Вы находитесь на странице: 1из 11

Cruciate Ligament Force during the Wall

Squat and the One-Leg Squat


RAFAEL F. ESCAMILLA 1 , NAIQUAN ZHENG 2, RODNEY IMAMURA3, TORAN D. MACLEOD 4 ,
6
W. BRENT EDWARDS 5 , ALAN HRELJAC 3 , GLENN S. FLEISIG
, KEVIN E. WILK7,
6 9
CLAUDE T. MOORMAN 1118, and JAMES R. ANDREWS '
'Department of Physical Therapy, California State University, Sacramento, CA,; 2 The Centerfor Biomedical Engineering,
Department of MechanicalEngineering and Engineering Science, University of North Carolina, Charlotte, NC; 3Kinesiology
and Health Science Department, California State University, Sacramento, CA; 4Department of Physical Therapy, Centerfor
Biomedical EngineeringResearch, University of Delaware,Newark, DE; 5Department of Kinesiology, Iowa State University,
Ames, IA; 6American Sports Medicine Institute, Birmingham, AL; 7 Champion Sports Medicine, Birmingham, AL; 8Duke
Sports Medicine Center, Duke University,Durham, NC; and 9Andrews Research and Education Institute, Gulf Breeze, FL

ABSTRACT
ESCAMILLA, R. F., N. ZHENG, R. IMAMURA, T. D. MACLEOD, W. B. EDWARDS, A. HRELJAC, G. S. FLEISIG, K. E. WILK,
C. T. MOORMAN, and J. R. ANDREWS. Cruciate Ligament Force during the Wall Squat and the One-Leg Squat. Med. Sci. Sports
Exerc., Vol. 41, No. 2, pp. 408-417, 2009. Purpose: To compare cruciate ligament forces during wall squat and one-leg squat
exercises. Methods: Eighteen subjects performed the wall squat with feet closer to the wall (wall squat short), the wall squat with feet

farther from the wall (wall squat long), and the one-leg squat. EMG, force, and kinematic variables were input into a biomechanical
model using optimization. A three-factor repeated-measure ANOVA (P < 0.05) with planned comparisons was used. Results: Mean
posterior cruciate ligament (PCL) forces were significantly greater in 1) wall squat long compared with wall squat short (0-800 knee
angles) and one-leg squat (00-900 knee angles); 2) wall squat short compared with one-leg squat between 00-200 and 900 knee angles;
3) wall squat long compared with wall squat short (70-00 knee angles) and one-leg squat (900-600 and 200-00 knee angles); and 4)
wall squat short compared with one-leg squat between 90'-70' and 00 knee angles. Peak PCL force magnitudes occurred between 800
and 900 knee angles and were 723 + 127 N for wall squat long, 786 197 N for wall squat short, and 414 133 N for one-leg squat.
Anterior cruciate ligament (ACL) forces during one-leg squat occurred between 00 and 400 knee angles, with a peak magnitude of 59
52 N at 30' knee angle. Quadriceps force ranged approximately between 30 and 720 N, whereas hamstring force ranged approximately

between 15 and 190 N. Conclusions: Throughout the 00-900 knee angles, the wall squat long generally exhibited significantly greater
PCL forces compared with the wall squat short and one-leg squat. PCL forces were similar between the wall squat short and the one-leg
squat. ACL forces were generated only in the one-leg squat. All exercises appear to load the ACL and the PCL within a safe range in
healthy individuals. Key Words: BIOMECHANICS, KINETICS, CLOSED CHAIN EXERCISES, KNEE

and no ACL forces throughout the knee range of motion


(8,11,12,31,35). In contrast, other squat studies reported
relatively low magnitude peak ACL forces between 30 and
500 N approximately between 0' and 60' knee angles
and PCL forces approximately between 600 and 1200 knee
angles (3,14,25,32). These data are supported by other
weight-bearing knee flexion studies, with ACL strain occurring at lower knee angles and PCL strain occurring at
higher knee angles (9,17). What is consistent in the squat
literature is that PCL loading occurs at higher knee angles
typically greater than approximately 600. What is inconsistent in the squat literature is whether or not ACL
strain always occurs at smaller knee angles. Part of the
inconsistencies in ACL strain during the squat is that
some studies estimated ACL strain in vivo using strain
sensors inserted within the ACL (3,15), whereas other
studies used biomechanical musculoskeletal models to
estimated ACL strain (8,11,12,31,35). However, it is clear
that when ACL strain does occur, it occurs at smaller
knee angles and its strain or force magnitudes are relatively
low. Using dynamic optimization techniques, peak ACL

commonly used by athletes to train the hip and


eight-bearing
exercises, Physical
such as therapists
the squat, and
are
the
thigh musculature.
trainers also have their patients or clients use squatting-type
exercises during anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) rehabilitation to allow them
to recover faster and return to function earlier (6,29,37).
Several studies involving barbell and body weight squat
exercises reported PCL forces between 300 and 2700 N

