Relative Squat Strength & Lower Body Injury Risk

The 2x bodyweight squat is often seen as the gold standard for reducing lower- body injury risk and the standard for when to add jump and plyometric variations into an athletes training programme.

Lower-body injuries account for approximately 50% of all injuries across multiple collegiate level sports (Hootman, Dick and Agel, 2007).

Lauersen, Andersen & Anderson (2018) recently reported that increased strength training volume and intensity reduced injuries by 66%, compared with non-resistance training injury prevention programmes.

I think most people are aware of how important strength training is for both performance and the prevention of injury.

The 1RM back squat is a very effective tool to screen athletes for lower-body injuries as it measures trunk- and lower- limb strength under heavy loads / forces. But can the weight one can squat help you and your coaches identify injury risk? Is there a correlation between squat strength and incidence of injury?

The study

Case, M. J. et al. (2020) explored whether there was a relationship between relative back squat strength and lower-body injury.

They had seventy-one athletes (age = 21 ± 1 yr) from Division 1 American football (male, n = 46), softball (female, n = 10), and volleyball (female, n = 15) take part in the study across an entire season (preseason, in-season and post-season).

Back squat 1 Rep Max was collected during pre-season testing. Squat depth of hip below knee was required, and absolute squat values were normalised for body mass (kg on the bar vs kg bodyweight).

In the study, a lower-body injury was defined as any physical or medical condition that occurred as part of competition or training activities that required medical attention.

The results

78% of American football players sustained a lower-body injury during this period, while volleyball and softball players reported a 52% lower-body injury rate.

Relative 1RM back squat was considerably lower in injured players compared to uninjured players for both men and women.

Uninjured men and women had back squat relative strengths of 2.2 x BM and 1.6 x BM respectively. Whereas injured men and women had back squat relative strengths of 1.9 x BM and 1.4 x BM, respectively.

Important Considerations

To begin, it is important to acknowledge that squats are not for everyone. Whilst I think squats are a fundamental strength exercise and I do use them with most of my athletes, they can be problematic in some, for example; not everyone has sufficient mobility to perform them correctly. Some athletes have asymmetry as a result of skeletal variations in their hip sockets and femoral heads. Others may have experienced injuries that means squats are painful.

If you can squat with good form and have plenty of experience in doing so, then the details within this post are certainly worth considering.

Within the study, approximately 70% of the uninjured subjects fell in the range for relative back squat strength of 1.82-2.58x Bodyweight for men and 1.34-1.92x Bodyweight for women.

However, and this goes without saying, that there is much more to reducing injury risk of the lower-body than simply squatting more weight. The data here shows that almost 50% of the injured males had back squat relative strength > 2.0.

Injuries are multifactorial....

Yes, leg strength and therefore general robustness and general resilience of joints, ligaments, tendons and other tendons can help significantly reduce risk, but the root cause of injuries can also be associated with fatigue, technique, exposure to volume/frequency and even psychology.

Other than back squat strength, here are some practical considerations you can make with your programme.:

  • Monitor training load from week to week (i.e. distance covered, RPE, number of sessions, sets x reps, time on court/track/field, balls hit/thrown etc) with the aim of preventing spikes sudden in volume.

  • Ensure you're developing strength/power across all planes of motion (e.g. lateral jump, skater jumps, rotational power movements and change of direction). Particularly if your sport emphasises one plane (i.e. weightlifting & powerlifting largely sagittal plane).

  • Include a balanced mixture of low- and high-velocity strength training (e.g. back squats, jump squats, plyometrics etc).

  • Aim to continuously develop technique in all areas of your sport, regardless of how good you think you are. Your posture and shape during acceleration, deceleration, change of direction and throwing mechanics are key areas to master in order to reduce injury risk.

  • Acknowledge that optimal recovery does not occur on its own. Learn, master and adopt effective recovery techniques between training sessions and competition.

Final note

1) Injuries are multifactorial, meaning just being stronger on a selected exercise cannot develop the robustness of all tasks. All areas of physical and technical development should be considered, however developing lower body strength is certainly useful

2) Using squat strength to determine whether you're strong enough to perform high-velocity exercise robs you of developing the coordination and adaptations to faster movements. It also means when an you're ‘ready’ to perform these movements, a significant amount of time will need to be taken to prepare you for intense jump and plyometric variations. In my opinion, these can be done alongside regular strength training regardless of your strength level. Significant strength in the range of >2x Bodyweight will certainly help you possess the neuromuscular foundations to develop greater levels of power, speed and plyometric ability, therefore it is certainly a useful target to aim for, however don't let lack of squat strength prevent you from working on these key areas.

3) Who says strength is only dictated by how much you squat? There is a long list of other exercises that may be more biomechanically similar to the movements you're trying to develop on court; split squat, RFE Split Squat, Front Squat, Deadlift, Trap bar Deadlift, Romanian Deadlift, Lateral Lunge etc. Aim to develop strength across a variety of movements, positions, range of motion and planes.

4) As discussed above, Case, M. J. et al. (2020) found that the uninjured men and women had back squat relative strengths of 2.2 x BM and 1.6 x BM respectively. These may be appropriate guidelines to aim for yourself in the medium to long-term as part of a holistic approach to reducing lower-body injury risk.

Remember, this is just one part of the jigsaw puzzle.

#backsquat #squat #strength #strong #injuryprevention

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