Squat Depth – How Does it Affect Strength, Function, and Pain

I often question whether I should be allowing my patients with knee pain to perform partial or “half squats.” My thought has been that if I can load and strengthen them in the partial range, hopefully this will provide pain relief, and an eventual carryover into a deeper and more functional squat range. This article (found here) suggests this may not always be the case. Researchers found, not surprisingly, that a 10-week resistance training program of “full squats” was superior to “parallel” and “half squats” as measured by 1-rep max, jump tests, and sprint tests. The “half squat” group was the only group to show no increases in strength or functional performance at all.

More surprisingly to me, they found that the “half squat” group was also the only group where participants reported significant acute INCREASES in pain, stiffness, and physical functional disability.

Admittedly, this study was performed on “healthy resistance-trained men,” and cannot therefore precisely dictate how my patients with pain, OA, and other complicating factors may respond. This does get me thinking, however, about whether I should shift my focus to unloading squats for my patients (with TRX assist, total gym squats, light leg press, etc) and encouraging them to achieve as close to “full squat” range as possible. This recommendation comes with an expectation that this will provoke some level of pain, but that the pain should only be of mild to moderate intensity and should not be a source of increased fear about their knees. As the research findings suggest, this focus on full depth squats may be more beneficial in managing pain, increasing strength, and improving their functional limitations.

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A final word on the study’s findings is in reference to their control group, which was instructed to cease all resistance training for the 10-week duration of the study. This group, composed of previously healthy resistance-trained men, showed “severely decreased neuromuscular and functional performance” in response to the cessation of training.

These participants showed statistically significant losses in strength as measured by 1RM tests, height in jump tests, and speed in sprint tests. Regardless of your patient’s characteristics and complexity of physical demands, loss of strength, power, and speed will undoubtedly result in worsening physical function and activity tolerance. This decrease in functional capacity with cessation of resistance training highlights the importance of consistent participation in some sort of resistance training program, even in periods of injury elsewhere in the body, periods of transition between training programs or focuses, or periods where other circumstances make it difficult for a patient to continue with their training program.

This is where I feel like Physical Therapy as a whole can really improve: in stressing the importance of and facilitating the continuation of exercise, strength training, and other wellness behaviors in our patients once they have completed a bout of PT. This is an area where I constantly strive to improve, and one that I will continue to research and write about to put us all in a position for better outcomes.

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