Address for correspondence: Rafael F. Escamilla, Ph.D., P.T., C.S.C.S.,


FACSM, Professor, Department of Physical Therapy, California State
University, Sacramento, 6000 J Street, Sacramento, CA 95819-6020;
E-mail: rescamil@csus.edu.
Submitted for publication September 2007.
Accepted for publication July 2008.
0195-9131/09/4102-0408/0
MEDICINE & SCIENCE-IN SPORTS & EXERCISE
Copyright 2009 by the American College of Sports Medicine
DOI: 10.1249/MSS.0b013e3181882c6d

408

forces have been reported to be less than 20 N during body


weight squatting (30).
Although the effects of exercise technique variations on
cruciate ligament strain while performing the barbell squat
have been examined (11,12), there are no studies that have
examined the effects of technique variations on cruciate
ligament loading while perform.ing the one-leg squat and
wall squat. One-leg squat and wall squat exercises are both
performed in training and rehabilitation settings. Wall
squats can be performed with varying techniques, such as
positioning the heels farther or closer to the wall. Positioning the .heels farther from the wall typically results in the
knees being maintained over the feet at the lowest position
of the squat, whereas positioning the heels closer to the wall
typically results in the knees moving anterior beyond the
toes at the lowest position of the squat. Performing a oneleg squat also causes the knees to move forward beyond the
toes at maximum knee flexion. Clinicians and trainers often
believe that anterior movement of the knees beyond the toes
during the wall squat or one-leg squat may increase cruciate
ligament loading, although there are very limited data that
support this belief (1). Moreover, it is unclear if the ACL or
the PCL is loaded when anterior knee movement occurs.
The purpose of this study was to compare cruciate ligament tensile forces among squat types (wall squat with the
feet farther away from the wall-wall squat long; wall squat
with the feet closer to the wall-wall squat short; and the
one-leg squat) and squat phases (squat descent and squat
ascent) at specific knee angles (0', 100, 20', 30', 40', 50,

and 25 2 yr, 60 + 4 kg, and 164 + 6 cm, respectively, for


females. All subjects were required to perforrn wall squat
and one-leg squat exercises pain-free and with proper forrri
and technique for 12 consecutive repetitions using their 12
repetition maximum (12 RM) weight.
To control the EMG signal quality, the current study was
limited to males and females that had average or below
average body fat, which was assessed by Baseline skinfold
calipers (Model 68900; Country Technology, Inc., Gays
Mill, WI) and body fat standards set by the American
College of Sports Medicine. Average body fat was 12%
4% for males and 18% + 1% for females. All subjects
provided written informed consent in accordance with the
Institutional Review Board at California State University,
Sacramento, which approved the research conducted and
informed consent form.

600, 700, 800, and 900). It was hypothesized that 1) ACL

45.s-1. The surface of the wall was smooth, and a towel

tensile force would occur at knee angles 30' or less in the


one-leg squat and wall squat short; 2) PCL tensile force
would occur throughout the knee angle range of motion
in the wall squat long; 3) PCL forces would generally be
greater in the wall squat long compared with the wall squat
short and one-leg squat; 4) PCL forces would generally not
be significantly different between the wall squat short and
the one-leg squat; and 5) for all three squat types, ACL and
PCL forces would generally be greater at specific knee
angles during the squat ascent compared with the corresponding knee angles during the squat descent. Quadriceps
and hamstrings muscle force magnitudes will also be presented to help better understand ACL and PCL force magnitudes. Understanding how cruciate ligament tensile forces
vary among squatting techniques will allow physical therapists, physicians, and trainers to prescribe safer and more
effective knee rehabilitation to patients during ACL or PCL
rehabilitation.

