Coaching Cues in Exercise Instruction

There’s a lot of sacred cows in the exercise cueing world. An abundance of coaching points have stood the test of time and are used to this day despite the advancements of knowledge in the field of sport science. While I agree that there is some truth to those practices, in many cases we can do a much better job coaching.

What exactly am I talking about?

Let’s look at the squat, for example. There is this universal, agreed upon concept that a correct cue for the squat in terms of the lower limbs is to spread the floor with the feet, or push the knees out into external rotation. The wording used by coaches might vary, but the underlying idea is often the same, especially in the powerlifting world. A point used to support this idea is that the knees caving in towards midline (knee valgus) is dangerous. This spreading-the-floor cue is explained to recruit more gluteal musculature, since the femur will go through external rotation and abduction with the knees pushing laterally out to the sides. High level strength athletes and ACL specialist physical therapists alike often teach the squat in that way.

Despite all of that, if you look at elite weightlifters during the snatch or the clean and jerk, you will see that under those extreme loads, there is a rapid movement of the knee towards the midline during the upward motion of the squat. As such, the knees-in movement featured in a squat might not be an issue for highly athletic populations that demonstrate great joint biomechanics.

Let’s dive deeper into this.

The absorption of forces along with the creation of propulsive forces is what accompanies the human body during movement. The gait cycle is the fundamental movement pattern for all humans. The gait cycle consists of the stance and swing phases, with the absorption of forces and creation of propulsive forces playing a crucial role in the stance phase. Even though we have to acknowledge that gait and squatting aren’t the same movement pattern, looking at the gait cycle can help us understand the movement of the femur in the squat.

As we go through the gait cycle, the femur has a tendency to feature certain movements. Mostly during the swing phase, the femur will go through flexion, abduction, and external rotation, whereas mostly during stance the femur will match extension with adduction and internal rotation. Flexion, abduction, and external rotation are used to prepare for force absorption, while extension, adduction, and internal rotation prepare for propulsion.

The femur is the link between the gait and the squat. Although different movements, both of those patterns rely on the femur and the femur ultimately possesses its preferred strategy for both force absorption and production.

The descent during the squat is the force absorption phase and the subsequent push to stand up is the propulsive phase of the squat. Referring back to the movements of the femur, it would naturally flex, abduct, and externally rotate during the descent of the squat, and extend, adduct, and internally rotate during the concentric push up from the squat. According to Pat Davidson, this is simply an intelligent strategy to use from an energy conservation point of view, as flexion, abduction, and external rotation of the femur lead to lengthening the extensor, adductor, and internal rotation musculature, which can both maximize the length-tension relationships of those tissues, and provide a stretch reflex to assist the concentric push out of the squat.

So, what’s with the knees-out cue?

This idea was most likely figured out by someone who had done a significant amount of resistance training. As such, they would have gone through specific training adaptations, such as tissue remodeling and muscle hypertrophy. But someone who has trained extensively with heavy weights also moves differently. Heavily resistance trained people often present with an anteriorly tilted pelvis.

Anterior pelvic tilt is the key player here. Anteriorly tilted pelvis makes the femurs passively follow the pelvic tilt. Visually, the femurs would orient internally and towards the midline of the body. Remember, this is what would happen passively, like in a case in which the person is subconscious.

In an active state, the femurs would reflexively start to abduct and externally rotate to work against the passive tendency to go into internal rotation and adduction. This is a necessary movement strategy for someone with an anteriorly tilted pelvis, as if the femur would be allowed to follow the pelvic tilt, they would collapse under the effects of gravity. This is commonly the case with a heavily resistance trained individual, such as a powerlifter.

If you lay this person down on a table to measure the range of motion of the femur, a few interesting characteristics emerge. Laying down removes the necessity for the femurs to work against gravity. This removes the femurs' reflexive behavior of externally rotating and abducting. As such, the femurs will exist in a passive state of adduction and internal rotation, as they are following the pelvic tilt as described above.

Testing for how well their femurs move in that state will indicate reduced adduction and internal rotation motion. This is because the femur is already in an internally rotated and adducted state. As such, it has less room to move into further internal rotation and adduction.

