National Strength and Conditioning Association Volume 26, Number 2, pages 4246

Keywords: squat; lower extremity exercise; proprioception exercise; anterior cruciate ligament; ACL; medial collateral ligament; MCL

Suspended Chain Squats: A Novel Exercise Technique

Brian Inselman,CSCS; Matt Briggs, ATC, CSCS, NSCA-CPT; Chris Oltmans, Nick Wissink Creighton University Medical Center, Omaha, Nebraska Christopher J. Durall, PT, DPT, ATC, CSCS University of WisconsinLa Crosse, La Crosse, Wisconsin

summary
The conventional back squat (CBS) is commonly employed to enhance strength in the lower extremities. The suspended chain squat (SCS) provides a unique challenge to the musculature of the ankle, knee, hip, abdomen, and lumbar spine and may be a benecial adjunct to any sports training or rehabilitation program. In addition,the SCS may prove to be benecial in the rehabilitation and reduction of such injuries as anterior cruciate ligament (ACL) damage, medial collateral ligament (MCL) damage, and patellofemoral pain syndrome. The proposed benets may be due to the abduction torque and rotation of the tibia that occurs when performing the SCS.

xercises are being utilized to incorporate various functionally specific components within a resistance training/rehabilitative regimen. The goal of these functional exercises is performance enhancement, injury reduction, and rehabilitation. Sports-enhancement exercises for both training and injury rehabilitation are a popular choice in many exercise protocols.

Back squats are the strength-producing exercise of choice for the lower extremity and are implemented in several sports resistance-training programs. Back squats tend to challenge all the major muscle groups of the lower extremity and trunk. The conventional back squat (CBS) has been shown to enhance lower extremity strength as well as spinal stability (2, 8). Certain injuries and conditions may prevent athletes from performing the CBS with appropriate technique and purpose. An alternative exercise to incorporate in any training regimen for those seeking additional exercise challenges is the squat performed utilizing suspended chains (Figure 1). The proposed benefits of the suspended chain squat (SCS), when performed correctly and all involved muscles are activated, include (a) increased ankle muscle strength and ankle joint stability, (b)

Figure 1. Suspended chain squat front view.

increased activation of the medial thigh musculature stabilizing the knee, and (c) increased hip/lumbar/abdominal muscle stability.

Technique
In order to perform the SCS, the following equipment is necessary: (a) 2 chains able to support the individuals weight, (b) straps to be used as stirrups for the

42

April 2004 Strength and Conditioning Journal

Figure 3. Suspended chain squat front view with weight lower position.

Figure 2. Suspended chain squat oblique view with weight starting position.

Ascent The body is raised to an erect position while maintaining control and a neutral spine alignment. Exercise is repeated until the desired effect is achieved. With any exercise in which stability is dramatically decreased, the risk for injury increases, so safety precautions must be considered and utilized. When using this exercise in the rehabilitation process, the athlete must be at a stage in which a qualified specialist monitoring and progressing the athletes program feels this individual is ready for the increased challenge. If the SCS is used too early, it may not facilitate, but rather hinder, performance enhancement and progression. Provided the SCS is utilized at an appropriate time in an athletes exercise program, it seems to provide a favorable opportunity to enhance joint stability, muscular strength, and endurance by challenging the athlete in a manner that will help prepare him or her for the addi-

tional external stresses presented during the athletic performance.

Exercise Theory
In theory, the increased exercise challenge for the ankle musculature and joint position neuroreceptors during the SCS is the result of reduced support surface stability. Ankle musculature joint control, e.g., is presumably enhanced to a greater extent during the SCS versus the CBS due to the intrinsic support surface instability with chains (9, 14). Logically, ankle muscle activation would be greater during the SCS to maintain an upright posture. As a result, this increased challenge may provide the athlete with an increased ability to control ankle movement during dynamic activities, as it may increase ankle joint stability and strength. During the CBS, the ankle plantar flexors eccentrically control dorsiflexion of the ankle. In contrast, ankle dorsiflexion in the SCS is controlled concentrically or isometrically by the ankle dorsiflexors. Limited ankle dorsiflexion mobility may increase the

feet, and (c) a solid horizontal beam to suspend the chains (i.e., a power squat rack). Starting position (Figure 2) Standing in an upright position with the feet shoulder-width apart in the stirrups, suspended above the ground. Feet placement in stirrups at approximately the midtarsal joint. Arms placed in front of the chains in a horizontally abducted position with the chains over the posterior axial line of the shoulder. For additional balance, the hands may be placed above the head to guide the chains. Descent The body is lowered to the desired depth using the same mechanics of CBS (Figure 3).

