Today’s guest post is by Dr. Michael Mash. I’ve long admired Barbell Rehab—an approach aimed at helping barbell athletes overcome pain and improve performance without getting stuck in endless corrective-exercise routines. In short, it’s about using lifting to fix things.
DO YOU REALLY NEED TO “SCREEN” THE SQUAT?
When it comes to screening the squat, coaches vary from no screen at all to dozens of assessments before a bodyweight squat. So, what’s the best way to screen the squat?
First, what is a screen for, in general?
A screening test is used to detect potential health issues in people who don’t have symptoms. Applied to the squat, a screen would look for joint, muscle, or movement problems in people without pain. For a screen to be useful, a failed test should strongly predict future injury or pain; otherwise, you risk false positives—telling someone they’re doomed to injury when they aren’t.
IT’S TOUGH TO REALLY PREDICT PAIN AND INJURY
To judge a screen’s value, we need to know if it can reliably predict injury. The evidence isn’t clear. One common movement screen, the FMS, is only about a coin-flip away from predicting injuries. That doesn’t mean it’s useless, though. The FMS can show how someone moves, but it shouldn’t be used to predict injury.
If the FMS isn’t a reliable injury predictor, what is?
Pain is a multidimensional experience influenced by biology, psychology, and social factors. It’s too simplistic to blame pain solely on “tight hamstrings” or “bad form.” Stress, anxiety, depression, lack of social support, job dissatisfaction, and poor sleep and nutrition can all affect pain. So a comprehensive approach makes more sense than relying on one test.
WHAT IS AN EFFECTIVE MOVEMENT SCREEN?
An effective screen needs to be specific, and there’s no better way to be specific than to have the client perform the movement itself. In other words, the best way to screen the squat is to have the client squat. This provides the information you need to decide whether it’s safe to load them, without lengthy joint-by-joint tests or isolated muscle tests for asymptomatic individuals.
A simple process I recommend for asymptomatic individuals to determine if they’re safe to squat:
STEP 1: SHOW ME YOUR SQUAT
Ask the client to show you a squat. This reveals how they move and how willing they are to move. Some will drop into a deep, smooth squat; others will hesitate or move slowly, which can be informative—especially if there’s a history of pain or fear of movement. If the squat looks good, you’re ready to load. If it needs work, move on to the next steps.
STEP 2: COACH THE SQUAT
After seeing the squat, coach it. People’ll squat with different stance widths, toe angles, and torso positions, but it helps to start from a common reference. I suggest a heels-at-shoulder-width stance with about 20–30 degrees of toe out, and have them squat as far down as they comfortably can. This won’t work for everyone, but it covers most people. In this initial coach phase, some may have discomfort or can’t reach parallel—and that’s okay.
STEP 3: MODIFY STANCE AND DEPTH IF NEEDED
If coaching them into a shoulder-width, slightly toed-out stance causes pain or limits depth, don’t panic. Two common pain points in a bodyweight squat are in the hip and knee. Pain doesn’t necessarily mean injury or the need for a rehab referral; it can be just how someone is built. For example, someone with highly retroverted hips might pinch in the front with a narrow stance and little toe-out. Widening the stance and turning the toes out more can often relieve this. Pain during coaching doesn’t mean you’ve done something wrong; it may just be a built-in pattern.
If you can relieve pain by adjusting the stance, you’re within your scope as a trainer or coach to make that change without diagnosing or treating.
STEP 4: CHANGE THE EXERCISE AND/OR REFER OUT
Sometimes the squat pattern is so sensitive that stance or form adjustments aren’t enough. If that’s the case, don’t make them squat. Instead, use a similar, tolerable exercise like a rear-foot-elevated split squat or a lunge variation. If the person’s goal is to squat, consider referring to a qualified rehab professional. You can continue to train them with exercises they tolerate, while the rehab professional addresses the pain.
A QUICK NOTE ON SQUAT DEPTH
Depth means the greater trochanter of the hip is below the top of the patella from the side view. If depth is limited by pain (even after stance adjustments), refer out. If it’s just a feeling of tightness, you can load to tolerance and work on mobility at the same time. There’s no evidence that squatting above parallel is inherently dangerous. You can train the squat to the depth the client can tolerate and add mobility work concurrently. This approach tends to move clients toward deeper squats faster than mobility work alone.
Tying it all together
The squat is one of the most beneficial lower-body movements to coach. People will squat with different stances, toe angles, and variations, but you don’t need an extensive screening process before loading them up. A practical approach is:
1) Have the client “show me a squat” to see how they move.
2) Coach the squat with a moderate stance and slight toe-out, and have them squat as deep as they can.
3) If pain arises, find a stance, toe-out, and depth that they can tolerate. If possible, load them.
4) If pain persists after adjustments, pause squatting for now and refer to a rehab professional for further assessment.
ABOUT THE AUTHOR
Dr. Michael Mash is the founder of Barbell Rehab, a training and education resource for fitness and rehab professionals focused on improving the management of barbell athletes.