was positioned between the wall and the subject to minimize friction as the subject slid down and up the wall. The
stance width (distance between inside heels) was 32 + 6 cm
for males and 28 + 7 cm for females, and the foot angle
was approximately 00 (feet pointing approximately straight
ahead), and both stance and foot angle were according to
subject preference.
The wall squat was performed with two technique variations, wall squat long (Fig. i) and wall squat short (Fig. 2).
The foot position relative to the wall for the wall squat long
was determined using a heel-to-wall distance that resulted
in the legs being approximately vertical and the knees positioned above the ankles when the thighs were parallel with
the ground (Fig. 1), which is commonly recommended by
clinicians and trainers. The average heel-to-wall distance for
the wall squat long was 45 3 cm for males and 41 3 cm
for females. The heel-to-wall distance for the wall squat
short was one half the distance of the heel-to-wall distance
for the wall squat long. The shorter heel-to-wall distance for
the wall squat short resulted in the anterior surface of the
knee moving beyond the distal end of the toes 9 -2 cm at
the lowest position of the wall squat short (Fig. 2).

METHODS
Subjects
Eighteen healthy individuals (nine males and nine
females) without a history of cruciate ligament pathology
participated with an average age, mass, and height of 29 +
7 yr, 77 + 9 kg, and 177 6 cm, respectively, for males,

ONE-LEG SQUAT AND WALL SQUAT

Exercise Description
Wall squat (Figs. 1 and 2). The wall squat began with
the right foot on a force platform and their left foot on the
ground, both knees fully extended (00 knee angle), the back
flat against the wall, and a dumbbell weight held in both
hands with the arms straight and at the subject's side. From
this position, the subject slowly flexed both knees and
squatted down until the thighs were approximately parallel
to the ground with the knees flexed approximately 90'1100, and in a continuous motion the subject returned back
to the starting position. A metronome was used to help ensure that the knees flexed and extended at approximately

One-leg squat. The one-leg squat started with the subject standing on one leg with the right foot on a force
platform, the right knee fully extended, the left knee bent

Medicine & Science in Sports & Exercise 409

FIGURE I

and 15 +-3 kg for males and 10 + 3 kg for females for the


one-leg squat.
Blue Sensor (Ambu Inc., L,inthicurn, MD) disposable surface electrodes (type M-00-S) were used to collect EMG
data. These oval-shaped electrodes (22 mm wide and 30 mm
"long)were placed in a bipolar electrode configuration along
the longitudinal axis of each muscle, with a center-to-center
distance of approximately 3 cm. Before positioning the electrodes over each muscle, the skin was prepared by shaving,
abrading, and cleaning with isopropyl alcohol wipes to reduce skin impedance. As previously described (2), electrode
pairs were then placed on the subject's right side. for the
following muscles: a) rectus femoris, b) vastus lateralis, c)
vastus medialis, d) medial hamstrings (semimembranosus and
semitendinous), e) lateral hamstrings (biceps femoris), and f)
gastrocnemius.
Spheres (3.8 cm in diameter) were attached to adhesives
and positioned over the following bony landmarks: a) third
metatarsal head of the right foot, b) medial and lateral
malleoli of the right leg, c) upper edges of the medial and
the lateral tibial plateaus of the right knee, d) posterosuperior greater trochanters of the left and the right femurs,
and e) lateral acromion of the right shoulder.
Wall squat with feet farther from wall (wall squat long).

approximately 90', and a single dumbbell weight held with


both hands in front of the chest. From this position, the
subject slowly flexed the right knee and squatted down until
the right knee was flexed approximately 90 100' with the
trunk tilted forward approximately 30-40' (Fig. 3), and in
a continuous motion the subject returned back to the starting position. A metronome was used to help ensure that the
right knee flexed and extended at approximately 45-s-O. At
the lowest position of the one-leg squat, the anterior surface
of the knee moved 10 + 2 cm beyond the distal end of the
toes (Fig. 3).