April 2004 Strength and Conditioning Journal

43

difficulty of performing the CBS. Alternatively, the SCS may be performed, as limitations of ankle dorsiflexion will not impair performance of this exercise; the support surface in which the SCS is performed allows the foot to move in space around an axis under the midtarsal joint without having to change the position of the ankle joint in regard to dorsiflexion or plantarflexion. The SCS appears to increase activation of the hip adductor musculature due to the decrease of frontal-plane stability while standing in the stirrups and the abductor torque imposed by gravity. The stirrups also allow the tibia to rotate laterally while descending during the squat. This may result in greater activation of the musculature surrounding the medial aspect of the lower extremities. In particular, the pes anserine (gracilis, semitendinosus, and sartorius) musculature may also increase its activity to control the abduction torque and lateral rotation of the tibia at the knee (5). These muscles play a critical role in maintaining medial and lateral rotatory stability of the tibiofemoral joint. Concentrically, the medial hamstrings (semimembranosus and semitendinosus) as well as the pes anserine produce medial rotation and eccentrically control lateral rotation of the tibia (13). The SCS, in theory, should elicit higher levels of activity in these muscle groups, possibly resulting in greater muscular control, timing, and strength in order to counter external stresses that may result in various knee injuries. Therefore, repetitive performance of the SCS could improve muscular control of tibial rotation as the ability of the hamstrings (17), specifically the semimembranosus and the semitendinosus, may be enhanced due to their line of pull into adduction and medial rotation of the tibia. In addition, the vastus medialis oblique (VMO) may have a tendency to contribute more to force generation and stabilization in the SCS than in the CBS (12). The hip/lumbar/abdominal musculature is challenged in a unique manner

during the SCS due to the unstable surface (7, 23). The hip adductors may be challenged to a greater extent during the SCS due to the tendency of the hips to abduct while standing in the stirrups. Additionally, because of the nature of the exercise, the role of the core trunk musculature controlling the pelvis may prove to be enhanced. All claims have not been proven or refuted. Further research is needed in order to validate or disprove the theories proposed. Research using electromyographic studies of the muscle activity concerning the aforementioned musculature is needed. In addition, comparison of the effects of rehabilitation across different populations should be undertaken. Injury reduction and rehabilitation from injuries, including damage to the anterior cruciate ligament (ACL), damage to the medial collateral ligament (MCL), patellofemoral pain syndrome, lateral patellar tracking problems, low-back pain, and deltoid ligament damage at the ankle, may be enhanced from use of the SCS. ACL injuries commonly occur when a valgus force is accompanied by rotation at the tibiofemoral joint, while MCL injuries tend to occur due to an abnormal valgus stress (1, 4, 10, 19, 22). By enhancing the ability of the stabilizing musculature to detect and control changes in joint position through appropriate training, ACL and MCL rehabilitation, as well as prevention, may be improved. As previously mentioned, the SCS should, in theory, enhance the activity of the musculature surrounding the medial aspect of the tibiofemoral joint, helping to restrain excessive valgus and rotational forces across the joint (6, 21). Patellofemoral pain syndrome and lateral patellar tracking are often associated with an improper balance in strength or onset of activation of the vastus medialis and vastus lateralis (11, 16, 18). Lowback pain is frequently associated with individuals who suffer from weak core

trunk musculature (20). The SCS may provide a unique stimulus that proves to be beneficial in improving these conditions. The combination of training the vastus medialis and pes anserine may decrease patellofemoral pain and lateral patellar tracking. Constant utilization of the abdominals and lower back musculature may minimize low-back pain. Furthermore, low-back stress may be reduced, as the additional resistance is not loaded through the spine. By increasing the strength of the medial musculature surrounding the ankle (tibialis anterior, tibialis posterior, etc.), the stress on the deltoid ligament may be reduced, thereby decreasing the likelihood of an eversion injury (3). In addition, strengthening these muscles may help control pronation and supination of the joints in the foot (15).

Summary
Resistance training is utilized to enhance performance, reduce injuries, and facilitate rehabilitation. Utilizing a variety of exercises provides different input to the musculoskeletal system in order to achieve these outcomes. Reduced-stability exercises provide a unique stimulus that may be absent when performing an exercise in which stability is not challenged. By enhancing the muscles potential to control the joints through appropriate training, the ability to counter the unanticipated torques, which may occur during competition, is improved. The suggested benefits of performing the SCS may play a significant role in any workout regimen, when not contraindicated. Such benefits may include, but are not limited to (a) increased ankle muscle strength and ankle joint stability, (b) increased activation of the medial thigh musculature stabilizing the knee, and (c) increased hip/lumbar/abdominal muscle stability. These benefits may prove beneficial in injury prevention and rehabilitation from such injuries as ACL and MCL tears, patellofemoral pain syndrome, lateral patella tracking, low-back pain, and deltoid ligament damage at the ankle. Rehabilitation of the injured athlete

44

April 2004 Strength and Conditioning Journal

must address joint range of motion, muscle strength, muscle endurance, and joint stability. When developing an exercise program for any athlete, all aspects mentioned should be addressed. By incorporating an activity such as the SCS, in which many, if not all, of these aspects are addressed, an athletes training as well as rehabilitation may be enhanced.

