In case you missed it, here is the piece I wrote for my buddy Dr. Dan Pope's site FitnessPainFree.com:
Proper squatting forms the basis of any performance system and is essential to meaningful function as an athlete and human - which includes the elderly (might need to scale though, bro). As an athlete and as a practitioner who treats fellow CrossFitters frequently, one of the things I love is the emphasis on the squat pattern. But with high squatting volume in any performance system we need to ensure it’s reproducible.
I understand and share the pride that comes with the ability to squat deep while lifting some serious weight. However, many athletes are unable to squat deep with load due to hip or low back pain. Femoral-acetabular impingement is often the culprit here, where the neck of the femur is literally jamming into the acetabulum of the pelvis. Dan goes into much greater detail in one of his prior posts on FAI. These same biomechanics also cause butt winking where there is a reversal of the lumbar spine causing a loss of segmental control. This spinal shear under load is dangerous and never okay - a butt wink is an immediate fault and nobody gets a pass. Altering squat width is a strong start to fixing these train wrecks.
So how do we determine best squat width for depth and performance (and to help prevent hip pain and butt winking)? “Shoulder width” is often used however that differs for each individual. Many times we just start with a random width and that becomes the default. However, factors such as motor control of the entire system (particularly the over-extended spine), hip and ankle mobility, and individual structural differences in acetabulum and femur alignment all influence squat width and depth.
The sooner the femur runs into the pelvis, the less depth you’ll achieve and squat numbers will plateau. But you don’t need an x-ray to determine how you should squat. Rather, we need to find the best squat width that allows the most depth while maintaining movement integrity (such as a neutral spine). The best position yields the best performance and the fewest injuries. The test below helps find where these limitations are least restrictive and determines the best starting squat width.
I like this test (originally from Dr. Stu McGill, spine biomechanist) as a screen for new lifters, those who are having hip or low back pain, and athletes whose squat numbers are plateauing.
Things to consider with this test:
1) Performing this test on your hands and knees allows you to assess the hip and core without bringing other structures into the equation. You’re also performing this in an unloaded position (i.e. not standing) which helps eliminate movement inefficiencies you might find while standing.
2) Demonstrates lumbopelvic motor control. If a strong contraction of the anterior core allows greater depth prior to butt winking or decreases pinching in the front of the hip, motor control deficits are present. This is not an anatomical variation, you need to improve trunk stiffness as the lumbar spine is over-extended causing the pelvis and femur to meet prematurely. In so many cases, we can prevent butt winking and un-impinge the hip with appropriate movement patterns and control rather than rushing to surgery to correct bony deformities. Improve motor control first and foremost regardless of structure.
3) Once you’ve found the width that allows the most depth without impinging or butt winking, this is where you should start when squatting. Can use this screen for those new to squatting as a way to determine the most effective width to start while you work on motor control and mobility to allow for a variable squat program.
4) Those who show poor motor control in this test and have hip or low back pain will most likely need to correct this for successful rehabilitation and return to squatting.
So ultimately, what is the best squat width? The one that allows the best depth while preserving a neutral spine. Regardless of starting squat width or structural variation, this does NOT change the essential movement principles of the squat. Feet should be straight, knees tracking over the foot, shins vertical as possible for as long as possible, hips externally-rotated. You MUST prioritize and control the lumbar spine and pelvis, above all else. In my opinion, the ability to control the spine and pelvis is a prime determinant in the performance ceiling of athletics and human function so don’t lower that ceiling with improper movement patterns. Squat depth and width do not matter if these principles are not upheld.
Acknowledge what we can’t change (structural alignment), optimize the many variables we can change including squat width, and then vary it for an effective motor program.
What is the definition of a good athlete? Is it the pitcher who throws a great curveball? Or the elite 100m sprinter? How about the 3-point artist on the basketball team? How about the individual that does all of them well and easily picks up new skills - the one kid in high school who didn’t play basketball until his senior season and was easily the best player.
Perhaps the definition of an athlete ought to be someone who can easily adopt new motor skills and excels at being strong in weak and novel positions. Unfortunately, sport specialization at an early age yields kids who may be quite proficient at one particular movement but helpless when those movements become variable and unpredictable.
Multiple studies support the notion that children who play multiple sports are less likely to experience burnout or blow out an elbow or knee before finishing puberty. Injury rates in our youth are skyrocketing with a higher incidence of injuries such as fractures and sprains in those who specialize in one sport early in development. In my mind there is no acceptable reason for a 12 year old to present to my clinic with elbow pain due to repetitive throwing or for an ACL rupture (rates of which have gone up nearly 400% in the past 10 years according to some studies). Cutting physical education classes and sticking children in desks for 8 hours at school only serves to exacerbate children’s lack of skilled, variable movement.
So what do we do? The best way to drive athleticism and virtuosity of movement is to expose children to a variety of skills through free-play at an early age - expanding their motor skill repertoire. Waiting until adulthood to explore new movements (while still an excellent pursuit and a reason CrossFit is so powerful) will not suffice in driving athleticism and preventing injury in our youth. When a child is consistently moving poorly AND repetitively, the threshold for injury is much lower because they are out of movement options. Any extra perturbation, increase in load, increase in volume, or increase in stress and that poor position becomes an untenable one. Poor adaptability and less variability of movement are huge markers for injury and performance loss. The fewer weak or novel positions the child has, the less likely it is that injury occurs and performance suffers. The margin for error is greater. And by the way, the average Olympic athlete played two or more sports during childhood - so sport specialization at an early age will not likely even help a child become great at one sport anyway. And kids who specialize early in one sport are more likely to become physically inactive later in life.
From a motor learning perspective, our brains are designed to move us through, and interact with, the surrounding environment. Using our body helps us learn more quickly. The more sensory inputs that children experience through free-play, the better they understand this interaction. Kids who move well and move often throughout development have accelerated cognitive abilities and improved academic performance - it’s no wonder that children who suffer from autism do much better when performing motor tasks and altering sensory inputs. The beauty of safely exposing children to various motor tasks is they can understand what a new position feels like and inherently develop a way to adapt quickly and appropriately. And these movements don’t need to be (nor should they be) extraordinarily complex and skilled. Free-play and performing common variable movements - such as those in gym class, group exercise, and multiple sports - is all they need. Kids who delay sport specialization until at least age 12 are more coordinated and physically fit because they’re subjected to a variety of environments, inputs, and outputs.
Too often I see young adults who clearly have not yet mastered even the basics of human movement and it is not surprising to hear they did not play sports or only specialized in one and then burned out and/or were injured. We can do better - encourage kids to participate in recess, free-play, and multiple sports.