Once the electrodes and the spheres were positioned, the

subject warmed up and practiced the exercises as needed,


and data collection was commenced. A six-camera peak

_71

Data Collection
Each subject came in for a pretest I wk before the testing session. The experimental protocol was reviewed, the
subject was given the opportunity to practice the one-leg
squat and wall squat exercises, and each subject's heel-towall distances for the wall squat short and wall squat long
were determined. In addition, to nonnalize intensity between the wall squat and the one-leg squat exercises, each
subject's 12 RM was determined. To determine the weight
used for the wall squat short and long, each subject used
their 12 RM weight while performing the wall squat using a
heel-to-wall distance that was halfway between the heel-towall distances for the wall squat short and wall squat long,
and this weight was used for both the wall squat short and
the wall squat long during the testing session. The mean
total dumbbell mass used was 56 + 9 kg for males and 36 +
8 kg for females for the wall squat short and wall squat long

410

Official Journal of the American College of Sports Medicine

FIGURE 2 Wall squat with feet closer to wall (wall squat short).

http://www.acsm-msse.org

accuracy of the calibration system resulted in markers that


could be located in three-dimensional space with an error
less than 4-7 mm. The raw position data were smoothed
with a double-pass fourth-order'Butterworth low-pass filter
with a cutoff frequency of 6 Hz (11). Joint angles, linear
and angular velocities, and linear and angular accelerations
were calculated using appropriate kinematic equations (11).
Raw EMG signals were full-waved rectified and
smoothed with a 10-ms moving average window throughout the knee range of motion for each repetition. These
EMG data were then normalized for each muscle and were
expressed as a percentage of each subject's highest corresponding MVIC trial. The MVIC trials were calculated
using the highest EMG signal over a 1-s time interval
throughout the 5-s MVIC. Normalized EMG data were then
averaged over the three repetition trials performed for each
exercise as a function of knee angle and were used in the
biomnechanical model described below.

FIGURE 3-One-leg squat.

performance motion analysis system (Vicon-Peak Performance Technologies, Inc., Englewood, CO) was used to collect 60-Hz video data. Force data were collected at 960 Hz
using a force platform (Model OR6-6-2000; Advanced Mechanical Technologies, Inc.). EMG data were collected at
960 Hz using a Noraxon Myosystem unit (Noraxon USA,
Inc., Scottsdale, AZ). The EMG amplifier bandwidth frequency was 10-500 Hz. Video, EMG, and force data were
electronically synchronized and simultaneously collected as
each subject performed in a randomized manner one set of
three continuous repetitions (trials) during the wall squat
short, wall squat long, and one-leg squat.
After completing all exercise trials, EMG data were
collected during maximum voluntary isometric contractions
(MVIC) to normalize the EMG data collected during each
exercise (11). The MVIC for the rectus femoris, vastus
lateralis, and vastus medialis were collected in a seated
position at 90' knee and hip flexion with a maximum effort knee extension. The MVIC for the lateral and the
medial hamstrings were collected in a seated position at
90' knee and hip flexion with a maximum effort knee
flexion. MVIC for the gastrocnemius was collected during
a maximum effort standing one-leg toe raise with the
ankle positioned approximately halfway between neutral
and full plantarflexion. Two 5-s trials were randomly collected for each MVIC.
Data Reduction
Video images for each marker were tracked and digitized
in three-dimensional space with peak performance software.
Ankle, knee, and hip joint centers were mathematically
determined using the external markers and appropriate
equations as previously described (11). Testing of the

ONE-LEG SQUAT AND WALL SQUAT

Biomechanical Model
As previously described (11,41), a biomechanical model
of the knee (Figs. 4 and 5) was used to continuously estimate cruciate ligament forces throughout a 900 knee range
of motion during the knee flexing (squat descent) phase
(00-900) and the knee extending (squat ascent) phase (900.
0') of the lunge. Resultant force and torque equilibrium
equations were calculated using the inverse dynamics and
the biomechanical knee model (11,41). Anteroposterior
shear forces in the knee were calculated and adjusted to
ligament orientations to estimate ACL or PCL forces (16).
Moment arms of muscle forces and angles for the line of
action for the muscles and the cruciate ligaments were expressed as polynomial functions of knee angle using data
from Herzog and Read (16). Knee torques from cruciate
and collateral ligament forces and bony contact were assumed to be negligible as were forces and torques out of
the sagittal plane.
Quadriceps, hamstrings, and gastrocnemius muscle
forces were estimated as previously described (11,41). Because the accuracy of estimating muscle forces depends
on accurate estimations of a muscle's physiological crosssectional area (PCSA), maximum voluntary contraction
force per unit PCSA, and the EMG-force relationship, resultant force and torque equilibrium equations may not be
satisfied. Therefore, each muscle force FJi(,) was modified
by the following equation at each knee angle:
F,,,()

cjk1k,,iAio,,,,(i) 1EMGi/MVICi].

