On this episode of the #AskMikeReinold show we talk about the old recommendation of not allowing your knees to pass your toes when you squat. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 223: Can Your Knees Pass Your Toes When You Squat?
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Show Notes
- Should Physical Therapists Squat and Deadlift with Their Patients?
- 4 Ways to Modify the Squat So Everyone Can Perform
- Is Perfect Squat Form a Myth?
Transcript
Mike Reinold:
Mike says, “In lifting, you’re told to not let your knees go past your toes because it puts additional stress on the knees.” And his question is, “Does this really matter? Would you do deep squats with a heel lift to compensate? What would you do?” So, let’s knock out that last part, and then we’ll go to the rest of it. But, I think if you put your heels up, does that make your toes go forward more?
Dan Pope:
Yeah, it’s going to send those toes forward.
Mike Scaduto:
Yeah.
Mike Reinold:
All right, so we’ll disregard that part. But let’s say, do we let the knees pass the toes when squatting? And really, if anyone can start with this, I’d love to hear this. Where’d this come from? I don’t want to say it’s one of those old wives’ tales that continue to be always said, like, “if you shave, it grows in twice as thick.” You could tell my personality growing up. I remember when I was 16, and I’d started shaving. My grandmother, old Italian grandmother, full Italian, just, “Oh, be careful, it’s going to get twice as thick.” And I’m like, “Well, grandma doesn’t that mean in a few years then I’d just have one big hair, if it just got twice as thick every time I shave?” I’m like, “That doesn’t seem to make sense.”
Mike Reinold:
So, I always had an inquisitive mind, I guess. But to me that seems like one of those old wives’ tales that probably started with good intention, but I don’t know. I’m going to argue and I’m going to say this, and hopefully, maybe somebody in the crowd here has some of the history on this, that I don’t think anybody said, if your knee passes your toes by a millimeter, your leg is going to explode. I think we’ve gotten this carried away that someone was like, “Oh, you can’t do that at all.” But maybe I’m wrong. It seems like one of those things to be a nice conservative modification for training is like, “Well, don’t let your knees pass your toes.” But I don’t know. Maybe somebody was hardcore and get out a whip back in Roman times and whipped the person if their knee… I don’t know, Game of Thrones times. Wait, is Game of Thrones in the future?
Dave Tilley:
No.
Dan Pope:
Who knows the world, man.
Mike Reinold:
Star Wars is in the future. Anyway, sorry. All right, I’m going to stop rambling because I’ve ruined the episode. Dan, why don’t you save this episode?
Dan Pope:
Man, there’s a lot to this right here. In terms of history, I think there’s a little history in terms of the deep squat. I think there’s research in Asian populations that squat deep for hours and hours every day. And that does actually lead to more knee away. But in terms of the knee going past the toe, I don’t know the history of that and how it got vilified. I guess, short answer to this, knees past the toe is not a bad thing. I think this question might be result of what’s going on in terms of social media. Obviously a lot of trainers will say, “don’t let your knees go past your toe,” it’s dogma. I’m not trying to hate on trainers, obviously I think for folks with knee pain, pushing the knees back is a great modification for those folks.
Dan Pope:
But what I will say is that, doing deep, deep squats, you’ll find in Olympic weightlifting where the knee certainly goes beyond the toe. And if you’re looking at Elite Male Olympic weightlifters, they have higher rates of patellofemoral osteoarthritis than the general population. So I guess what I’m getting at is it’s not bad to have your knees go pass your toes, which definitely increases the stress within the patellofemoral joint, and also on the patellar tendon, on the quadricep tendon. It’s not necessarily a gray statement where knees beyond the toes is good or bad, it just changes the stress and it can cause problems for longterm, if we do too much of it. And I’m talking elite level Olympic weightlifting, I’m not talking about the average person. But for the majority of folks it’s probably okay, but I think what you see is two ends of the spectrum. One side, that’s very anti-knees pass the toes to get to cause a problem. Then you have the other end of the spectrum, they’re doing pistol squats on their toes and saying it’s good for the knee. And there’s probably somewhere in between that’s smart, right?
