Variety Matters for Patient Athletes!
Ian Wright, PT, DPT, SCS, OCS, CSCS
Physical Therapy Medical Director l Founder @ Competitive Advantage Athletics LLC | Doctor of Physical Therapy, ABPTS Orthopedic and Sports Clinical Specialist, Strength and Conditioning Coach (CSCS)
Goblet Squat:
The patient athlete will take a squat stance as determined from the quadruped “frog” test while holding onto a dumbbell, kettlebell. med ball or weight-plate in a “goblet” fashion (palms together and facing the ceiling) out in front of the body at chest height. Holding any of the aforementioned implements immediately pitches the patient athletes COM forward while engaging the core (core is defined in this writing as musculature anatomically originating from the trunk, hip, and shoulder girdle regions), making the descent into a deeper squat easier through improved muscular engagement and joint stability through the principle of irradiation.
Shoulder blades are to be squeezed (retracted) and depressed into the opposite buttock (right scapula retracted and depressed into L buttock, left scapula squeezed and depressed into R buttock) throughout the lift as scapula depression through latissimus engagement is important to promote lumbar extension through its attachment point. However, lumbar neutral is still the priority as both excessive lumbar rounding or flexion and lumbar hyperextension predisposes the patient athlete to back pathologies, especially when under load. Eyes should be fixed straight ahead on an external target (Tip: place a piece of tape on the wall for gaze fixation) with chin tucked to ensure the cervical spine vertebrae are properly stacked throughout the lift.
As the patient athlete descends into their bottom squat position while maintaining appropriate spinal and joint alignment (lumbo-pelvic rhythm), it is important for the patient athlete to maintain their weight over their mid-foot while maintaining three points of contact at their feet with regards to the ground (big toe, small toe, and heel) through an “active” foot.
Assuming the definition of a squat for a patient athlete to be their maximum knee and hip bend within the limits of stability of their LE joints, the patient athlete should strive to descend into this bottom most squat position while keeping their LE joints stacked (knees in line with second toe, hips in line with knees, although it needs to be understood that this imaginary line will be angled outward laterally due to the patient athlete ABDucting their hips to varying degrees depending on their stance width when squatting) at all times.
Once the patient athlete reaches their limits of stability and descends into their maximum hip and knee bend, the patient athlete simply extends their hips and all their LE joints to stand back up to the original starting position (hips and shoulders should rise and extend at the same time and rate). It is important for the patient athlete to think of leading with the head and shoulders when ascending from the bottom of a squat position as the rest of the body will follow what the head and shoulders do (head-hips relationship). [3]
The patient athlete will repeat for prescribed sets and reps as dictated by their treating clinician.
Goblet Squat Press-Out
The patient athlete will follow the same set-up and cues as described in the Goblet Squat intervention until the patient athlete reaches the bottom squat position.
As the patient athlete descends into the squat, he or she will press the weighted implement (MB, DB, KB, weight-plate) out in front of their body until their elbows are extended completely at approximately chest height or 90 degrees of shoulder flexion.
Once the patient athlete descends into their lowest squat position, the patient athlete will either remain in the bottom most squat position while pressing the implement toward and away from their chest in an isometric squat pattern, or the patient athlete will simply ascend from the bottom squat position to the original standing position through extending their hips and all of their LE joints (hips and shoulders should rise and extend at the same time), depending on the desired outcome of the intervention.
The external weight is utilized as a “pattern assist,” which means it helps to promote a posterior hip hinge by allowing the hips to sit back and between a patient athlete's base of support (feet) into the squat movement pattern while maintaining heels to the floor through an erect posture. This is accomplished through increased core engagement and alteration in center of mass (COM) of the patient athlete.
The patient athlete should be able to perform this squat pattern without heel lift or knee valgus (knees caving in) while keeping all LE and trunk joints stacked over one another (no posterior pelvic tilt, lumbar hyperextension, and thoracic kyphosis) through an active foot position. The patient athlete should feel as if the press out makes it easier to squat compared to “air squats”. This technique is utilized if there is a mobility restriction in the trunk or lower extremities during the squat pattern.
The patient athlete will repeat for prescribed sets and reps as dictated by their treating clinician.
Goblet Squat Walk
The patient athlete will follow the same set-up and cues as described in the Goblet Squat progression until the patient athlete reaches the bottom squat position or predetermined squat depth height (quarter, half, three-quarter, and so on).