where Ai is the PCSA of the ith muscle, or-(i) is the MVIC


force per unit PCSA of the ith muscle, EMGi and MVICi
are the EMG window averages of the ith muscle EMG
during exercise and MVIC trials, ci is a weight factor
(values given below) adjusted in a computer optimization
program to minimize the difference between the resultant
torque from the inverse dynamics (Trc,) and the resultant

Medicine & Science in Sports & Exercise 411

weight factor c was to adjust the final muscle force calculation. The bounds on c were set between 0.5 and 1.5.
The torques predicted by the EMG driven model matched
well (<2%) with the torques generated from the inverse
dynamics.
Data Analysis

FIGURE 4-Computer optimization with input from measured knee


torque from inverse dynamics and predicted knee torque from muscle
model, where TK is the resultant knee torque, FK is the resultant knee
force, I is the moment of inertia about leg center of mass, a is the
angular acceleration of leg, in is the mass of leg, a is the linear
acceleration of leg, g is the gravitation constant 9.80 m.s-2, Fext is the
external force acting on foot, T,,, is the external torque acting on foot,
FQ is the quadriceps force, F1, is the patellar tendon force, F11 is the
hamstrings force, and FG is the gastrocnemius force. Note that to
simplify the drawing, the equal and the opposite forces and torques
acting on the distal leg and proximal ankle are not shown.

torque calculation from the biomechanic al model (T,,i)


(Fig. 4), k1i represents each muscle's force-length relationship as function of hip and knee angles (based on
muscle length, fiber length, sarcomere length, pennation
angle, and cross-sectional area) (33), and k,,i represents each
muscle's force-velocity relationship based on a Hill-type
model for eccentric and concentric muscle actions using
the following equations from Zajac (38) and Epstein and
Herzog (10):
k, = (b - (a/Fo)v)/(b + v)

To determine the effects of squat type (wall squat long,


wall squat short, and one-leg squat), squat phase (squat
descent and squat ascent), and knee angles (00-90' in
10' intervals) on cruciate ligament forces, a three-factor
repeated-measure ANOVA with planned comparisons was
used. Bonferroni t-tests were used to evaluate the significance of pairwise comparisons. The level of significance
used was P < 0.05.

RESULTS
Mean cruciate ligament force curves are shown in
Figure 6. Main effect differences were identified among
the three squat types (P < 0.001), between the two squat
phases (P < 0.001), and among the 10 knee angles (P <
0.001). When examined at each knee angle, a significant
squat type by squat phase interaction was identified at 0'
(P = 0.039), 10 (P = 0.002), 20 (P = 0.003), 300 (P

0.011), 40 (P = 0.010), 500 (P < 0.001), 600 (P = 0.048),


80' (0.003), and 90' (P < 0.001). Pairwise comparisons of
mean cruciate ligament forces at specific knee angles (090') between squat exercises and between squat descent
and ascent phases are shown in Table 1. During the squat
descent phase, mean PCL forces were significantly greater
in the wall squat long (259-757 N range) compared with
the wall squat short (100-786 N range) between 0' and 800

concentric

kv = C - (C - 1)(b + (a/Fo)v)/(b - v)

eccentric,

with F 0 representing the isometric muscle force, lo is the


muscle fiber length at rest, v is the velocity, and a = 0.32Fo,
b = 3.210 -s, and C = 1.8.
PCSA data from Wickiewicz et al. (33) were used to
determine the ratios of PCSA between muscle groups (41).
According to Narici et al. (24), the total PCSA of the quadriceps was approximately 160 cm 2 for a 75-kg man. Total
PCSA of the quadriceps was scaled up or down by individual body mass (41). Forces generated by the knee flexors
and extensors at MVIC were assumed to be linearly proportional to their PCSA (41). Muscle force per unit PCSA at
MVIC was 35 N'cm -2 for the knee flexors and 40 Nccm-2
for the quadriceps (7,23,24,34).
The objective function used to determine each ith muscle's coefficient ci was as follows:
niinf(ci) = I(X(

-)2

i)2

i=1i=

subject to Clow <Ci < Chi,h, where Clow and Cihig.h are the
lower and the upper limits for ci, and k is a constant. The

