Squats can be one of the most frustrating exercises for both clinician and patient to take on. Despite the squat having a strong evidence base supporting its use across a range of musculoskeletal conditions, it is an exercise requiring complex coordination across several joints. As a result, learning efficient form can be a frustrating experience for both patient and clinician

Without going into the debate of whether squats should be coached with a hip or knee bias (they both have a place in rehabilitation and performance training), one body region that we as Physiotherapists spend a lot of time addressing is the lumbar spine posture. This is particularly so when progressing a patient through their back rehabilitation. One way to ease the coaching process is by coaching the squat from a seated position and simply focus on postural control at the bottom of the squat

Two simple drills I coach patients through to facilitate lumbo-pelvic-hip postural awareness are Loaded Seated Hip Hinge and Loaded Seated Pelvic Tilts. I should note, that I start with unloaded versions of the two movements and then progress towards these low load versions.

Ultimately the aim is to progress to free standing squats, however as a coaching tool these drills can be very helpful in building both awareness and confidence in patients.

Key Coaching Points:

Loaded Seated Pelvic Tilts:

  1. With bar in position, assume a neutral spinal position. In most cases emphasis is on lumbar spine, however in some cases thoracic and cervical spine posture also needs to be addressed.

  2. Coach the patient to smoothly rock their pelvis back and forward as comfortable.

  3. The aim being for the patient to increase their postural awareness under load.

Loaded Seated Hip Hinge:

  1. With bar in position, assume a neutral spinal position as above.

  2. Maintaining spinal position, lean forward to maintaining some weight through the pelvis, then return to starting position.

  3. The aim being for the patient to shift their weight forward enough to then stand tall completing the 2nd half of a squat.

These coaching variations and more are covering during Strength & Conditioning Essentials for Physiotherapists course.