The long term effects of Squats

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AK_MD2BE

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I thought I would try to get some advice from all of you kind people in the Orthopedic world.
What do you guys think about the long term effects of PROPERLY done squats on the knees and low back? As a former hockey player, I used to do squats all the time to improve speed, explosiveness, power, etc. Now that I am a medical student (and not playing hockey anymore b/c I am living in a "hockey challenged" area), I want to get back into lifting legs but I am concerned about what kind of condition the cartilage and ligaments in my knees will be as a result of doing squats/other quad exercises.
Thank you very much for your advice.

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I thought I would try to get some advice from all of you kind people in the Orthopedic world.
What do you guys think about the long term effects of PROPERLY done squats on the knees and low back? As a former hockey player, I used to do squats all the time to improve speed, explosiveness, power, etc. Now that I am a medical student (and not playing hockey anymore b/c I am living in a "hockey challenged" area), I want to get back into lifting legs but I am concerned about what kind of condition the cartilage and ligaments in my knees will be as a result of doing squats/other quad exercises.
Thank you very much for your advice.

It's awesome that you're asking this in the ortho forum.

While I am just a dumpy, unathletic general surgery resident (at least on the internet), I've found my interest in heavy squats diminish over time. Eventually as you get farther into your surgical education, you'll find "personal bests" to be less important. For me, there was a simultaneous recreational sports injury and inability of patients to take me seriously as an MS3 that had me dialing down my lifting intensity, and I've been able to begrudgingly accept the decrease in strength.

Squats are a beautiful thing, but are definitely the most taxing and most dangerous thing you can do for legs, no matter how good your form is. That includes long term back and knee problems. You don't have to be an ortho meathead to know that.

My suggestion is to just decrease the amount of weight you are doing. Are you really training for anything anymore? Besides, your legs will feel much better the next day during surgery, where as a med student on ortho, you may be literally lifting legs for multiple hours...
 
It's awesome that you're asking this in the ortho forum.

While I am just a dumpy, unathletic general surgery resident (at least on the internet), I've found my interest in heavy squats diminish over time. Eventually as you get farther into your surgical education, you'll find "personal bests" to be less important. For me, there was a simultaneous recreational sports injury and inability of patients to take me seriously as an MS3 that had me dialing down my lifting intensity, and I've been able to begrudgingly accept the decrease in strength.

Squats are a beautiful thing, but are definitely the most taxing and most dangerous thing you can do for legs, no matter how good your form is. That includes long term back and knee problems. You don't have to be an ortho meathead to know that.

My suggestion is to just decrease the amount of weight you are doing. Are you really training for anything anymore? Besides, your legs will feel much better the next day during surgery, where as a med student on ortho, you may be literally lifting legs for multiple hours...

What does squatting have to do with patient's taking you seriously?
 
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What does squatting have to do with patient's taking you seriously?

It was an overall clownish appearance as a newly-minted MS3 that made me change my entire outlook on lifting...not just legs. Since many of us are type A overachievers, we strive to be the best at everything. I got carried away in my desire to be the strongest, and simply got too big.

Patients hopefully still took me seriously for the most part, but the shirt and tie with white coat combo made my neck and traps look ridiculous, along with a young-appearing face, and I heard several comments from the patients (and residents). More than that, however, my priorities just changed.

For legs specifically, I was not enjoying standing in the OR and climbing hospital stairs the day after a heavy leg workout.
 
It was an overall clownish appearance as a newly-minted MS3 that made me change my entire outlook on lifting...not just legs. Since many of us are type A overachievers, we strive to be the best at everything. I got carried away in my desire to be the strongest, and simply got too big.

Patients hopefully still took me seriously for the most part, but the shirt and tie with white coat combo made my neck and traps look ridiculous, along with a young-appearing face, and I heard several comments from the patients (and residents). More than that, however, my priorities just changed.

For legs specifically, I was not enjoying standing in the OR and climbing hospital stairs the day after a heavy leg workout.

Yeah, I'm sure your massiveness just made it impossible to take you seriously. Perhaps it was the way you presented yourself instead?

If your priorities truly changed, then that's great. Nothing wrong with changing gears as your priorities in life and lifting evolve. But you make it sound like you were self concious about comments from patients/residents, and I just can't imagine letting other people influence my life like that.
 
Yeah, I'm sure your massiveness just made it impossible to take you seriously. Perhaps it was the way you presented yourself instead?

If your priorities truly changed, then that's great. Nothing wrong with changing gears as your priorities in life and lifting evolve. But you make it sound like you were self concious about comments from patients/residents, and I just can't imagine letting other people influence my life like that.

I think hearing it from other people helps you realize how far you've taken things. It's not like I thought I looked awesome, but changed to make other people happy......it's that it finally dawned on me how silly it is to be concentrating heavily on that when there are other things you should be doing.

I still lift frequently, but I've learned moderation, and spend a lot more time on the cardio side.....the weight I do for squats now is much safer and less likely to lead to injury. That was the main point of my original comment.....

