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Clinical Squat Modifications

Table of Contents

Key Takeaways:
  • The squat is one of the most popular compound barbell lifts in existence, so its important that you understand how to bend it around symptomatic patients
  • Making modifications to the squat can be very simple, including:
    • Taking weight off the bar
    • Adjusting the range of motion of the movement
    • Slowing the squat down with tempo or pause tactics
    • Altering the stance width

Why You Need To Know Squat Modifications

As a physical therapist, you are going to have to make modifications to people that regularly go to the gym. Considering how popular strength training has become, it’s only a matter of time before someone needs you to help them get back into squatting. If you want to avoid taking them out of the gym altogether, its in your best interest to learn how to make a wide range of modifications so you can keep them training as hard as they can tolerate. I say as hard as they can tolerate because that leaves you and them open to making flexible changes in the moment and over your time working together.

The staircase method is the best framework to utilize when considering modifications. The long and short of the staircase method is that you want to take as few steps down the stairs as possible. As you take your patient or athlete down these steps, there are more and more modifications that happen. You only want to take as many steps down as needed to reach a tolerable entry point.

The most common modifications that you’re going to see made in the world of lifting include:

  • Weight
  • Speed 
  • ROM
  • Stance 

Before we break down the specifics of the squat modifications, let’s establish what we mean when we say “squat”.

The Squat

The steps we advocate here at Across The Continuum include:

  1. Put the bar at chest height
  2. Place the bar on your upper back (either high bar or low bar)
  3. Find a comfortable foot position (around shoulder width apart)
  4. Choose somewhere to look
  5. Take and hold a big breath 
  6. Descend to a comfortable depth 
  7. Stand up
  8. Breathe out

If you’re a visual learner, take the opportunity to watch the squat demo video below that is included in our continuing education course, the 6 Week Clinical Coach Challenge.

Load Selection

Weight is one of the first things that most coaches consider when making any adjustment to a lift, squatting included. Let’s say someone has trouble with squatting 315 pounds, but doesn’t have trouble squatting 300 pounds. That is an easy modification and less than a 10% change in training load. Sometimes it takes a more substantial weight adjustment to alleviate symptoms, but sometimes it can be a small as 15 pounds.

This modification can span all the way down to an empty bar, so if the specific movement variation is within the goal context, this might be a great place to start to avoid changing other important components of the specific movement. A lot of inexperienced physical therapists (and athletes) will choose an arbitrary stopping point when it comes to weight reduction. It might be 225 pounds, 135 pounds or anywhere else on the weight spectrum. It could possibly be a pride thing or a tactic to avoid a painful truth, but you can take the weight all the way down to just the bar when trying to find a comfortable weight based entry point. You can even go lower if you have dumbbells.

Speed

Slowing things down can be a great modification to make as it forces the weight being used to change as well as drives the intensity of the movement up without the external load going up. To say this is another way, 3 sets of 5 reps with 100 pounds at a regular tempo is going to be less intense than 3 sets of 5 reps at a slower tempo. The former may be RPE 5 for someone, whereas the latter may be RPE 7-8 due to the change in time under tension. If the desire is to keep the RPE consistent, then the weight would need to come down from 100 pounds to something lighter.

Tempo lifts are a means of controlling the descent (eccentric) and ascent (concentric) speeds. For the squat, you can give someone something like a 3-0-0 tempo squat, which they would perform a 3 count slow descent, no pause, and a regular speed ascent. You can also assign something like a 3-1-0 tempo squat, in which the person would perform a 3 count slow descent, a 1 count pause at the bottom of the squat, and a regular ascent. You can make any tempo you want in this manner, depending on what is appropriate for your athlete and what the situation requires.

Range Of Motion

If you find that someone is having a range of motion (ROM) based symptomatic presentation, adjusting the ROM can be quite simple. Something like a box squat can create a specific turn around point that will coincide with the symptomatic ROM of the squat. Most boxes will have different heights to each side, and you can even use something like a bench, or like an adjustable box if you have access to it.

If you are lucky enough to have a squat rack in your clinic, pin squats can be a great way to finely adjust squat depth by utilizing the safeties. If you don’t have a squat rack, consider that they are much cheaper than you probably think.

Stance

Just like the other modifications, squatting stance exists on a spectrum, from very narrow to very wide. Don’t let popular squatting and physical therapy gurus try to tell you there is a 1 size fits all stance when it comes to the squat. This is a recipe for disaster if the person you are teaching to squat doesn’t fit into that mold, and a reductionist way of viewing human motion.

As a general rule stances get narrower, the athlete is going to need to use more of a knee heavy action to compete to lift. As stances get wider, more hips and adductors become involved. I know what you’re thinking: “but what about anterior hip pain. That is going to get worse with a more narrow stance.” You’re probably right, which is why the specific responses and needs to the individual human in front of you need to come into consideration.

Don’t feel like you need to make only one of these modifications at a time. Its better to start small and see what the least amount of modification that you can make to create a tolerable training environment, but if needed, multiple changes can be made at a time. As you make these modifications, be sure to check over time to see if you and your patient can update what tolerable training means and move another step up towards to the goal movement.

As an additional note, these modification categories only scratch the surface when it comes to making changes to human movement. Stick with the content we put out regularly here at Across The Continuum and you’ll learn more of the principles that can be bent around physical activity.