Mike Reinold:
What do you guys think of that? Does that work on Zoom by the way? Or is it backwards?
Dave Tilley:
Yeah, I like it.
Mike Reinold:
So this is to me what the biomechanical equation… This is for our YouTube viewers, right? That if you look at stress over time, it’s safe and then the second you hit your knees, it goes up till you’re about to break, right? It’s just like, boom, boom, boom, you’re about to break. People have to understand biomechanically, just the deeper you go, the more stressful it is, right? The deeper you go, it just gets more stressful over time. It’s called compressive force. It’s called resultant force vectors, right? This is just basic biomechanics that the deeper you go, the more patellofemoral compression force you’re going to have, the more probably poster your tibiofemoral force on your meniscus and everything you’re going to have the deeper you go.
Mike Reinold:
So to Dan’s point here is some people will say then, anything within a range is acceptable. It’s like, well, maybe it just depends on the person, right? So I think the first thing we have to understand when we’re trying to tackle this concept here is that stress, it happens with everything, right? Stress happens with every depth of a squat. If it’s teeny little bit or super deep, it just changes throughout the range of motion. And you just have to accept that a little bit. I think somebody just made an arbitrary statement. Because it was pretty easy about the knees that you’re starting to get deep, it’s starting to get more stressful, right? I don’t think there’s anything more than that. But all right, so based on that, let me ask the question to you guys then. So does any of this matter? Stress goes up, but is stress good sometimes? Is stress bad sometimes? How do we determine what’s a good stress and a bad stress and specifically to the squad discussion?
Dave Tilley:
I can share here. I think you guys are saying it really well is it’s all about optimal dosage. I think we’re learning with that quite a bit with the research on a lot of these joints and a lot of these different rules of thumb we have is I think one thing that people forget is if you don’t allow the knees to move too far, the stress of 135 pounds in a back squat still has to go somewhere. You know what I mean? Just because it’s not on your knee, doesn’t mean it doesn’t exist. I think the problem that people have is they don’t realize that stress can shift elsewhere and cause injuries, or not injuries, but cause pain or discomfort elsewhere. Say for the extreme examples, take someone who has no tibial angle at all and they pretty much do a weighted 135 good morning. That’s a lot of stress on their back, you know what I mean?
Dave Tilley:
I think that the rule of thumb came up because people were just putting a lot of the pressure onto their knees and they weren’t thinking about the hip and the low back and what they can do. And so we’ve been talking about optimal dose of stress. It’s like, well, you’re trying to get a training effect, they’re trying to get something that makes you maybe sore in a good way, like muscularly and doesn’t have a negative impact on your performance or your joints themselves long-term in terms of not being able to train the next day or having some pain in your daily life. So we try to always tell people that it’s about finding that optimal dose and how you respond. If you did 135 for five by five and your knees were really sore the next day, maybe that’s too much for you. For somebody else for Dan, he could probably do that, roll out of bed and do that, no problem and have no issues at all. It’s all about what’s his history and what’s the goal that you’re trying to get to.
Mike Reinold:
So Dan, is too much stress bad?
Dan Pope:
Yeah, I’d say so. I think just to add with Dave, and I think this is something that happens oftentimes as a trainer, and if you’re a trainer, this is current to you, make sure you link up with a good physical therapist to just tag team the people that you’re working with. But if you have someone with that knee pain and when I was a personal trainer, if someone has knee pain, it was so easy just to say, “hey, don’t let your knee come forward.” And their pain would just disappear, right? So if we look at some conditions and I think patellar tendinopathy comes to mind, right? The way we get better with patellar tendinopathy is we load the quad. We do step downs, we have the knee go past the toe over and over and over again and it builds strength and it gets better over the course of time.
