About 20 years ago I wrote an article in which I said that one reason you see so many super-fit people in hardcore aerobic classes is that the students who have orthopedic issues such as knee and back pain quickly drop out. If you’re a personal trainer trying to build your business, or if you’re one of those aerobic class dropouts, then maybe adopting a “survival of the fittest” attitude is not a good idea.
Although statistics vary, it’s estimated that 20 percent of the US population is currently suffering from back pain and that more than 80 percent will suffer back pain at some point in their lives. Many of these individuals also suffer from knee and hip pain. In fact, one government-sponsored report says approximately 100 million Americans – a third of the population – currently suffer from chronic pain. How many of these chronic pain sufferers do you think would be willing to, or capable of, performing heavy squats? Compromises often have to be made.
I realize I’m not the only strength coach who considers the squat the king of exercises because it gives the most bang for the buck to athletes and trainees who are working to largely improve strength qualities and body composition. However, there are many trainees who require some level of structural balance training before being able to squat, and they need good alternatives. Don’t worry – I’m not going to suggest a program of power walking and leg extensions.
In the field of strength and conditioning, some people have suggested two classifications of leg exercises: “hip dominant” vs “quad dominant.” Exercises such as deadlifts, reverse hypers, and back extensions are classified “hip dominant”; and exercises such as step-ups, lunges and leg presses are called “quad dominant.” If you are not performing squats, your lower body workouts should contain exercises from each category.
Let’s start with deadlifts. Just as there are many types of squats, there are many types of deadlifts. Among my favorites are long-range deadlifts (such as the snatch grip and standing on platforms), which work the legs through a greater range of motion. There are sumo deadlifts, which use a wider foot stance to increase the work of the thigh adductors; and there are hex bar and trap bar deadlifts, which, due to a more upright stance, reduce the stress on the lower back. The major disadvantage of any deadlift is that it does not effectively work the quadriceps muscle known as the vastus medialis oblique (VMO), which is why deadlifts need to be teamed with quad-dominant exercises.
For those with lower back problems, exercises such as reverse hypers, back extensions and even glute-ham raises are better choices for hip-dominant exercises. I especially like reverse hypers because they can strengthen the erector spinae muscles of the lower back with minimal compressive forces on the spine, forces that may exacerbate lower back pain. Some individuals cannot squat because their lower back muscles are relatively weak; when they try to squat, they often round their spine during the lift, increasing the risk of injuring the disks of the spine. You are only as strong as your weakest link!
Regarding quad-dominant exercises, one of the most popular forms is the leg press, which can be performed vertically, horizontally and angled. This exercise emphasizes the quadriceps, especially the vastus lateralis, which is positioned towards the outside of the leg. The advantage of leg presses is that they produce less stress on the lower back because the trunk is stabilized. As such, those with lower back injuries or medical conditions that make squatting painful, such as scoliosis, often can perform leg presses without discomfort.
Although I understand the mentality of those with back pain to prefer machines over free weights, exercises such as lunges, split squats and step-ups are a better alternative (and note that the difference between a split squat and a lunge is that with the split squat, you use a stationary stance). There are many variations of these exercises, and they can be used for rehabilitation, structural balance, body composition training and high-performance athletic fitness. Another reason I like these exercises relates to the concept of structural balance.
Structural balance refers to the major muscles of the body being in balance with each other. This means balance not only between opposing muscle pairs, such as the quadriceps and hamstrings for the legs, but also between the limbs. For example, just as there must be a proper strength ratio between the hamstrings and quadriceps, the strength of the quadriceps and hamstrings on the right leg should equal the strength of those muscles on the left leg.
For those who can’t squat due to knee pain from such problems as tendinitis, I often use a progression of step-ups – the Poliquin step-up, Petersen step-up, step-up and side step-up – which is taught in our PICP™ Level 2 class. The progression of implements used to add resistance is dumbbell, barbell on back, and then barbell on front. From there, we progress into split squats, lunges, and then squats – and throughout this process we include various forms of leg curls.
The squat is unquestionably the king of all exercises, but there are many effective exercises besides the aforementioned examples if someone can’t squat – or simply doesn’t want to squat.