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National Strength & Conditioning Association

Volume 22, Number 3, pages 3037

The Benefits and Controversy of


the Parallel Squat in Strength Training
and Rehabilitation
Jennifer A. Neitzel, PT, ATC, CSCS
Gundersen-Lutheran Sports Medicine, La Crosse, Wisconsin
George J. Davies, MEd, PT, SCS, ATC, CSCS
University of WisconsinLa Crosse, Wisconsin
Keywords: parallel squat; anterior cruciate ligament; patellofemoral syndrome; rehabilitation; strength
training; closed kinetic chain.

THE SQUAT HOLDS AN UNPARalleled position of eminence in


strength training and conditioning
as well as in rehabilitation. No
other lifting movement, with the
exception of the 2 olympic-style
lifts (the snatch and the clean and
jerk), places as much stress and
strain on the musculoskeletal system as does the squat (31). Between these lifting styles, there is
1 major difference. Squatting permits the lifter to maintain a mechanically strong lifting base
throughout the full range of movement, and the knees are not subjected to the danger of stress and
strain as they are in snatching
and cleaning. This article will perform a brief biomechanical analysis of the squat, including description of the muscle activity involved
in its execution. It will also describe the importance and contro-

versy of the squat in sport and in


lower-extremity (LE) rehabilitation, particularly in patients who
have patellofemoral syndrome
(PFS) or anterior cruciate ligament
(ACL) deficiencies or who are
postACL reconstruction status.
Although the LEs are primarily responsible for movement during the parallel squat, the upper
extremity (UE) and trunk are involved in stabilization. In descent,
the UE and trunk are maintained
in the starting position as much
as possible. The trunk will have a
tendency to flex, and this movement should be controlled so that
stress on the lumbar spine is kept
to a minimum (21).
In a study by Tibero (48) and
OShea (31), a detailed biomechanical analysis of the LE during
the squat is described. The descending phase demonstrates

knee flexion, internal rotation of


the tibia and femur, subtalar joint
(STJ) pronation, ankle dorsiflexion, talus adduction, and calcaneal eversion. When rising from
a squat, knee extension, external
rotation of the tibia and femur,
STJ supination, ankle plantar
flexion, talus abduction, and calcaneal inversion occur. In
closedkinetic chain (CKC) activity, the synchronous actions of the
knee and STJ are interdependent
motions, and the rotation of the
lower leg is an obligatory action
that is necessary for normal kinematics of both joints (48).
Steindler (44) describes this muscular pattern as the concurrent
shift. Biarticular muscle actions
of the LE during the parallel-squat
exercise are also quite distinctive;
the same muscle undergoes simultaneous eccentric contraction

30

Strength and Conditioning Journal

June 2000

(lengthening of the muscle) at one


joint and concentric contraction
(shortening of the muscle) at the
other. For example, the hamstrings concentrically contract as
the hip extends and work eccentrically as the knee extends.
Therefore, the muscles change little in overall length through the
large-joint excursions. The muscles of the LE also undergo opposite modes of contraction during
the ascending, as compared with
the descending, phase of the
squat. For illustration, during the
lowering phase of the squat, the
quadriceps control knee flexion by
acting eccentrically, then work
concentrically in extension to return the body to an erect posture.
Strength and conditioning
specialists can utilize their understanding of the muscle activity
patterns and biomechanics that
occur during the squat to assist
with proper PFS rehabilitation.
Ninos et al. (27) analyzed the muscle activity during the parallel
squat from the 0 to 60 range of
motion (ROM) in the knee. They
found that the peak activity levels
in the vastus medialis oblique
(VMO), vastus lateralis (VL), and
biceps femoris muscle groups occurred from 50 to 60 during the
ascending and descending phases, respectively (27, 51). No significant changes in muscle activity
were found to occur in the hamstrings during either the descending or ascending phases of the
squat. Wilk et al. (51) found that
the greatest level of quadriceps activity during the full squat occurred from 88 to 102 of knee
flexion. A plausible explanation
for the variation of findings in the
studies by Wilk et al. (51) and
Ninos et al. (27) is the type of
squat (full versus parallel) used in
the research designs. Ohkoshi et
al. (29) confirmed increased
quadriceps activity with increased