412

Official Journal of the American College of Sports Medicine

FIGURE 5-Forces acting on the proximal tibia: F,, = force from


hamstrings; FG = force from gastrocnemius (note that this force does
not act directly on proximal tibia); FPT = force from patellar tendon;
F,CL = force from ACL; Fpc. = force from PCL; and FTF = force
from femur.

http://www.acsm-msse.org

1000
o

800
6400
"400

0200

0
U<-200
0

20

40

60

80

1O0

Squat Descent (Knee Flexing)

---

80
Sqiuat Ascent (Knee Extending)

Knee Flexion Angle (deg)

Squat Short
Wall Squat Long
One Leg Squat

FIGURE 6-Mean (SD) cruciate ligament force during the one-leg squat and wall squat.

knee angles, significantly greater in the wall squat long


compared with the one-leg squat (64-414 N) between 00
and 900 knee angles, and significantly greater in the wall
squat short compared with the one-leg squat between 0020' and 90' knee angles. During the squat ascent phase,
mean PCL forces were significantly greater in the wall
squat long compared with the wall squat short between 70'
and 0' knee angles, significantly greater in the wall squat
long compared with the one-leg squat between 900-600 and
20-0' knee angles, and significantly greater in the wall
squat short compared with the one-leg squat between 9070' and 00 knee angles. For all three squat exercises, mean
peak PCL force magnitudes occurred between 80' and 90'
knee angles during the squat ascent and were 723 127 N

for the wall squat long, 786 197 N for the wall squat
short, and 414 133 N for the one-leg squat. ACL forces,
which were generated only during the one-leg squat (31-59
N range), occurred between 00 and 400 knee angles during
the squat descent and at 0' knee angle during the squat
ascent. The mean peak ACL force magnitude during the
one-leg squat was 59 52 N and occurred at 300 knee angle
during the squat descent.
Significant differences (P < 0.05) in cruciate ligament
force at specified knee angles between the descent and the
ascent phases of each squat exercise are shown in Table 1.
Mean PCL force was significantly greater in the ascent
phase compared with the descent phase between 600 and
800 knee angles for the wall squat long, 700-90' knee

TABLE 1. Mean SD cruciate ligament forces (N) among the three squat types (wall squat long, wall squat short, and one-leg squat) and between the two squat phases (squat decent
and squat ascent) as a function of knee angle.
Knee Angles for Descent Phase
0.
100
200
30
40*
50D
600
70*
800
900
Knee angles for ascent phase
90,
800
70
600
500
40o
300
20'
100
00

Wall Squat Long


(WSL)
482 209
423
316
261
259
295
348
445
573
659

+ 205

Wall Squat Short


(WSS)
297 152

One-Leg Squat
(OLS)
-31 52

135
124
121
122
133*
136*
149'
150

243
143
100
109
157
231
324
439
578

140
131
100
77
70
81
101*
129*
158*

-36
-51
-59
-22
64
160
227
326
386

723 127
757 185*
714 181 *
542 144*
408 137
355 120
363 141
436 180
539 223
529 249

786
702
529
366
267
223
206
222
253
274

197*
200*
+ 177*
146
141
174
158
139
155
178

414 133
391 169
368 157*
374 178*
329 172*
266 - 159*
231 132*
209 142*
88 130
-37 146

54
77*
52*
66*
93*
97*
81*
118
121

Significant Differences (P< 0.05) between Squat Types


WSL > WSS (P= 0.002); WSL > OLS (P< 0.001); WSS > OLS (P< 0.001)
WSL > WSS (P= 0.011); WSL > OLS (P< 0.001);
WSL > WSS (P= 0.049); WSL> OLS (P< 0.001);
WSL > WSS (P = 0.023); WSL > OLS
WSL > WSS (P= 0.014); WSL > OLS
WSL > WSS (P= 0.005); WSL > OLS
WSL > WSS (P = 0.034); WSL > OLS
WSL > WSS (P= 0.022); WSL > OLS
WSL > WSS (P= 0.017); WSL > OLS
WSL > OLS (P< 0.001); WSS > OLS

WSS > OLS (P< 0.001)


WSS > OLS (P< 0.004)
(P< 0.001)
(P= 0.002)
(P< 0.001)
(P < 0.001)
(P< 0.001)
(P< 0.001)
(P = 0.003)