Once reaching the bottom squat position, the patient athlete will walk forward, backward, or laterally (with or without pressing the weighted implement out in front of their body at chest height with their elbows are extended completely at approximately chest height or 90 degrees of shoulder flexion), depending on the targeted effect of the intervention while maintaining an isometric bottom squat position.
Much like the goblet squat press-out intervention, a weighted implement is utilized in this exercise to pattern assist the athlete down to the desired depth with the added benefit of a forward or lateral translation movement. Cueing and joint alignment is the same as described in the goblet squat and goblet squat press-out interventions.
The patient athlete will repeat for prescribed sets and reps as dictated by their treating clinician.
Tempo Goblet Squat
See description of Goblet Squat for details on cueing and proper execution.
The only difference between a goblet squat and a tempo goblet squat is the emphasis on which component(s) of the movement the patient athlete should focus on (Eccentric, isometric, concentric). Commonly written in a x:x:x format [6] for time and convenience sake, this shorthand abbreviation should be read and interpreted as the specified time periods of the eccentric: isometric: concentric muscle contractions for an intervention if found in a program, regardless of the specified intervention and/or exercise. For example, a 3:2:0 exercise should be read as a 3 second eccentric or lowering/lengthening phase (depending on if the context is a movement versus muscle action), a 2 second isometric or static hold phase, and a 0 or “fast as possible” concentric or shortening phase with the intended intervention.
The patient athlete will repeat for prescribed sets and reps as dictated by their treating clinician.
Elevator Goblet Squat
See description of Goblet Squat for details on cueing and proper execution.
The main difference between a Goblet Squat and an Elevator Goblet Squat is that in this intervention, the patient athlete will experience much more time under tension due to the multiple positions that they will need to achieve within the movement.
From the initial start position of the Goblet Squat, the patient athlete will flex their LE’s to a three-quarter standing position, or phrased another way, the patient athlete will perform a quarter squat. Once achieving this position, the patient athlete will return to the above-described start position (the patient athlete will maintain a slight unlock of the knees when standing to maintain tension within their musculature as full extension of the patient athlete’s knees and hips would allow the patient athlete to shift demands to their passive restraints- ligaments, joints, and so on).
The patient athlete will then repeat the above-described steps by descending into a half-standing position (half squat), quarter standing position (three-quarter squat), and a full squat position that is within the patient athletes’ limits of stability and mobility constraints of their trunk and LE joints. The patient athlete needs to be sure to return to the start position for a Goblet Squat before descending into consecutively lower positions as described above, while being sure to maintain a slight unlock of the knees during this start position for the above-mentioned reasons of maintaining tension on targeted musculature.
Once the patient athlete returns to the start position from the full standing position, the patient athlete will repeat for prescribed sets and reps as dictated by their treating clinician.
Tennis Goblet squat
See description of Goblet Squat for details on cueing and proper execution.
The set-up, cueing and execution of a Tennis Goblet Squat versus a Goblet Squat is the same with one minor difference. In a Tennis Goblet Squat, a patient athlete’s heels are elevated either with plates, a ramp, Olympic shoes, etc. This is performed in an attempt for the patient athlete to be more erect (vertical) in the bottom most position of a squat through an artificial heel which shifts the patient athlete’s COM anteriorly to the forefoot. This is usually done to either shift emphasis to a muscle group (quads versus posterior chain) through altered foot positioning, to groove a more efficient movement pattern (squat versus “good morning” squats), or to work around a LE mobility issue (commonly ankle dorsiflexion).
The patient athlete will repeat for prescribed sets and reps as dictated by their treating clinician.
Sissy Goblet Squat
See description of Goblet Squat for details on cueing and proper execution.
The set-up, cueing and execution of a Sissy Goblet Squat versus a Goblet Squat is the same with one minor difference. In a Sissy Goblet Squat, the knees are blocked from behind (posteriorly) with a barbell resting on safety squat pins in a squat rack (the barbell is against the uprights of a squat rack), if the machine version is unavailable. This allows a patient athlete's knees to become the fulcrum point from which the entire movement is based to better shift emphasis to the knee extensor or quadriceps muscle group, much like in a closed kinetic chain (CKC) version of a leg extension machine.
If elastic stretch bands were used to “block” a patient athlete’s knees versus a barbell, this intervention is known commonly by the name of a Spanish Squat. The execution is otherwise the same as detailed above.
The patient athlete will repeat for prescribed sets and reps as dictated by their treating clinician.