Dan Pope:
So I think it’s important to understand is that for somebody who has a history of patellar tendinopathy, if we have them sit back in the squat all the time, they may not have pain in the squad anymore, but are we actually building the strength of that tendon to the point where it can handle things like jumping and their sport and whatever else it is? So it’s going to really depend on that individual and what they’re trying to get back to. You might have someone who’s 50 years old with patellar tendinopathy, and just have them squat with their hips back and never have their knees cross their toes, and they’re fine for the rest of their life. It doesn’t matter. So going back to your point, it really completely depends on the individual, what they’re trying to get back to, what their goals are, what the pain level is currently. Just trying to meet them where they are and progress them towards their goals over time.
Mike Reinold:
Yeah, so it seems like the deeper you go, the more stressful it is, and everybody has a different capacity for stress, right? And I think that’s what it comes down to. Now, again, I think what people are then going to say in the comment section of this episode, right? Here, we’re trying to go, is that well, in order to build more capacity, you have to go deeper to be able to handle going deeper in the future. Anyone want to talk about that real quick because I just know that someone’s going to say that.
Dan Pope:
You need it. Do you need that? If you have to do pistols, if you have to do really challenging, heavy, loaded squats, super deep, definitely. If you’re an Olympic weightlifter, of course you have to be able to handle that. But if you’re a regular person, I don’t think so. Or maybe if you really want to, as a regular person, then go for it. But I do think that to your point, Mike, you’re putting more stress on that structure. We know the athletes that stress a particular structure are more likely to have things like tendinopathies over the course of time, so you might be increasing your risk slightly of having pain by doing that. And if it’s really important to you, go for it, but if it’s not, I don’t know. I don’t think you need it.
Dave Tilley:
I think the perfect example here is Dan and I have a mutual friend who, she trains for the national level sprinting and in another sport as well. And we were helping her first at one of the camps we were at, she was… If she squats deeper than parallel, or she does dead lifting with a hex bar and conventional, does not feel great for her. You think about her sports, she lives above parallel, sprinting as fast as she can for 400 meters. Does she need to go super, super deep? Why can’t she just do a trap bar deadlift and box squat or something else like that? Or do single-leg versions and her back feels way better, her hips feel way better [crosstalk 00:11:01] pelvic injury and stuff like that. It’s like, what’s the goal? What’s the end goal of doing that? So for her, she’s going to sprint for her life, that’s her sport. She doesn’t need to do super, super deep front squats, you know what I mean? So there’s an example there that I think is helpful.
Mike Reinold:
I think that makes sense. So here’s, I think, one other topic I want to talk about here. EMG studies show that the quadriceps is more active, the deeper you go. So people are going to say that you need to go deep to get strong. Dan? Dave?
Dave Tilley:
Yes, but what’s the trade off between- Sorry. Between strength and injury.
Mike Reinold:
Yeah, so going deeper gets more EMG activity. So you need to go deep to get the quads strong. Discuss.
Dan Pope:
Gosh, I think you can get your EMG to go up by just adding more weight. Do a knee extension and put some more weight on there. Or do an upright squat and add some more weight to the bar, you’re going to get more EMG without having to go deep. There’s a lot of ways to add stress, right? You can add speed, you can add load, you can even do things like DFR to maybe get that same type of stimulus to the muscle without potentially causing stress to the joint if you really want to. So it really depends on what you’re trying to get back to. If you need to get back to high speeds, high loads, then maybe you do need to try to train that, but if you don’t, again, we don’t need to do that, I don’t think. We’re trying to build the capacity that the individual needs, right? So if someone is making that argument, you need to build more capacity, be like, do you really? Do need that much capacity of the knee? Or are you just increasing the risk of hurting because you’re giving them too much?
