Emily Snee, SPT, CSCS
 
Squat Technique: What variables matter?
 
The squat at its core is a movement that most people perform on a daily basis. It is one of the most functional exercises that challenges the entire body. When the squat is assessed in the physical therapy setting, it is most likely chosen because it is one of the greatest tests of lower-extremity strength. The squat activates the quadriceps, gluteal muscles, hamstrings, hip adductors, hip abductors, and many other stabilizing muscles. But can we as physical therapists manipulate technique variables in order to increase the activation of specific muscles?
Increased quadriceps muscle strength and size are desired outcomes for various patients rehabbing from ACLR, anterior knee pain, etc. Studies have shown that to increase the activation of these muscles during the squat, the patient must perform the motion to at least parallel. When loading the squat, it has been shown that loading in a front rack position leads to increased quadriceps muscle activity as compared to the typical “back squat” position. Stance width does not have any effect on the activation of the quadriceps muscles.
If the desired outcome of the squat is to target the gluteus maximus, the only variables that need to be altered are depth and stance width. A patient must squat as deep as possible and with a wide stance (140-200% greater trochanter distance) in order to increase glute max activation. To ensure increased activation of the hip adductors, have the patient squat with a wide stance as well. Other factors in squat technique, such as degree of hip external rotation and heel height, did not influence the activation of any muscle.
Optimizing muscle activation by manipulating technique variables is a great way to make the squat a more useful intervention, however the simplest and most effective way to increase muscle activation is to increase the load. Studies have shown that utilizing 70-90% of a patient’s 1RM will activate the lower-extremity muscles to the greatest degree, while maintaining safe and correct technique.
 
References:

1. Caterisano, A, Moss, RF, Pellinger, TK, Woodruff, K, Lewis, VC, Booth, W, and Khadra, T. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res 16: 428–432, 2002.
2. Wretenberg, PER, Feng, YI, and Arborelius, UP. High- and low-bar squatting techniques during weight-training. Med Sci Sports Exerc 28: 218–224, 1996.
3. Contreras, B, Vigotsky, AD, Schoenfeld, BJ, Beardsley, C, and Cronin, J. A comparison of gluteus maximus, biceps femoris, and vastus lateralis EMG amplitude in the parallel, full, and front squat variations in resistance trained females. J of App Biomechanics. 2015.
4. Pereira, GR, Leporace, G, Chagas, DV, Furtado, LF, Praxedes, J, and Batista, LA. Influence of hip external rotation on hip adductor and rectus femoris myoelectric activity during a dynamic parallel squat.J Strength Cond Res 24: 2749–2754, 2010.
5. McCaw, ST and Melrose, DR. Stance width and bar load effects on leg muscle activity during the parallel squat. Med Sci Sports Exerc 31: 428–436, 1999.
6. Paoli, A, Marcolin, G, and Petrone, N. The effect of stance width on the electromyographical activity of eight superficial thigh muscles during back squat with different bar loads. J Strength Cond Res 23: 246–250, 2009.
7. Edwards L, Dixon J, Kent JR, Hodgson D, Whittaker VJ. Effect of shoe heel height on vastus medialis and vastus lateralis electromyographic activity during sit to stand. J Orthop Surg Res. 2008;3:2. Published 2008 Jan 10. doi:10.1186/1749-799X-3-2
8. Lee, SP, Gillis, CB, Ibarra, JJ, Oldroyd, DF, and Zane, RS. Heel-Raised Foot Posture Does Not Affect Trunk and Lower Extremity Biomechanics During a Barbell Back Squat in Recreational Weightlifters. J Strength Cond Res 33(3):606-614, 2019.
9. Clark, DR, Lambert, MI, and Hunter, AM. Muscle activation in the loaded free barbell squat: A brief review. J Strength Cond Res. 26(4)/1169–1178, 2012.
10. Yavuz, HA, and Erdag, D. Kinematic and Electromyographic Activity Changes during Back Squat with Submaximal and Maximal Loading. Applied Bionic and Biomechanics. Volume 2017. https://doi.org/10.1155/2017/9084725.
11. Tillarr, RV, Andersen, V, and Saeterbakken, AH. Comparison of muscle activation and kinematics during free-weight back squats with different loads. PLoS ONE 14(5): e0217044. https://doi.org/10.1371/journal. pone.0217044

Michael J. Hogan SPT

Sleep is an altered state of consciousness that individuals should spend one third of their lives in. Unfortunately, studies find that Americans only get 6.1-6.8 hours of sleep per night, which is below CDC recommendations for all age ranges. Eight hours of quality sleep is considered optimal for anyone over the age of twelve, but when life gets stressful with busy schedules, late nights, and work that just has to get done, sleep is often the first thing to go. Losing a couple hours of sleep often gets brushed off, but consistent sleep loss can have adverse effects on our bodies.   