In the end, being the strongest was no longer a priority. But, if your screen name is "Big Steve" I'm guessing it's a big priority to you, so have fun.

As for my massiveness, it's not like I came into this thread to talk about how awesome I am. I was trying to give advice on a topic that I also struggled with as an MS3. I've been on this board for 3+ years, and I've never really discussed lifting before, but this topic hit close to home.
 
I think hearing it from other people helps you realize how far you've taken things. It's not like I thought I looked awesome, but changed to make other people happy......it's that it finally dawned on me how silly it is to be concentrating heavily on that when there are other things you should be doing.

I still lift frequently, but I've learned moderation, and spend a lot more time on the cardio side.....the weight I do for squats now is much safer and less likely to lead to injury. That was the main point of my original comment.....

In the end, being the strongest was no longer a priority. But, if your screen name is "Big Steve" I'm guessing it's a big priority to you, so have fun.

As for my massiveness, it's not like I came into this thread to talk about how awesome I am. I was trying to give advice on a topic that I also struggled with as an MS3. I've been on this board for 3+ years, and I've never really discussed lifting before, but this topic hit close to home.

My post came off harsher than I intended. I didn't mean to stir anything up, but it is also a topic that I feel strongly about. Good luck with the rest of your training (medical training, that is).
 
Hmm, funny that you mention this stuff. I used to be really into lifting (still am) and heard comments from patients along the lines of 'you sure you is a med student....I've seen guys in jail as big as you'. I have toned down the lifting and am trying to maintain some semblance of a physique.... we'll see what happens when I start residency.

I think hearing it from other people helps you realize how far you've taken things. It's not like I thought I looked awesome, but changed to make other people happy......it's that it finally dawned on me how silly it is to be concentrating heavily on that when there are other things you should be doing.

I still lift frequently, but I've learned moderation, and spend a lot more time on the cardio side.....the weight I do for squats now is much safer and less likely to lead to injury. That was the main point of my original comment.....

In the end, being the strongest was no longer a priority. But, if your screen name is "Big Steve" I'm guessing it's a big priority to you, so have fun.

As for my massiveness, it's not like I came into this thread to talk about how awesome I am. I was trying to give advice on a topic that I also struggled with as an MS3. I've been on this board for 3+ years, and I've never really discussed lifting before, but this topic hit close to home.
 
Hey guys...I see that we got a little off topic. :)
What do you think the long term effects of squats done with moderate weight (around 200 pounds) are to the cartilage and ligaments in your knee? It seems like a ways in the future, but I don't want to be that 50 y/o guy with pre-mature osteoarthritis and can no longer play with his kids. Thanks.
 
I'd worry more about the discs in your lumbar spine.
 
Well, it has to be asked. For those of you that were so big that patients said they had seen "guys in jail as big as you"...did your sheer size intimidate any nurses or residents or attendings? Having to do 50% less scut would be a reason alone to take a few steroids and get Hyooooge.

(am semi kidding...but people are people, and it seems plausible that some of the more pencil necked residents might give you a pass on scutting you or making you stay late if they subconsciously felt intimidated)
 
Well, it has to be asked. For those of you that were so big that patients said they had seen "guys in jail as big as you"...did your sheer size intimidate any nurses or residents or attendings? Having to do 50% less scut would be a reason alone to take a few steroids and get Hyooooge.

(am semi kidding...but people are people, and it seems plausible that some of the more pencil necked residents might give you a pass on scutting you or making you stay late if they subconsciously felt intimidated)

Sorry about the late reply...I don't spend much time in the ortho forum. Honestly, I think the opposite would be true. The larger guy may be subjected to more scut, and more abuse....partially because the nurses, residents, and attendings will judge/pigeonhole you as being a certain way, which they usually don't like.

"Pencil-necked" residents won't be intimidated by you. They know that they have the hammer. Instead, they'll probably clown on you, and could potentially be very mean to you.....is there some underlying jealousy or physical intimidation? Who knows, but it's irrelevant. Intellectual intimidation is much more rampant in the medical world.

The immature meathead knee-jerk response to this is to assume it's out of intimidation, or to fantasize about some glorious badass thing you could say or do to put the resident in their place.......

The better thing to do would be to develop a sense of humor, and be able to make fun of yourself...and then spend some time proving that these people were wrong about you, as far as clinical skills/patient interaction/priorities.
 
If you do them properly there really isn't a ton of risk involved from what I have read been told. The problem is MOST people can't/don't do squats properly. I used to hate the lift because when I would rack the bar I would feel my knees/spine decompress, because I wasn't doing the lift correctly. Now it's my favorite lift and I'm maxing 350 pounds, and their is no strain on either my spine or knees what so ever. Squats are a very mental lift and you need to be very conscious of how your body is moving. The most common error is letting your knees bow in on the uplift, which is completely mental and easily overcame with just focusing on driving up through your heels and keeping your knees straight ahead. Also, buying a pair of squatting shoes can be beneficial, and because of how they distribute the weight over your heels and make it easier to lift off your heels, I have had people tell me just the shoes adding 50 pounds to their maxes. Squats are a lot of fun when you do them right, and are an absolutely crucial lift for anybody trying to get a total body workout plan in.
 