The more the pelvis anteriorly tilts, the more the femurs will passively internally orient and adduct to follow the pelvic tilt, thus the more will the femurs externally rotate and abduct in an active weight bearing situation to work against that.

Individuals with anterior pelvic tilt will lack adduction and internal rotation, but they need those actions in the concentric phase of the squat. They cannot adduct or internally rotate, but they are able to further abduct and externally rotate. Herein lies the answer and the relevance of this knees-out cue during squatting.

Further shoving their knees out into external rotation with the cue of spreading-the-floor will provide them with a bit of adduction and internal rotation on the way up. In other words, even though they are existing in a state of external rotation and abduction of the femurs from the start, going deeper into external rotation and abduction on the way down will provide them with a bit of relative internal rotation and adduction on the way up as they come from the extreme end of external rotation and abduction back towards the middle. It's a spectrum. They never operate at the true internal rotation and adduction end of the spectrum but rather go back and forth on the external rotation side. You will never see their knees crashing towards the midline, most likely because they just don’t have access to that motion, but they still rely on the same movement strategy as someone who is showing true adduction in the squat.

When you deal with young athletes or people with less resistance training experience, they have likely not yet gone through those typical adaptations that lead to anterior pelvic tilt. These are the people that can probably get into actual internal rotation and adduction actions of the femurs. In such a case, seeing their knees come towards midline does not imply danger. It’s just a representation of how the femur is actually supposed to move during the squat.

Wait, but isn’t knee valgus bad? Especially for the ACL?

The mechanism of injury for the ACL is when the knee moves medially and rapidly internally rotates. The key here is that the ACL injury is dependent not just on what the femur does, but also what the tibia does. For the ACL tear to happen, there has to be torque, twist, and a difference in direction between the femur and the tibia. A common sight with an ACL injury is that the tibia is, relative to the femur, translating laterally and externally rotating, while the femur is doing the opposite – it is translating medially and internally rotating.

During a squat, maintaining a flat foot with the weight evenly balanced throughout the whole foot and not allowing the foot and tibia complex to externally rotate during the descent of the squat will make sure the internal rotation of the femur during the ascent will cause no harm to the soft tissue structures of the knee. If we, however, allow for the foot and tibia complex to spin out as the femur is internally rotating, we might start threatening our knee health.

As long as we are controlling for the relationship between the femur and the tibia, internal rotation of the femur during the ascent of the squat will be fine.

This really wraps the discussion on this one specific squat cue of “knees out” and “spread the floor”. Before starting to coach internal rotation of the femur during the squat out of your clients and athletes, think about what you're actually doing. As Pat Davidson put it, if you think you are smarter than the human organism which has gone through millions of years of evolution to figure out the most effective way to live in this complex environment, you are ignorant of the depth of reality.

Think critically about your coaching practice. When teaching the squat for a beginner who has access to true joint actions of extension, adduction, and internal rotation, cueing them to drive their knees out is probably not a good strategy. The best strategy is to perform in the mid zone of abduction and adduction, and internal and external rotation. Going into either extreme is probably damaging the joints in the long run.

What cues to use instead?

Focus on helping them find their mid foot on the descent and on the subsequent push back up. Don’t just focus on the heel, but help them find and feel their big toe and push through the medial arch of the foot on the way back up from a squat. Observe the movement of their femurs as they work to distribute force throughout the whole foot during the squat. Use range of motion tests to monitor joint actions. Progress with load over time if the training is serving the set aims.

Hopefully this very specific example of a common squatting cue puts you on the path to start thinking critically about if what we are cueing as coaches is actually what we should be cueing. There is a ton of things taught wrong in exercise execution, with another squat phenomenon being “don’t let your knees go over your toes” which is a representation of stupidity in its own league. Anyways, this is beyond the scope of this article.

Just because something has been taught a certain way for ages doesn’t mean it is the best way to do it. Sport science as a field is ever-evolving. We cannot be married to what we know at this very moment, as this could soon be proven to be entirely false.

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