What is the Deep Squat?

The deep squat describes a position in which one is resting in full flexion of the hips, knees and ankles with the feet on the ground. The deep squat is a comfortable resting position which is more stable than standing because of the low center of gravity. The deep squat serves as an alternative to sitting and is especially handy to avoid sitting on a sharp or dirty surface. Go ahead and give it a try.

Comfortable right?

Or not? For some people the deep squat is very difficult and can only be accomplished with one or several compensations. Your squatting ability can be placed in one of three categories based on the following test.

Stand with your feet together. Squat down as low as you can without letting your heels come off the ground and keep your arms and trunk as upright as possible.

Uncompensated deep squat: Able to squat all the way down to a resting position with the heels on the ground and arms behind toes. Compensated deep squat: Able to squat all the way down to a resting position but heels came off the ground or arms came forward. Unable to deep squat: Pain during movement or unable to reach resting position.

Me demonstrating an uncompensated deep squat with feet together. You will recognize this picture from my logo.

Deep Squatting in Japan

Now that you have your results, lets see how you compare to a sample of 71 healthy male Japanese college students studied by Tatsuya Kasayma and colleagues. They published the results of the deep squatting test described above in the Journal of Physical Therapy Science in 2009.

Of the 71 students only 55 had an uncompensated deep squat. That’s a 22.5% failure rate.

Kasayma and colleagues measured the following variables in an attempt to uncover why some of these students could pass the squatting test and others could not.

Anthropometric variables

age

height

weight

BMI – body mass index= (mass in kg)/ height in meters squared

Range of motion variables

Hip flexion with knee extension- straight leg raise

Knee flexion- heel to buttock distance in prone

Hip flexion with knee extension and spinal flexion-toe touch distance from floor

Hip extension- modified thomas test

Ankle dorsiflexion- modified lunge test

Only two variables showed a significant correlation with the ability to deep squat.

1.Ankle dorsiflexion- strongly association, diagnostic accuracy of 85% (p= < .001)

2. Weight- weak association P= .02

How to measure your own ankle dorsiflexion



The ankle range of motion test that Kasayma et al used is called the modified lunge test.

Krause et al compared various ways to measure ankle dorsiflexion and reported that the modified lunge test was the most reliable. This simple test can be done at home. Facing a wall, place your toes at the edge of the wall and bend your ankle to touch your knee to the wall, being very careful to keep the knee and thigh in line with the foot. If you are able to touch the wall with your knee, start over with your toe further from the wall. Repeat this process until you find the furthest distance from your toe to the wall that you are able to touch touch your knee to the wall. Measure this distance in centimeters.

How much ankle dorsiflexion was needed to squat?

Using the modified lunge test Kasayma et al found that subjects with >10.75cm from the wall on the right ankle and 11.25cm from the wall on the left ankle were able to pass the deep squatting test.

This woman spends all day cleaning the grass from between the cobblestones of the streets in Nuevo Rocafuerte. She has the most ankle dorsiflexion I have ever seen in my life, my guess would be around 60 degrees. Her lunge test would be off the charts.

How To Increase Your Ankle Dorsiflexion

If you were less than 11cm from the wall in your lunge test, I recommend working on that ankle range of motion to improve your squatting. Grey Cook popularized the self mobilization for the ankle to increase dorsiflexion demonstrated in this video. I recommend this drill before squatting for anyone with limitations in ankle dorsiflexion. The drill looks a lot like the lunge test but has a few helpful cues to make sure you don’t do it wrong.

Conclusion

In a young healthy population, dorsiflexion is the mostly likely culprit for an inability to deep squat well. I add the qualifier “well” here because the test of deep squatting used by Kasayma et al is more difficult than a typical deep squat. Kasayma require the feet to be together which eliminates the possibility of collapsing through the arch to increase to effective dorsiflexion.

Many people can get down into a deep squatting position but they collapse through the arch to achieve it. This is potentially harmful because it stretches out the arch of the foot as well as forcing the knee into a valgus (knock- kneed) position which has been shown to be a risk factor for knee cap pain (patello-femoral pain syndrome) as well as injury to the knee ligaments (MCL and ACL during landing). Some people may be able to get away with this compensated pattern their whole life without pain, but I certainly wouldn’t recommend it. If you have limited dorsiflexion, work on improving it diligently until you have reached the maximum your body will allow to get your squatting mechanics as good as possible.

Finally, ankle dorsiflexion is not the be-all end-all of deep squatting. Other factors can come into play such as femur length, torso length, limited knee or hip flexion and perhaps most importantly: coordination. In the clinic I often see asymmetrical squat patterns in patients recovery from surgery of the hip or knee

Gallery of Deep Squats

Me deep squatting to receive my hood for my doctor of physical therapy degree.

I saw this arch collapsing compensation frequently throughout Ecuador and Peru. One of the hallmarks of this compensation is the out-turned toes with the knees facing forward.

This woman (in red) squats every day to milk her cows and has a squatting toilet but still does not have good squatting mechanics.Notice her left toes turned out. Jessica (in black) is demonstrating an uncompensated squatting pattern with feet apart.

None of these boys from a remote Andean farming village in Peru could squat without their heels coming off the ground, some even fell over.

We met this woman while traveling on a river boat from Iquitos to Pucallpa Peru. She is able to squat without compensation with her feet apart.

References

1. Kasayma et al. Ankle joint dorsiflexion measurement using deep squatting posture.J. Phys. Ther. Sci.

2. Krause DA, Cloud BA, Forster LA, Schrank JA, Hollman JH. Measurement of ankle dorsiflexion: a comparison of active and passive techniques in multiple positions. J Sport Rehabil. 2011 Aug;20(3):333-44.