When recovering from an injury, sleep could be the catalyst for a smooth recovery and lack of sleep could elongate the healing process. Studies have shown that decreased sleep is associated with increased pain perception, decreased ability to recover, and decreased max vertical jump. While increasing sleep to optimal levels is associated with increased athletic performance, decreased reaction time, and improved subjective mood. Therefore, achieving optimal sleep could improve an individual’s ability to rehabilitate and improve their outcomes. 

The safest and most effective way to increase sleep time and improve sleep quality is to establish healthy sleep hygiene. Sleep hygiene includes establishing a regular bedtime routine as well as consistently going to sleep and waking up around the same time. Bright lights from phones and TVs should be avoided at night, especially right before bed. The bedroom should be kept cool, dark, and comfortable. Caffeine, nicotine, and alcohol should all be avoided before bed. Finally, you should not spend excessive time in bed outside of sleeping hours. These recommendations can be used to guide individuals toward optimizing their sleep.  

Sources: 
1. Bolin, D. J. (2019). Sleep deprivation and its contribution to mood and performance deterioration in college athletes. Current sports medicine reports, 18(8), 305-310.
2. Larson, R. A., & Carter, J. R. (2016). Total sleep deprivation and pain perception during cold noxious stimuli in humans. Scandinavian journal of pain, 13(1), 12-16.
3. Chase, J. D., Roberson, P. A., Saunders, M. J., Hargens, T. A., Womack, C. J., & Luden, N. D. (2017). One night of sleep restriction following heavy exercise impairs 3-km cycling time-trial performance in the morning. Applied Physiology, Nutrition, and Metabolism, 42(9), 909-915.
4. Mah, C. D., Sparks, A. J., Samaan, M. A., Souza, R. B., & Luke, A. (2019). Sleep restriction impairs maximal jump performance and joint coordination in elite athletes. Journal of sports sciences, 1-8.
5. Mah, C. D., Mah, K. E., Kezirian, E. J., & Dement, W. C. (2011). The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep, 34(7), 943-950.
6. Kroshus, E., Wagner, J., Wyrick, D., Athey, A., Bell, L., Benjamin, H. J., ... & Watson, N. F. (2019). Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness. British journal of sports medicine, 53(12), 731-736.

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By Logan Chaffin ATC, SPT
 
Deep Vein Thrombosis, most commonly referred to as DVTs, are relatively common not only in the elderly but also young athletic populations. DVTs if identified and treated early on can be a minor setback, however, if left untreated can quickly develop into a very dangerous and potentially life-threatening situation. Your physical therapist is highly trained in not only rehabilitating the joint or muscle that brought you to them, but also to screen for dangerous disease processes like DVTs. Your physical therapist should educate you on the signs and symptoms of DVTs and will be able to answer any questions you may have about possible DVTs.
     Unfortunately for some there are predictors of who will likely get DVTs, however, anyone can get a DVT and any DVT can progress into a life-threatening situation. Women are more likely than men, post-operative patients (most commonly total knee replacements), and the older you are the more likely you are to get a DVT. Considering this, the patient that comes to mind is a 75-year-old woman who just underwent a total knee replacement; however, recent studies have also shown that 1 in 40 young people who undergo an ACL reconstruction will experience a DVT. There are some predisposing factors that you can control such as smoking and being sedentary that both drastically increase your possibility of getting a DVT.
            Some signs and symptoms to look for of a DVT are pain that gradually progresses it is most commonly in the posterior calf that is often described as a cramp or spasm. You should also keep an eye out for redness or warmth that is not present in your other lower extremity. Finally, one other thing to watch for is swelling or prominent deep veins that again are not present in the opposite lower extremity.
            If you suspect that you may be experiencing a DVT consult your physical therapist who will examine you and your symptoms. Using what is known as the Wells clinical prediction rule, they should be able to identify if you are someone who needs to undergo further imaging for a DVT. With a possible DVT it is often better to be safe than sorry and with the ease and relative cheap and easily available doppler ultrasound when in doubt get it checked out.
 

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3. Bishop, M., Astolfi, M., Padegimas, E., DeLuca, P., & Hammoud, S. (2017). Venous Thromboembolism Within Professional American Sport Leagues. Orthopaedic Journal of Sports Medicine.
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5. Erickson, Brandon J et al. “Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction: A Systematic Review.” Sports health vol. 7,3 (2015): 261-6. doi:10.1177/1941738115576927