knee flexion during a static squat;


they also found increased hamstring activity with increased
angle of trunk flexion (Table 1).
Ninos et al. (27) and Signorile
et al. (40) found that muscle activity patterns can be affected by
changes in knee flexion and the
direction of movement but not by
LE axial rotation. Anderson et al.
(1) found that the VMO/VL ratios
could not be increased by widening the squat stance. These findings refute the belief that varying
the position of the feet during the
parallel squat can target specific
muscles of the quadriceps (7, 20,
25, 30, 33, 34). They further indicate that patients or athletes
should place their feet in a position of comfort that also provides
the greatest stability and safety for
the lift.
The knee angle also needs
consideration when rehabilitating
the patellofemoral joint (PFJ) during CKC and openkinetic chain
(OKC) exercises. CKC exercises require the distal segment be fixed
to a supporting surface (either
stationary or moving), whereas in
OKC exercises, the distal segment

June 2000

Strength and Conditioning Journal

Table 1
Muscle Tension of Quadriceps and Hamstrings
in Relation to Percentage of Body Weight (SD)
Flexion angle (degrees)
Knee
Trunk
30
0
15
30
60
90

Muscle tension (N)


Quadriceps
Hamstrings
0.53 0.30
0.04 0.03
0.44 0.22
0.25 0.30
0.38 0.25
0.33 0.30
0.29 0.2
0.60 0.44
0.39 0.35
0.62 0.45

60

1.91
1.91
1.37
1.17
1.02

0
15
30
60
90

0.90
0.68
0.81
0.68
0.65

0.15
0.15
0.29
0.35
0.32

0.32
0.24
0.51
0.39
0.37

Table data is as reported in Ohkoshi et al. (29).

is free to move. Upon analysis of


the PFJ during the CKC squat exercise as the knee moves from 0 to
90 flexion, PFJ stress is steadily
increased (29; Figure 1).
Steinkamp et al. (46) demonstrated that PFJ reaction force
and stresses were significantly
greater in the leg press, a CKC exercise similar to a squat, than during leg extension (OKC) exercises
at 60 and 90 of knee flexion. They
also found that PFJ reaction force
and stresses were significantly
greater with OKC exercises than
in the squat at 0 and 30 of flexion. Steinkamp et al. (46) concluded that increased knee flexion
during CKC exercises results in
PFJ stress comparable to OKC exercises that approach full knee extension. This demonstrates an inverse relationship of PFJ reaction
force with CKC and OKC exercises. Steinkamp et al. (46) recommend limiting the knee from 0 to
45 flexion to decrease PFJ stress
during squats.
Despite the increase in PFJ
stresses with increasing knee flexion, Van Kampen and Huiskes
(49) and Ninos et al. (27) found
31

Figure 1.

Mean ( SD) of patellofemoral joint stress at 4 flexion angles (46).

that patellar tracking is not affected by exercise type (OKC versus


CKC) with knee flexion greater
than 25 to 30, respectively. They
found that from 0 to approximately 30 of knee flexion in CKC exercises there is less lateral patellar
tracking and less PFJ stress, possibly due to the effects of internal
tibia and femoral rotation and
synergistic muscular activity of
the LE (27, 49). It has been found
that most functional activities are
performed between 0 to 40 of
knee ROM; and this is also where
the patella is least stable (27).
Ninos et al. (27) and Steinkamp et
al. (46) conclude that in the functional ROM, the squat allows for
better positioning and less PFJ irritation when performing activities to strengthen the VMO. However, when exercising from 30 to
90 ROM, OKC may be a better
choice than CKC exercises because there may be less PFJ
stress and more VMO electromyographic activity (27).