To say that you can put 350lbs on your shoulders and it will not have an effect on the disks in your lumbar spine is kind of misleading. The tensional forces on the annulus of your L5-S1 disk is 5X the weight that it is supporting. IE if you put 200lbs on your shoulders that is an additional 1000lbs of force on the annulus, even if your form is absolutely perfect. (This is a near quote from the 2nd edition of Orthopedic Basic Science, either the biomechanics chapter or the spinal disk chapter, forget which). If you used bad form the forces are even more, I would guess. I've seen patients who have lifted their whole life in clinic with DDD of the lumbar spine in their 40s and have asked my ortho/spine attendngs, "could doing heavy squats since I was a teenager have contributed to this?" The answer was yes every single time. My $0.02
 
There ARE ways to get huge gains in strength without going to 90+% of your one rep max. Do you think those guys that squat over a 1000 actually go anywhere near that every single time? You don't have to train your squat by simply doing squat. I almost exclusively use a safety squat bar now. That combined with chains or bands uses less overall weight but still absolutely kills you. Combined with pin pulls, box squats, glute ham raises, PROPER good mornings, RDLs, Pull-thrus, kettle bell training etc. helps a lot. Most of the serious powerlifters I know actually don't have much in the way of back problems. The number one injury tends to be a torn pec in the weight classes around 240 lbs+, which has a lot to do with the bench being too narrow they suspect.

I've actually seen a lot more people develop knee pain from using those friggin elipitcals or other stupid machines in the gym. I'd dump the satan of the gym, the smith machine, before I ever got rid of squats.

My one squat injury was from Zercher squats when some guy couldn't wait and bumped into my bar as I was going up. I got a nice twist in my upper back with about 280 in the crooks of my arms.

Bottom line is that if you consider 200 pounds "moderate" weight then you are probably going to be fine. That tells me that you really aren't off the charts or anything. If you were hitting the 500+ range then I might start checking things out a bit deeper.

You can also do barbell lunges or prowler/sled training. Much less weight is needed. I squat around 550 right now (embarrassing for me but I'm tall so whatever) and I am hesitant to do lunges over 250. Same with weighted split squat jumps which will kill you but keep the weight around 105 to 135.

If you REALLY want more information then PM me. I talk with some of the top sports trainers and strength specialists on a fairly regular basis. Although, you probably won't get much sympathy from Wendler or the other guys.
 
Squats pose no danger to a healthy knee unless you are moving huge loads at high velocities, i.e. powerlifting or olympic style lifting. Even then, the danger is primarily to the patellofemoral joint, not the tendons/ligaments.

I have chondromalacia patella in my right knee and still squat regularly. I developed the condition from running, not from squatting. The most important things are to minimize acceleration at the turnaround (start/stop the movement slowly) and to keep the number of sets low.

Unfortunately most of the strength training community now recommends exactly the opposite- large numbers of explosive reps. If you engage in this style of training then you might hurt your knees or something else. Some people can train like this for years and never get hurt, but I feel it has to do with genetic predisposition and that the average man should not assume that he can get away with the same.
 
Like the OP, I too am curious about the topic.

Does anybody have any further advice? This thread got derailed by comments not pertaining to the topic at hand, but I think it could be a good thread going forward.

Thanks for the advice.
 
If you keep your butt behind your toes you elicit co-contractions with the quads, hamstrings, and gluteals. This is considered the universal athletic position and is consistent across many (all?) land based sports that use a ball or a puck.

This position maximally distributes forces over maximal muscle cross-sectional mass, thereby reducing the overload over any one group. Therefore, by reducing quad dominance, it reduces PF compression.

We all squat every day when we rise out of a chair. I say unless you are training at ridiculous levels, Squats are an exercise for life.

Truthseeker PT ATC
 
What do you guys think about Strong Lifts 5x5:


The StrongLifts 5×5 Program
.

So here’s the Program. 5×5 stands for 5 sets of 5 reps with the same weight.

StrongLifts 5x5

Workout A


Workout B

Alternate 3 days a week, e.g. M/W/F
 
Squatting and olympic lifts are not only the most effective moves, they are also perfectly safe.


Squatting is like EVERYTHING ELSE, in the sense that, you have to learn how to do it properly. You don't just load the bar up and drop your butt to ankles. It is a learned movement.

Claiming that improperly done squats are dangerous, thus all squats are dangerous is inherently stupid.

Weaving your car through traffic on the wrong side of the road at 180mph while drunk is dumb too, it doesn't make driving wrong.

Soccer, basketball, and jogging load your joints in more awkward angles than squatting. You are more likely to get hurt playing other sports than lifting weights in the gym. I don't have to write "safely lifting weights" because it's implied that you learn how to do it safely. Just because my 1 rep max is high, doesn't mean yours is. You have to learn what weights are appropriate for you.

We are all going to be doctors, so we can apply some science and reason to our arguments. Don't talk about squatting unless you actually know something about how to squat.
 
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