Healthy Life: Squatting Ability (798)

Healthy Life: Squatting Ability

蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

The idiom says, “ If you do not use it, you lose it”. Therefore, a lay back life style can bring many problems. Australians have almost surpassed the Americans in the area of obesity. Overweight can overload the cardio-respiratory systems and has proven to be a leading cause of diabetes. Certainly, obesity can limit physical activities and can lead to early joint degeneration. It can cause sleep problems such as apnoea. However, there is one problem that many have overlooked – squatting ability.

Around twenty years ago, I came across an A grade basketball player with minor knee problem. During the examination, I asked him to squat with foot flat. His knees and hips were able to bend fully but his foot forward bending (or dorsiflexion see diagrams) movements were restricted. That caused him to unable to squat without falling back because the limitation of dorsiflexion did not allow his centre of gravity to fall in front of the ankle.

Source: http://posturemovementpain.files.wordpress.com/2012/11/vmbspaiaerrfc4016qzwpsihtzqcbmhlpeiro8q-k_a.jpg?w=625&h=390&crop=1

The picture shows an Ecuadorian woman pulling grasses. The author said that her backward bending of the ankle or ankle dorsiflexion was 60 degree which was a world record. The author found that the inability to squat was not limited by muscles or joints of the knees or hips but ankle dorsiflexion.

Source: http://www.jsams.org/article/S1440-2440%2810%2900163-5/abstract

The picture shows you how to measure ankle dorsiflexion. The most important thing is to keep the heel of the ankle you measure on the floor and your hands pushing against the wall to take the weight off your knees when you lunge forward. You slowly move your foot away until you cannot touch the wall without lifting your heel. Kasayma et al found that you need to have >10.75 cm for your right foot and 11.25 cm for your left foot to be able to squat properly.

After more than twenty years, my observation and findings are consistent. It seems to me that the inability to squat or the limitation in ankle dorsiflexion is getting worse. My hypothesis is that we are living in a comfortable environment and with many electronic gadgets, people hardly need to squat. In my generation living in Hong Kong, we have squatting toilets. If you cannot squat, you cannot go to toilet. It is a necessity.

Recently, I had a 13 year old female basketball player with right ankle injury. Her right ankle dorsiflexion was 0 cm while the good one was only 5 cm. She was as tall as I am. My ankle dorsiflexion for the left ankle is 16 cm and my right is 13 cm because I torn my Achilles tendon in 1993 and had operation. Her younger sister was with her and was playing ipad all the time during the consultation. I asked her mum for permission to measure her ankle dorsiflexion. To my surprise, she had no ankle injury before but her ankle dorsiflexion was only 2 cm. Obviously, when I asked her to squat with feet flat. She could not without lifting her heels up.

I am very concerned with the future generation. The lack of dorsiflexion does not only limit your squatting ability but other athletic ability such as jumping, sprinting and climbing. It put more pressure on knees and hips and may cause early degeneration in these joints. It may even cause back pain. I hope to do some study in this area. Whether it is possible, it is up to God because I am on the verge of retirement.