Stiene et al. (47) compared the


effect of OKC and CKC exercise
(including the parallel squat) on
quadriceps muscle performance
and perceived function in patients
with PFS. Statistical analysis
showed that both groups had significant improvement in peak
torque at all speeds of OKC testing
but that only the CKC group
showed significant improvement
in CKC testing and perceived
functional status. They concluded
that CKC training, including the
squat exercise, might be more effective than OKC exercise in
restoring function in athletes and
patients with PFS.
In the past decade, the squat
has become the standard of care
for not only patients with PFS disorders but also for the rehabilitation of patients with ACL-deficient
and ACL-reconstructed knees (10,
38). Closedkinetic chain exercises such as the squat appear to
have gained popularity over more
traditionally used OKC exercises

32

Strength and Conditioning Journal

because many clinicians believe


that CKC exercises are safer and
more functional (4, 8, 9, 13, 14,
16, 35, 38, 39, 41). There reportedly are decreased shear forces at
the knee joint in the parallel squat
as compared with OKC exercises
(3, 4, 7, 12, 13, 27, 29, 32, 35, 36,
50, 52). The squat decreases the
shear on the ACL by 3 mechanisms.
First, the squat involves cocontraction of the hamstrings
with the quadriceps femoris,
whereas OKC knee extension results in isolated quadriceps contraction unless there is an artificial activation of the hamstrings
(29). Renstrom et al. (36),
Solomonow et al. (42), and Lutz et
al. (22) have studied the effect of
the hamstrings as a counterforce
to the anterior pull of the quadriceps. When the hamstrings are
activated, the knee stiffens and
decreases anterior shear associated with isolated quadriceps contraction in the end range of extension (24, 29, 36, 41, 42). During
squatting, the hamstrings are
thought to produce a greater magnitude of contraction because
they stabilize the pelvis and the
trunk as well as the knee (17, 29).
Second, the squat is a weightbearing exercise, which causes increases in joint compression and
which also decreases tension and
shear on the ACL (15, 2224, 27,
28, 39, 50, 52). Lastly, contraction
of the gastrocnemius muscle aids
in stabilization of the tibia and
has an indirect effect that results
in a reduced amount of anterior
shear forces at the knee (29; Table
2).
There is debate whether these
3 mechanisms of decreasing
stress at the tibiofemoral joint are
enough to reduce the shear forces
that occur during the squat. Some
authors believe that the squat exercise can increase knee ligamenJune 2000

Table 2
Maximal Tibiofemoral Joint Kinetics During OpenKinetic Chain (Knee Extension)
and ClosedKinetic Chain (Leg Press) Exercises
Parameter
Maximal compressive force (N)
Direction
Maximal posterior shear force (N)
Direction
Maximal anterior shear force (N)
Direction
Maximal extension torque (N - m)
Direction

Parallel squat
6139 1709
descent
1783 634
ascent
NA
NA
150 40
descent

Exercise
Leg press
5762 1508*
descent
1667 556
ascent
NA
NA
160 41
ascent

Knee extension
4598 2547*
ascent
1178 +- 594*
descent
248 259*
ascent
200 120*
ascent

Data in table as reported by Wilk et al. (51).


* = Values were significantly different (p 0.05) from the parallel squat values.

tous laxity (18, 19, 37, 43, 52).


Klein (18) is the only researcher to
demonstrate that such is the case.
Using undescribed standard orthopedic tests, Klein (18) concluded that the full-squat exercise
was responsible for increased ligamentous laxity in the medial, lateral, and anterior cruciate ligaments. Meyers (26), using a
replicate of Kleins knee ligamenttesting device, concluded
that the full- and parallel-squat
exercises did not produce significant differences on lateral or medial collateral ligament stretch.
Chandler et al. (5) concluded that
anterior or posterior knee stability
did not change with 8 weeks of the
parallel- or full-squat training as
measured by the KT-1000 knee
ligament arthrometer.
Some research has demonstrated a decreased amount of
strain to the tibiofemoral joint
during the squat as compared
with OKC exercises in subjects
with a partially torn (13) or a completely ruptured ACL (15, 23, 29,
52). Henning et al. (13) found that
CKC exercises such as the parallel
squat are safer than OKC exercises secondary to reduced shearing
on the partially torn ACL. Henning
et al. (13) estimated ACL strain as

