Footwear and Elevated Heel Influence on Barbell Back Squat: A Review

A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice

The squat is one of the most frequently prescribed exercises in the rehabilitative setting. Performance of the squat can be modified by changing parameters such as stance width, foot rotation, trunk position, tibia position, and depth. An understanding of how the various squatting techniques can influence joint loading and muscular demands is important for the proper prescription of this exercise for various clinical conditions. The purpose of this clinical commentary is to discuss how the biomechanical demands of the squat can be influenced by various modifiable parameters. General recommendations for specific clinical conditions are presented.

Level of Evidence

5.

Kinematic variations in the barbell back squat under different footwear conditions in female college athletes

BACKGROUND

The barbell back squat is one of the most performed exercises, being important for the strengthening of lower limbs and trunk. Recently, it has become popular to train under different conditions of footwear or without it, and some investigations have analyzed the changes that this brings, with some contradictions in this regard. The purpose of this study was to analyze the kinematic variations under different shoe conditions (running shoes, barefoot and barefoot with heel raised) in the back squat in female university athletes.

METHODS

Fifteen athletes in the three conditions with a load equal to 70% of their one-maximum repetition (1RM), were recorded and analyzed to determine the angles of the ankle, knee, hip and trunk by five movements in each condition.

RESULTS

The use of enhancement significantly increased (P<0.05) the dorsal flexion angle of the ankle, against the footwear condition and barefoot without enhancement (109.6±11.1° vs. 99.1±9.0° vs. 101.3±11.5°). No significant differences were observed in any of the other variables.

CONCLUSIONS

An optimal squat technique is important for preventing injuries, optimal rehabilitation and for improving sports performance. Increased dorsal ankle flexion angle may protect distal tibiofibular joint.

The Limitations of Anterior Knee Displacement during Different Barbell Squat Techniques: A Comprehensive Review

Based on seminal research from the 1970s and 1980s, the myth that the knees should only move as far anterior during the barbell squat until they vertically align with the tips of the feet in the sagittal plane still exists today. However, the role of both the hip joint and the lumbar spine, which are exposed to high peak torques during this deliberate restriction in range of motion, has remained largely unnoticed in the traditional literature. More recent anthropometric and biomechanical studies have found disparate results regarding anterior knee displacement during barbell squatting. For a large number of athletes, it may be favorable or even necessary to allow a certain degree of anterior knee displacement in order to achieve optimal training outcomes and minimize the biomechanical stress imparted on the lumbar spine and hip. Overall, restricting this natural movement is likely not an effective strategy for healthy trained individuals. With the exception of knee rehabilitation patients, the contemporary literature suggests it should not be practiced on a general basis.

Predicting the metabolic cost of exoskeleton-assisted squatting using foot pressure features and machine learning

Introduction: Recent studies found that wearable exoskeletons can reduce physical effort and fatigue during squatting. In particular, subject-specific assistance helped to significantly reduce physical effort, shown by reduced metabolic cost, using human-in-the-loop optimization of the exoskeleton parameters. However, measuring metabolic cost using respiratory data has limitations, such as long estimation times, presence of noise, and user discomfort. A recent study suggests that foot contact forces can address those challenges and be used as an alternative metric to the metabolic cost to personalize wearable robot assistance during walking. Methods: In this study, we propose that foot center of pressure (CoP) features can be used to estimate the metabolic cost of squatting using a machine learning method. Five subjects' foot pressure and metabolic cost data were collected as they performed squats with an ankle exoskeleton at different assistance conditions in our prior study. In this study, we extracted statistical features from the CoP squat trajectories and fed them as input to a random forest model, with the metabolic cost as the output. Results: The model predicted the metabolic cost with a mean error of 0.55 W/kg on unseen test data, with a high correlation (r = 0.89, p < 0.01) between the true and predicted cost. The features of the CoP trajectory in the medial-lateral direction of the foot (xCoP), which relate to ankle eversion-inversion, were found to be important and highly correlated with metabolic cost. Conclusion: Our findings indicate that increased ankle eversion (outward roll of the ankle), which reflects a suboptimal squatting strategy, results in higher metabolic cost. Higher ankle eversion has been linked with the etiology of chronic lower limb injuries. Hence, a CoP-based cost function in human-in-the-loop optimization could offer several advantages, such as reduced estimation time, injury risk mitigation, and better user comfort.

Effect of Heel Lift Insoles on Lower Extremity Muscle Activation and Joint Work during Barbell Squats

The effect of heel elevation on the barbell squat remains controversial, and further exploration of muscle activity might help find additional evidence. Therefore, 20 healthy adult participants (10 males and 10 females) were recruited for this study to analyze the effects of heel height on lower extremity kinematics, kinetics, and muscle activity using the OpenSim individualized musculoskeletal model. One-way repeated measures ANOVA was used for statistical analysis. The results showed that when the heel was raised, the participant’s ankle dorsiflexion angle significantly decreased, and the percentage of ankle work was increased (p < 0.05). In addition, there was a significant increase in activation of the vastus lateralis, biceps femoris, and gastrocnemius muscles and a decrease in muscle activation of the anterior tibialis muscle (p < 0.05). An increase in knee moments and work done and a reduction in hip work were observed in male subjects (p < 0.05). In conclusion, heel raises affect lower extremity kinematics and kinetics during the barbell squat and alter the distribution of muscle activation and biomechanical loading of the joints in the lower extremity of participants to some extent, and there were gender differences in the results.