A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice.
Rachel K Straub, Christopher M Powers
PMID 38576836WHAT IT FOUND
Squat mechanics can be adjusted to bias the hip or knee.
The trunk and tibia relationship can indicate which extensors are emphasized. This review gives expert recommendations, not tested clinical outcomes.
Key findings
01Rotating the feet outward 30° has been reported to decrease the knee valgus moment by 50% and increase the knee varus moment by 80%, while not changing quadriceps, hamstrings, or gastrocnemius activation.
02The review suggests that a trunk-tibia angle difference of 10° can be used to infer hip or knee extensor bias.
03For patellofemoral pain, the review recommends hip-biased squats early and shallow-to-medium depth to limit patellofemoral joint stress.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a narrative clinical commentary, not a trial or systematic review, so it does not test whether any squat recommendation improves pain, function, or injury risk. The paper states that comparisons across cited studies, especially muscle activity measurements, should be interpreted cautiously because normalization and control of confounding factors differ. Many findings describe joint moments or muscle activation, not patient symptoms or clinical outcomes. Stance width effects on knee and hip flexion moments are reported as conflicting. The authors state that additional work is needed to establish appropriateness and effectiveness of squatting for musculoskeletal conditions.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not read these recommendations as proof that a specific squat style improves pain or function. The paper reviews biomechanical moments and expert suggestions, not clinical outcomes.