a percentage of the strain that occurred during a 36.3-kg Lachmans test, reporting 21% strain
during a single-leg parallel squat.
They found that the strain of leg
extension exercises, from 22 to 0
of range of motion was 79% for the
woman subject and 12% for the
man subject; leg extension from
36 to 0 was 7% in the woman
subject (Table 3).
Fitzgerald (9) questions the efficacy of this particular study by
Henning et al. (13), stating that the

June 2000

Strength and Conditioning Journal

strain behavior measurements


taken from subjects with partially
torn ACLs are most likely different
than those from subjects with intact ACLs. Therefore, inferences
made by Henning et al. (13) may
not be applicable to the strain on
an intact ACL graft. Also, the large
degree of variability in the measurements between the 2 subjects,
combined with a small sample size,
reduces the meaningfulness of any
conclusions made from these measurements (9).

Table 3
Estimated Percentage of Anterior Cruciate Ligament
Strain During Various Activities in Subjects With ACL
Activity
ACL strain (%)
Single-leg parallel squat
21
Walking (FWB)
36
Jogging on floor
89
Stationary cycling
7
Leg extension (from 220 of flexion)
Women
79
Men
12
Leg extension (360 of flexion)
7
All data are as reported by Henning et al. (13) and are for
women except as noted. ACL strain is a percentage of
strain occurring during a 36.3-kg Lachmans test.
ACL = anterior cruciate ligament; FWB = full weight bearing.

33

Little in vivo research has


been performed to date on intact
ACLs (3, 5, 45). Beynnon et al. (2)
found no significant difference in
ACL strain characteristics between OKC and CKC exercises
from 30 to 90 of flexion on intact
ACLs. Beynnon et al. (3) also
found no difference in ACL strain
between the parallel squat and
OKC exercises from 0 to 90 flexion. Beynnon et al. (3) further
demonstrated that using a sport
cord as resistance during the
squat does not produce a significant increase in ACL strain (2;
Table 4). ACL strain values were
calculated based on a reference
that differentiated between the
unstrained (nonload-bearing), and
strained (load-bearing) conditions
of this ligament.
Markolf et al. (24) and Shoemaker and Markolf (39) have studied the shear forces in ACL-deficient cadaver knees. Openkinetic
chain exercise always resulted in
an increased amount of anterior
tibial displacement than did CKC
exercise, regardless of position or
amount of force applied. They
found that CKC movement was,
however, more effective in limiting
anterior displacement at low levels
of applied force (50 N). When higher levels of applied force (200 N)
were utilized, the effects of joint
congruency were overcome, and
greater amounts of anterior tibial
shear occurred.
The majority of researchers
have not found either CKC or OKC
exercises to be superior in reducing anterior shear of the tibia but
instead found a more preferred
ROM for each exercise type. Jenkins et al. (16) measured tibial
translation in subjects with ACL
deficiencies in vivo and found
4.68-mm translation when performing OKC exercises and 1.26mm translation for CKC exercises
at 30 with a 400-lb force on the
34

Table 4
Maximal Percentage (Max %) of Anterior Cruciate Ligament Strain
Values During Open and ClosedKinetic Chain Exercises
Activity
Maximum strain on ACL (%)
Squatting (CKC)no resistance
3.6
Squatting (CKC)with sport cord
4
Knee extension (OKC)
3.8
Knee extension (OKC)with 45 N weight
3.8
Isometric knee extension15 of
knee flexion, 30 N*M torque
4.4
Isometric knee extension30 of
knee flexion, 30 N*M torque
2
Isometric knee extension60 of
knee flexion, 30 N*M torque
0
Isometric knee extension90 of
knee flexion, 30 N*M torque
0
All data are as reported by Beynnon et al. (2, 3).
ACL = anterior cruciate ligament, CKC = closedkinetic chain exercise, OKC = openkinetic chain exercise.

