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.

Common Physical Therapy Questions

Common Physical Therapy Questions

 

As a Physical Therapist, I have heard certain questions frequently over the years.  This past week, I have been treating numerous patients following a Total Hip or Total Knee Replacement Surgery.  Many of these patients have trouble lifting their operative leg into bed when transferring from the sitting to the supine position.  My previous post explains how using the S.O.D. Stretch Strap can assist the patient with maintaining independence while performing this technique.  However, most patients do not have a strap so soon following their return home from the hospital.  They accept the fact that they can't lift their leg and rely on a family member to lift it into bed for them.  Even weeks after surgery, they may rely on someone else's help for this.  When the family asks me if this is normal, I tell them that the weakness is normal.  However, it is not only muscle weakness that is the cause.  The patient must begin to redevelop the motor pattern to lift their leg into bed by practicing it over and over.  Many times, if I perform the leg raise while cueing the patient to assist, after a few times, the patient is amazed at how quickly the movement returns.  It is as if they must re-establish the brain-leg connection in order to perform the task again.  I advise family members to assist only after the patient has made an effort first.  This will help the patient recover quicker and will prevent the family member from injuring themselves in the process of helping.

 

I have also been working with many Worker's Compensation patients who have injured their backs.  Most of them tell me that they bent over to pick something up and felt it "go out" at that moment.  After weeks of successful therapy, including core stabilization activities, body mechanics and lifting education,  I usually get the same question:  "When can I go back to lifting like I used to, without having to think about it?" 

 

And I answer them with: "Never.  You should have never lifted like that to begin with.  That's why I have been teaching you body mechanics and lifting techniques.  It is your goal to establish new posture and body mechanics so that you don't have to think about it the next time you are required to bend to lift something."

 



 



So although most of us have rarely thought about how we are to lift something off the floor, if we are taught the correct way to do it, and practice it repetitively, our new habit will minimize the risk of lower back injury in the future.  Just because we have been lifting a certain way all of our lives, does'nt mean that we have been doing it correctly.  The older we get, the higher the chance that poor lifting techniques will catch up with us. 

 

Protect Your Back Even With Light Lifts

Protect Your Back Even With Light Lifts

 

 

Over ten years ago, due to heavy lifting with incorrect technique, I was unlucky enough to develop a herniated disc in my lower back.  This was the worst pain I ever experienced.  Thanks to Physical Therapy school, I was able to manage it conservatively.  However, every now and then it would "go out on me," causing severe pain with even the slightest movement.  One day, after being pain free for a few months, I told a family member I would help them move.  We had to lift and carry a 55-inch rear projection TV (the bulky kind, not the nice flat screens we have today).  I did my part without a problem.  Upon finishing up that day, I bent over to pick up a pencil from the living room floor, and fell to my knees in agony.  After everything I lifted and carried that day, a simple number 2 pencil drops me to my knees?  While on the floor, I had plenty of time to think about what had  just happened.  Why did my back tolerate heavy lifting all day long, but when I lifted something as light as a pencil, my back went out on me?  I realized that with every heavy lift, I did not just carelessly walk up to the item and lift it.  Instead, I prepared my back by co-contracting the spinal stabilizers prior to each lift and carry.  That's when I realized that it doesn't matter how heavy the object you are lifting is.  If you bend over to pick up an item, it is wise to perform the lift with proper body mechanics and pre-stress and stabilize your spine.  This will minimize your chances of injuring or re-injuring your spine. 

"Your Hips Are Like Headlights On A Car"

"Your Hips Are Like Headlights On A Car"

 

 

When teaching a client about proper body mechanics and lifting techniques, a good visual cue is to tell them that their hips are like  headlights on a car. 

 

 

 

 

 

 

 

 

 

 

 

To safely drive at night, you must point the car's headlights in the direction that you want to go.  Functionally, to safely lift or reach, you must point your hip bones in the direction of the activity.  This spares the spine by minimizing lumbar rotation/twisting while bending/lifting.

 

Here, the hips are pointed to the right, while his bending/lifting activity is to his left

 

As she turns to the right, she pivots on her feet and moves as a 'whole,' squaring-off her hips in the direction of her action

Take home message: 
Always "square-off" your hips in the direction of your action.  Do not twist and lift from the left or right with your hips pointing in a different direction.
 

 For more on Posture & Body Mechanics, go to: Posture & Body Mechanics DVD for over 80 minutes of education videos



Fitness Post Partum

As a Physical Therapist, I have treated many new moms who are suffering from lower back pain.  During the initial evaluation interview process, most moms say their back hurts whenever they bend over the crib rail to lift their infant or when they attempt to lift their toddler from the floor.  They have difficulty carrying their child especially when they are required to multi-task, a responsibility all moms are familiar with.  After assessing their movement patterns, I usually start by correcting their body mechanics.  Once the pain level is reduced, we begin a strengthening program to prevent this pain from returning.  CLick on the link below to see a few of the exercises.

http://www.youtube.com/watch?v=Wj5--8ZS-vo