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Teaching the Squat and

Deadlift in Clinical
Dr. Michael Mash, PT, DPT, Cert. TMM,
Who Am I?

Doctor of Physical Therapy Duquesne University,

Pittsburgh 2016
Passion for basic barbell lifts - competed in powerlifting
in college
Certified Strength and Conditioning Coach (CSCS)
Functional Movement Screen Certified (FMS)
Started Barbell Rehab in February 2016
Barbell Rehab

Mission is to promote the use of strength training in clinical practice

Help people of all ages and skill levels return to lifting weights pain-free
Decrease threat perception with education, manual therapy, novel stimuli
load it to promote tissue resiliency
Squat and deadlift teach fundamental human movement patterns pick
things up off of the ground, standing up from a chair
Psychological benefit to loading
What Youll Learn

How body anthropometrics and bar placement affects barbell squat

How to choose the optimal squat variation based on mobility demands
and injury history
How to coach the barbell deadlift utilizing simple cues to maximize body
How to properly prescribe the deadlift and its variations in clinical
practice based on patient presentation
The Squat
Squat Overview

FIRST Show me a squat!

1) Take a stance with your heels shoulder width apart
2) Turn your toes out a little bit
3) Squat all the way down
4) Shove your knees out
5) Tighten your low back
6) Stand up
Squat Overview


Goal is to load on DAY 1
Find stance width and degree of toe out that feels most comfortable for
the patient!
3 Laws
Heels stay on ground
No excessive knee valgus
No excessive lumbar flexion (butt wink)
Use box if necessary
Barbell Squat

Bar Position
Torso Angle
Core Function and Breathing
Knee Position
Foot Position
Box Squats
Clinical Implications
Bar Position
Torso Angle

Determined by two factors:

Anthropometrics (Femur Length)
Bar Placement (High Bar vs. Low Bar)

UniversalRule: load ALWAYS centered over the

middle of the foot
Femur Length

Longer Femur = More Forward Lean Shorter Femur = More Upright Torso
Bar Placement

Low Bar = More Forward Lean High Bar = More Upright Torso
Core Function and Breathing

Looking for 360 core bracing pattern

Should be able to sufficiently stabilize core with both regular
breathing and full exhale deadbug variations, plank, etc.
Valsalva maneuver best for axial loaded barbell exercises
Increases IAP to maximize spinal stability
Higher risk of orthopedic injury without breath holding than
cerebrovascular event with breath holding
Lock ribcage down on pelvis master cue
Knee Position

Dependent on foot position

Tracking directly over the foot
Goal is to minimize excessive
tibial IR/ER pure flexion and
Minimize excessive valgus collapse
AND varus
Foot Position

Whats most importantthat its COMFORTABLE

No uniform foot width and degree of toe out
Respect your bony anatomy:
More retroversion toes out
More anteversion toes forward
Bar Position
Low Bar wider stance, toes out, more posterior chain
High Bar closer stance, toes forward, more anterior chain
Box Squats

Simplest progression from loading the

sit to stand pattern
Still keep the bar over the midfoot
avoid large amount of torso rocking
Great teaching tool for depth watch
out for dependency though
Clinical Implications

High Bar Squat Low Bar Squat Box Squat

Requires more ankle Requires more hip Good option for those
dorsiflexion and flexion and shoulder fearful of deep hip
thoracic extension mobility flexion
Requires LESS hip Requires less ankle DF Good teaching tool for
flexion and thoracic extension depth
Great option for those Great option for those Great way to load the
with hip and low-back with knee pain and sit-to-stand pattern
issues or those fearful limited ankle and/or
of inclined torso thoracic mobility
The Deadlift
Hip Hinge Approaches

Top Down
Most popular version
Use of a dowel rod on the back, butt to wall cue
Works great for some, not for others - not necessary to safely barbell deadlift

Teaching the hip hingeby teaching the deadlift
Just getting into correct position
Usually a good option for those who cant understand top down
Deadlift Overview

1) Stand, toes forward, with the bar over the

middle of your foot
2) Bend down and grab the bar
3) Take your shins to the bar
4) Lift your chest up (NOT hips down)
5) Pull
Adapted from Starting Strength Mark Rippetoe
Barbell Deadlift

Hip Position
Scapular Position
Speed of the Pull
Lowering Phase

Bar is NOT touching the shins its

a few inches away over the midfoot
If you set up with bar on the
shinsit will roll away from you
Just grab the bar hip hinging
down to it can complicate it leading
to improper hip position

Take your shins to the barNOT

bar to you!
Bar should not move at all
This sets us up for proper hip,
spinal, and scapular positioning
Hip Positioning

The chest up cue puts the hips at

the proper height
The hips down cue usually sets them
too low
Hips too low and you lengthen the
horizontal distance to the sacrum
Hips too high and you dont get
enough leg drive and risk losing
neutral spine
Grab the Bar Shins to Bar Chest Up
Chest Up - YES Hips Down - NO
Scapular Positioning

Proper scapular positioning is slight protraction and depression

Protraction promotes an upright torso as possible, lengthening the
arms mechanical advantage
Retraction would make you have to pull a longer distance and its
nearly impossible to keep retraction under a heavy load
Depression activates the lats to enhance spinal stability
Slide shoulders in back pockets is a good cue for those who only
feel deadlifts in their low backs
Orange in your armpit is another good one
Speed of the Pull

Phase 1 Floor to Knees

Pull the slack out of the bar
Full body tension, lat activation
Slow and controlled movement of the bar until the knees
Phase 2 Knees to Lockout
Rapid hip extension torque
Spine in a better mechanical advantage
Dont forget to maintain full body tension
Deadlift Lockout

Finish by lightly squeezing the glutes

Avoid excessive posterior pelvic tilt
Avoid excessive lumbar extension
Standing straight up and down
Lowering Phase

Think of it as a controlled fall

Dont just drop the weight but also dont accentuate the eccentric
difficult to maintain form and get the hips in the correct position
Save the accentuated eccentrics for exercises that are pure hip
Easier to focus on form (only one joint)
Ex: RDLs, single-leg RDLs, and pull-through
Sumo Deadlift

Wider stance, hands are inside the

legs, lower hips
More vertical torso usually more
tolerable for low back pain
Increased demand on hip mobility
(more abduction/ER) may not be
tolerated by a cranky hip
Same steps as conventional deadlift
Block/Rack Pulls

Great option who dont have mobility to

pull from floor
Incorporate into hamstrings strain protocol
Good starting point for return to deadlifting
from lower back/hip injury
Not optimal for strength/hypertrophy
Clinical Implications

Conventional Deadlift Sumo Deadlift Block Pulls

Most ROM for maximal More vertical torso Good if cant pull from
strength/hypertrophy may be better for acute the floor
LBP Good for hamstrings
May not be tolerated in
acute LBP May not be tolerated strains
with hip issues Good stepping stone for
Watch hips too low
Limited range not return to conventional
optimal for Not optimal for
strength/hypertrophy strength/hypertrophy

Dont fear forward torso lean due to anthropometrics and bar position
Neutral lumbar spine, knees pushed out in line with toes
Variation will depend on patient preference and current/past orthopedic issues
Think chest up not hips down
Full body tension to engage lats via shoulder protraction/depression
Slow and controlled pull to the knees, then explosive hip extension
Variation depend on mobility demands and current/past orthopedic issues
Connect with Dr. Michael!
Instagram: @barbellrehab
Twitter: @mashdpt