Mike Reinold:
And I’m pretty sure there’s studies out there, I don’t have the reference on it. I’m sure the studies out there that say that deep squats versus non-deep squats, so we’ll just call them partial squats, I don’t even know what that means. But diverse, partial, you get less strength gains. But I’m pretty sure that the only variable that they manipulated was depth. So therefore they kept the resistance the same. We’re all, “of course,” right? So if there’s one thing we learned from the hip thrust, which, a great exercise, Bret Contreras helps really popularize this, right? The hip thrust [inaudible 00:13:07], it’s a weighted bridge, right? It’s what it is. You lay on the ground, you’re getting the last terminal range of hip extension, like 30, 40, 45 degrees. And you get huge hypertrophy of the glutes by doing that little bit. Maybe you don’t have to conventional deadlift for example, to get that hypertrophy of the quad. But you can double, triple your weight with the hip thrust, than you can when you deadlift. So maybe it’s the same thing with squat. Maybe if you just go down to a little bit above parallel, but you double the load, then I think you’re going to get stronger, right? Again, this just seems like common sense to me, to an extent. Am I wrong? Is anybody think that that’s off?
Lenny Macrina:
I think you’re right. And that’s where a lot of us PTs, including myself earlier in my career, fail is progressively loading people. I don’t even know if we have the equipment in the general PT clinic to do half this stuff. So I think that’s an issue too, is when you have 10-pound dumbbells and that’s it, and then some TheraBands or whatever. A lot of clinics are expanding and they’re realizing the popularity and the necessity of having more weights in the clinic, but if you don’t have this stuff, then you don’t. You’re doing, what’s that Chuck Norris thing where you slide up and down the… It was a gimmick.
Mike Reinold:
The Total Gym.
Dan Pope:
Total Gym.
Lenny Macrina:
Yeah, something like that. If that’s all you’re doing, then yeah, you’re not going to load the joint. But I think using common sense and appropriately loading people and increasing the resistance on the muscle is common sense stuff, but it’s just hugely important. We just don’t have that capacity in a lot of our PT clinics. Fortunately, we do at Champion, so…
Mike Reinold:
I’m seeing it right now, a new Total Gym with a huge LCD display where Chuck Norris works out with you. Right? So it’s like the Peloton. Is Chuck Norris still alive?
Mike Scaduto:
I think he just died, by the way.
Lenny Macrina:
Whoa.
Mike Reinold:
Did he?
Mike Scaduto:
I think so, I could be spreading fake news, but [crosstalk 00:15:00].
Dan Pope:
I didn’t think he could die. [crosstalk 00:15:03]
Lenny Macrina:
2020’s been tough, I don’t think it’s been that tough.
Mike Reinold:
Well, let’s just assume you just take back the last 30 seconds of this podcast. Just ignore us all around. So to summarize, is squatting past your toes evil? No. Does it put more stress on it? Yes. The deeper you go, there’s more stress. There’s probably more EMG, but there’s probably other ways you can also gain that strength. So I don’t know who vilified that and who made the knee the cutoff. I’m sure it was with really good intention, right? But it was just like, anything else, there’s some catchphrases, right? With us, rotator cuff, before, it was like, “you can’t go more than five pounds or your deltoid takes over.” I don’t know who came up with that. Again, that makes absolutely no sense. So there’s a lot of things that just don’t make sense, but let’s take a step back, let’s not get angry.
Mike Reinold:
Let’s not go on a Twitter rant or an Instagram rant where we’re saying how the whole world is the PT profession’s about to break because we say things like that and let’s just realize that it’s all a biomechanical equation. It’s an equation of stress, right? And we just intelligently apply stress. I think that’s a big part of our role is helping people navigate their ability to add stress, right? And so I think if more than anything else, physical therapy works on stress and capacity more than anything else. And it’s our job to help you determine if it’s too much stress, too little stress and vice versa. And that’s all that comes down. So go easy in the comment section, especially with the Chuck Norris stuff. We apologize, Chuck.
Mike Scaduto:
I fact checked, it seems he’s still alive. I did fact check that. I’m sorry for saying that.
Lenny Macrina:
Spreading rumors.
Dan Pope:
Sorry, Chuck.
Mike Reinold:
Thank you, Chuck, to all you’ve done. So I apologize. But anyway, great episode, I think. I can’t- I think that was a good episode. But anyway, thanks everybody. And I’m just going to say, we’ll see you on the next episode.