leg press machine. At the 60 position, the differences were 1.23


mm for OKC and 0.6 mm (posterior movement) for CKC exercises.
When one considers the 3-mm figure that Daniel et al. (6) has proposed as the difference between
the ACL-intact and ACL-deficient
knee, it is clear that the 30 OKC
position may need to be avoided in
the patient with a healing ACL

Figure 2.

graft. Openkinetic chain exercise


at 60 and the CKC squat exercise
at 30 have similar values and
may also need to be considered as
positions that cause anterior displacement, leading to possible
creep of the healing ACL graft (16).
The 60 position in the leg press
exercise appears to prevent anterior tibial displacement (16).
Lutz and colleagues (22) calcu-

Electromyographic (EMG) activity of the quadriceps and hamstrings


during the closedkinetic chain (CKC) leg press and openkinetic chain
(OKC) leg extension exercise and during the OKC exercise in the seated position (22).

Strength and Conditioning Journal

June 2000

Table 5
Tibiofemoral Joint Forces During Closed Kinetic Chain
(Squat) and Open Kinetic Chain (Leg Extension) Exercise
at Various Angles of Knee Flexion

2.
Exercise type
Closed kinetic chain

Open kinetic chain

Knee flexion
(degrees)
30
60
90
30
60
90

Shear force (N),


Mean SD
516 392
538 476
538 165
285 120
160 53
387 67

Direction
of shear
posterior
posterior
posterior
anterior
anterior
posterior

3.
All data are as reported by Lutz et al. (22).

lated that the squat exercise produced a posterior-directed force of


500 N on the tibia between 30 and
90 of knee flexion in ACL-intact
knees. For isometric contraction of
the quadriceps, an anterior-directed force was reported to act on
the tibia, increasing in magnitude
as the knee was extended (Figure
2). From these predictions, the investigators recommended exercises that involve squatting instead of
isolated, isometric quadriceps
muscle contractions to rehabilitate a knee during graft healing.
Despite the various benefits of
the parallel squat, there are some
limitations of this exercise that
should be noted. In particular, Lutz
et al. (22) found through an electromyogram study that only 63
21% maximum volitional contraction (MVC) of the hamstrings and
59 31% MVC of the quadriceps
was noted during the partial squat.
This is compared with 82 15%
MVC for the quadriceps and 68
14% MVC for the hamstrings during leg extension exercises. Graham et al. (11) found similar results. These findings stress the
importance of using both CKC and
OKC exercises for complete
strengthening and rehabilitation of
the LEs. See Table 5 for data.
In conclusion, with proper unJune 2000

derstanding of the biomechanics


and muscle activity patterns during a parallel squat, use of
strength training and conditioning
principles can be maximized, and
proper rehabilitation can be obtained. Several studies have found
the parallel squat advantageous
for people with PFS during the beginning ROM (030 or 45) as
compared with OKC exercises.
The squat has also been shown to
provide decreased anterior shear
of the tibia in individuals who are
ACL deficient. There is no evidence
to date that demonstrates any
benefits of the squat for a newly
reconstructed ACL, but inferences
can be made by comparing studies
on individuals who have intact
ACLs with those on individuals
who are ACL deficient. The question of debate, however, is which of
these 2 subject groups is best for
comparison of the effects on a
newly reconstructed ACL. Lastly,
it should be noted that for maximizing hamstring-strength gains,
OKC exercises are far more superior to the parallel squat.

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Neitzel

Jennifer Neitzel is a physical


therapist/certified athletic trainer
at Merrill Physical Therapy in
Merrill, Wisconsin. She also is the
Head Varsity Gymnastics Coach
at Merrill High School.

Davies

George J. Davies is the Clinical


and Research Services Director at
Gundersen Lutheran Sports Medicine in Onalaska, Wisconsin. He
is also a professor in the Physical
Therapy Department at the University of WisconsinLa Crosse, La
Crosse, Wisconsin.
37