spine, and lower themselves vertically toward the floor.  Their knees cross anterior to their toes, causing excessive stress on the knees

 

This is incorrect.  You want to maintain a straight lower back.  However you should do this by hip hinging, not by holding a vertical position

 

If the patient squats incorrectly, I will place a chair behind them for an external/visual cue.  I then ask them to lower themselves as if they are trying to sit in the chair. 

 

The chair will provide them with the "motivation" to hinge their hips, pushing their butt back to the chair.  As you can see, the lower back remains straight, not vertical

 

If the chair cue doesn't work I have my patient step as close to the sink as possible, placing their feet under the cabinet so that their knees come close to touching the cabinet door

 

Upon squatting, if still performed incorrectly with anterior knee translation in relation to the feet, the knees will hit the cabinet doors which will prevent any further anterior motion. 

 

As they continue to lower themselves, they will have no other option than to hinge at the hips, driving their butt back.  This will transfer their body weight onto their heels and should correct their squat

The Wall Squat

The Wall Squat

 

 Does the exercise above look familiar to you?  It may, especially if you have had Physical Therapy or Personal Training before.  In this exercise, a therapy ball is placed between the wall and your lower back.  You lean back against the ball, compressing it into the wall as you lower yourself into a squat, and return to upright.  This may be a leg strengthener, but how functional is it?  The squat is one of the most prevalent activities of your day.  Getting up and down from the edge of your bed in the morning, moving from the sitting to standing position from your chair at work, lowering yourself to pick something up from the floor are all examples of squatting activities.  In these activities, you must rely on your ankle, knee, hip and trunk stability to safely and efficiently lower your body and raise your body.  If you lean back too far, you will fall back, and if you shift forward onto your toes too much, you will fall forward.  There is no "safety mechanism" such as the therapy ball rolling on the wall to maintain your trunk's vertical orientation as you raise and lower your body. 

I prefer to customize my patient's exercises to be as efficient and focused as possible.  If I want them to strengthen their legs and I choose the squat as one of the exercises, they must first squat properly.  To do this, I have them train with a "real-life" version of the squat.  Instead of the Therapy Ball-Wall Squat, I will use the Box Squat or the Face The Wall Squat.

 

 

Above is the Box Squat.  Here, a bench, chair or plyo-box is placed behind you.  You hinge at your hips and push your butt back towards the box as you lower yourself down into the seated position.  Initially, I will have patients lower to the seated position, rest and then return to standing.  However, as they become stronger, I progress this exercise by having them lower themselves until they just about touch the box, and then return to stance.  Taking away the rest portion of the activity makes it more challenging due to the increased control and stability that is needed.  In the box squat, you must hip hinge and maintain proper knee alignment.

 

Do not allow the knees to cross anterior to your toes and do not allow the knees to "cave in" towards each other.

 

The Facing Wall Squat is another great activity that teaches proper squat technique while relying on your own body's feedback mechanism for stability rather than an external support.

Here, you stand close to the wall, facing it and lower yourself into a squat.  Your goal is to avoid hitting your knees or your head on the wall.  You will feel your weight shift back onto your heels and must stabilize to avoid falling backward.  Because of your position, the wall will give you the proper feedback to prevent your knees from shifting anterior to your toes.

 

The Therapy Ball Wall Squat reminds me of the Smith Machine.





The Smith Machine is another type of external support mechanism that in my opinion, reduces the use of your joint stabilizers to perform a movement such as the Bench Press, Shoulder Press or the Squat.

Here, the Smith Machine controls the bar, preventing it from shifting forward or back.  All you have to do is raise and lower it.  Less stabilization is required than if you had to control a free weight.

 



The Smith Machine Squat is similar to the Therapy Ball Wall Squat, as it prevents you from shifting forward or back as you raise and lower your body.  Less ankle, knee, hip, and trunk stability is required than if you were to perform a free standing squat (Box Squat or Face Wall Squat) that does not provide an external support system.

In my opinion, if a person can not do a proper body weight squat, then I would not have them perform a Smith Machine Squat using resistance/weight.  It is more important to perfect the squat movement prior to adding resistance to it.  I choose to use help my patients learn to properly squat for their everyday needs, rather than provide a bunch of external support so that they can increase the amount of weight that they squat.  If they can not squat their bodyweight properly, you should not be adding resistance to the movement.  This will only lead to bad habits, worse technique and injury.