The trials and tribulations of the perfect squat:Physical Therapy Guide


We have all come across those squat challenges which promise to give strong legs and a perfect butt. Despite being a very common and popular exercise, a lot of us struggle to get the squat form right. It is an exercise that is used a lot in Physical therapy. There are several variations of the squat such as the parallel squats, goblet squat, sumo squat, front squat, back squat and so on. The type of squat we choose depends on what our training goals are. Front squats focus more on quadriceps training whereas back squats focus on the gluteus and hamstring muscles1. Sumo squat (Fig. 2) incorporates more activation of the adductor muscles.



                                 Parallel squat physical therapy    Front squats physical therapy



Knee caving in physical therapy

Dysfunctions anywhere along the kinetic chain may potentially be a risk factor for injuries due to improper form while performing a squat. This dysfunction could be due to mobility or stability issues in any joint of the body (Fig. 3) and is something we look for in a physical therapy session.


One such example is stiffness in the hip or ankle joint causing compensatory anterior tilt at the pelvis, which in turn makes the lower back susceptible to injuries. Similarly, lack of lateral hip stability could lead to caving in of the knee, thus straining the medial knee.


We always hear our personal trainers, physiotherapists, coaches instructing us to maintain a head high position while doing a squat which essentially means a neutral cervical spine. But we tend to hyperextend at the neck which puts undue pressure on the posterior structures of the cervical region.

In any variation of the squat, it is important to drive the movement by pushing the butt posteriorly while maintaining an upright torso to eccentrically activate the gluteus muscles.


We have always heard that the knees shouldn’t cross the toes while performing a squat. This holds true when we perform squats in a short range of motion. However, as we go deeper into the squat, for example, while performing the goblet squat, the knees should be allowed to move in front of the toes. As per an article by Andrew C. Fry et al, in order to optimize the forces at all involved joints, it may be advantageous to permit the knees to move slightly past the toes when in a deep squat position2 (Fig.4)


deep squat physical therapy


The width of the stance depends on the variation of the squat performed. The sumo squat requires a wider stance with external rotation at the hip. It is important to externally rotate at the hip and not at the knee as it creates twisting forces at the knee making it prone to injuries3. As per an article by Brad J Schoenfeld, extreme rotation of the tibia can change normal patella tracking and potentially cause undesirable varus or valgus moments, it is better to avoid exaggerated foot positions in closed chain movements such as the squat4.


For those who encounter pain or discomfort while performing squats or for those who are unsure of their form, it is recommended to seek professional help. Addressing the mobility or stability dysfunction will help one seek the desired results in a safe and painfree manner and something we address in our physical therapy sessions.


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  1. Yavuz HU1, Erdağ D, Amca AM, Aritan S, Kinematic and EMG activities during front and back squat variations in maximum loads, J Sports Sci. 2015;33(10):1058-66. doi: 10.1080/02640414.2014.984240. Epub 2015 Jan 29.
  2. Fry AC1, Smith JC, Schilling BK, Effect of knee position on hip and knee torques during the barbell squat, J Strength Cond Res, 2003 Nov;17(4):629-33.
  3. Hartmann H1, Wirth K, Klusemann M, Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load, Sports Med. 2013 Oct;43(10):993-1008. doi: 10.1007/s40279-013-0073-6.
  4. Schoenfeld BJ1, Squatting kinematics and kinetics and their application to exercise performance, J Strength Cond Res. 2010 Dec;24(12):3497-506. doi: 10.1519/JSC.0b013e3181bac2d7.