Air squats, goblet squats, lunges, smith machine squats, thrusters, hack squats, back squats, front squats, overhead squats, and so on and so on…
How many of us have been performing one of the above mentioned squats in a gym setting and have been told by a trainer or other professional to “rotate your hips outward or inward” in order to achieve more ideal form?
Take a look at the illustration of a femur.
Notice the rounded head (top right), which fits into the hip socket. This ball and socket structure allows for a significant amount of freedom of motion, but anomalies do exist in how the femur (or leg bone) is shaped.
In some cases, the femur bone has an abnormal torsion to it. (We are going to practice a bit of spatial orientation now….). Pretend that the femur in the illustration is made out of clay. It is bendable and twistable (the femur is most certainly not very bendable and twistable in real life, particularly as we age, but humor me for a minute.).
Take the femur and hold it at both ends, one end with each hand. Now hold your top hand steady (the hand that is holding the “ball” shaped head of the femur), and twist the bottom hand either to the left or to the right. The result is going to be a bone that has more of “twist” to it down the shaft.
Some people are actually born with more of a twist in their femurs than the rest of the population. When the bone is twisted in one direction or the other, it is clinically known as “version” (anteversion or retroversion).
Why does this matter? The answer lies in how an anteverted or retroverted femur connects with both the hip up top and the knee down below. When a femur is anteverted, for example, the knees tend to turn inwards if the top of the femur is lying in the socket in a neutral position. The knees really have nowhere else to go because the femur bone has an internally rotated twist to it. If one were to correct the knee alignment and turn the knees slightly outwards, the hip would have to externally rotate up the chain for the same reason.
This leads us to performing squats. The big message here is that if you have either anteverted or retroverted hips, the regular rules of squatting do not really apply to you. Anteverted people, in order to be in a comfortable hip position, have to be turned inwards at the knee. This isn’t great for knee mechanics, but the only other choice is to place your hip in an uncomfortable position. The same applies to the retroverted hip. The knee and toes need to be slightly more outwardly turned than normal in order to have a normal hip position.
My advice to people performing squats is this: squat the way that feels most comfortable to your hips. If your knees and toes are excessively turned inwards or outwards, get tested to see if you fall into the anteversion or retroversion categories. From my clinical practice, I would say that anteversion of the hips is the more common of the two, and anteversion tends to affect females more often than males.
Here is a great link that I found that illustrates the “Craig’s Test.” This test is taught in most physical therapy schools and is a quick way that a good PT can assess you. (The video is halfway down the article, and the article is a good read as well.)