References
1. Bach, B. Acute knee injuries: When to refer. Phys. Sportsmed. 25(5):3946, 4950. 1997. 2. Baechle, T.R., and R.W. Earle, eds. Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics Pub., 2000. pp. 158, 369372. 3. Bahr, R., O. Lian, and I. Bahr. A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: A prospective cohort study. Scand. J. Med. Sci. Sports. 7(3):172177. 1997. 4. Beutler, A.I.L., W. Cooper, D.T. Kirkendall, and W.E. Garrett, Jr. Electromyographic analysis of single-leg, closed chain exercises: Implication for rehabilitation after anterior cruciate ligament reconstruction. J. Athl. Train. 37(1):1318. 2002. 5. Brindle, T., J. Nylan, K. Ford, A. Coppola, and R. Shapiro. Electromyographic comparison of standard and modied closed-chain isometric knee extension exercises. J. Strength Cond. Res. 16(1):129134. 2002. 6. Caraffa, A., G. Cerull, M. Projetti, G. Aisa, and A. Rizzo. Prevention of anterior cruciate ligament injuries in soccer. Knee Surg. Sports Traumatol. Arthrosc. 4(1):1921. 1996. 7. Caterisano, A., R.F. Moss, T.K. Pellinger, K. Woodruff, V.C. Lewis, W. Booth, and T. Khadra. The effect of back squat depth on the EMG activity of 4 supercial hip and thigh muscles. J. Strength Cond. Res. 16(3):428432. 2002. 8. Escamilla, R.F. Knee biomechanics of the dynamic squat exercise. Med. Sci. Sports Exerc. 33(1):127141. 2001.

9. Goldie, P.A. Postural control following inversion injuries of the ankle. Arch. Phys. Med. Rehabil. 75(9):969975. 1994. 10. Hiemstra, L.A, S. Webber, P.B. MacDonald, and D.J. Kriellaars. Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction. Med. Sci. Sports Exerc. 32(8):14721479. 2000. 11. Hinman, R.S., K.L. Bennell, B.R. Metcalf, and K.M. Crossley. Temporal activity of vastus medialis obliquus and vastus lateralis in symptomatic knee osteoarthritis. Am. J. Phys. Med. Rehabil. 81(9):684690. 2002. 12. Isear, J.A., J.C. Erickson, and T.W. Worrell. EMG analysis of lower extremity muscle recruitment patterns during an unloaded squat. Med. Sci. Sports Exerc. 29 (4):532 539. 1997. 13. Levangie, P., and C. Norkin. Joint Structure and Function: A Comprehensive Analysis (3rd ed). Philadelphia: F.A. Davis Company, 2001. 14. Mattacola, C.G. Rehabilitation of the ankle after acute sprain or chronic instability. J. Athl. Train. 37(4):413429. 2002. 15. Mattacola, C.G., and J.W. Lloyd. Effects of a 6-week strength and proprioception training program on measures of dynamic balance: A single case design. J. Athl. Train. 32(2):127135. 1997. 16. McConnell, J. The physical therapists approach to patellofemoral disorders. Clin. Sports Med. 21:363 387. 2002. 17. Ohkoshi ,Y., K. Yasuda, K. Kaneda, T. Wada, and M. Yamanaka. Biomechanical analysis of rehabilitation in the standing position. Am. J. Sports. Med. 19:605610. 1991. 18. Owings, T.M., and M.D. Grabiner. Motor control of the vastus medialis oblique and vastus lateralis muscles is disrupted during eccentric contractions in subjects with patellofemoral pain. Am. J. Sports Med. 30(4):483487. 2002. 19. Palmitier, R.A., K.N. An, S.G. Scott, and E.Y.S. Chao. Kinetic chain exer-

20.

21.

22.

23.

cise in knee rehabilitation. Sports Med. 11(6):402413. 1991. Shiple, B., and N.A. DiNubile. Relieving low-back pain with exercise. Phys. Sportsmed. 25(8):6768. 1997. Soderman, K., S. Werner, T. Pietila, B. Engstrom, and H. Alfredson. Balance board training: Prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg. Sports Traumatol. Arthrosc. 8(6):356363. 2000. Torry, M.R., D.D. OConnor, J.J. Kedrowski, W.I. Sterrett, and J.R. Steadman. Knee stability controlled by hamstrings and functional knee brace. J. Prosthet. Orthot. 13(4):9096. 2001. Vakos, J.P., A.J. Nitz, A.J. Threlkeld, R. Shapiro, and T. Horn. Electomyographic activity of selected trunk and hip muscles during a squat lift. Effect of varying the lumbar posture. Spine. 19(6):687695. 1994.

Inselman

Brian Inselman is a student in Physical Therapy at Creighton University in Omaha, NE.

Briggs

Matt Briggs is a student in Physical Therapy at Creighton University in Omaha, NE.

April 2004 Strength and Conditioning Journal

45

Oltmans

Chris Oltmans is a student in Physical Therapy at Creighton University in Omaha, NE.

Wissink

Nick Wissink is a student in Physical Therapy at Creighton University in Omaha, NE.

Durall

Chris Durall is the Director of the Physical Therapy department in the Student Health Center at the University of Wisconsin-LaCrosse.

Acknowledgments: We would like to acknowledge Dr. Joseph Threlkeld and Tom Purvis, PT, for their assistance in writing this article.

46

April 2004 Strength and Conditioning Journal