WSL > OLS (P< 0.001); WSS > OLS (P< 0.001)
WSL > OLS (P< 0.001); WSS > OLS (P<0.001)
WSL > WSS (P< 0.001); WSL > OLS (P < 0.001); WSS > OLS (P 0.035)
WSL > WSS (P< 0.001); WSL > OLS (P= 0.002)
WSL > WSS (P<0.001)
WSL > WSS (P = 0.020)
WSL > WSS (P = 0.007)
WSL > WSS (P<0.001); WSL > OLS (P= 0.005)
WSL > WSS (P< 0.001); WSL > OLS (P< 0.001)
WSL > WSS (P= 0.003); WSL > OLS (P< 0,001); WSS > OLS (P< 0.001)

ACL forces are listed as negative values, and PCL forces are listed as positive values. An asterisk (0) implies that there is a significant difference (P < 0.05) in cruciate ligament force at
the specified knee angle between the squat descent and the squat ascent phases of a squat exercise.

ONE-LEG SQUAT AND WALL SQUAT

Medicine & Science in Sports & Exercisee

413

TABLE 2. Mean + SD quadriceps and hamstrings force values during wall squat and one-leg squat exercises.
Ouadriceps Force (N)
Knee Angles for Descent Phase
00

10
200
30o
40
500

60'

70o
800
900

Knee angles for ascent phase


90
80
70,

60o
500
40o
300

20o
100
00

Wall Squat Long

Wall Squat Shou

63
83
108
150
209
290
384
478
502
419

57
68
88
114
145
174
190
203
171
158

31
53
84
116
164
235
318
408
486
559

29
51
74
83
98
123
145
155
156
159

505
475
684
632
499
358
263
197
139
93

151
145
196
227
217
161
110
86
62
48

595
705
717
643
525
403
304
221
146
86

205
240
286
260
217
175
139
102
73
51

angles for the wall squat short, and 20'-700 knee angles for
the one-leg squat. Descriptive data of mean quadriceps and
hamstrings force values during wall squat and one-leg squat
exercises are shown in Table 2. Quadriceps force ranged
approximately between 30 and 720 N and generally increased with knee flexion, whereas hamstring force ranged
approximately between 15 and 190 N. At each knee angle,
quadriceps and hamstrings forces were generally greater
during the ascent compared with the descent.

DISCUSSION
It is not well understood what PCL or ACL force magnitudes become injurious to the healthy or reconstructed ACL
and PCL. In healthy adults, the ultimate strength of the
ACL and PCL is approximately 2000 N (36) and 4000 N
(27), respectively, although these values depend on age and
anatomical factors. Therefore, the ACL and the PCL loads
generated during the one-leg squat and the wall squat
exercises appear to be well within a safe limit for the
healthy ACL and PCL. The reconstructed ACL and PCL
have similar ultimate strengths compared with the healthy
ACL or PCL, although these values can change considerably depending on graft type and donor characteristics
(e.g., autograft vs allograft; patellar tendon vs hamstrings
graft) (4,28). However, the healing graft site may be injured
with considerably less force compared with the ultimate
strength of the graft, although it is not well understood how
much force to the graft site is too much and how soon force
can be applied after reconstruction. Therefore, the mean
peak PCL forces of approximately 400 N during the one-leg
squat and approximately 750 N during the wall squat exercises may be problematic early after PCL reconstruction
when the graft site is still healing. Moreover, during PCL
reconstruction, at the same relative intensity, it may be appropriate to use the one-leg squat before wall squat exer-

414

Official Journal of the American College of Sports Medicine

Hamstrings (N)

One-Leg Squat
50 50
63 59
90 64

145 84
253
357
542
668

139
160
181
172

645 178
593 168
450
469
570
594

154
144
160
157

548 132
442 121

344 98
253 78
161 75
97 83

Wall Squat Long

Wall Squat Short

11

19
19
22
25
21
21
19
16
13
15

9
10
+ 24
32
17
18
16
12
9
9

21
24
38
28
26
27
31
33
+ 36
+ 48

53
60
55
49
45
42
40
40
39
44

35
36
35
34
31
29
23
18
21
15

24
23
21
22
20
+ 19
+ 13
8
12

32
49
63
54
49
47
50
55
61
66

35
41
40
39
38
39
40
+ 38
37
40

One-Leg Squat
47
40
39
51
59
61
61
50
47
56
97
81
97
132
152
166
182
192
178
149

29
28
29
24
30
33
33
33
25
26
57
51
51
60
65
72
82
100
112
112

cises due to less PCL loading during the one-leg squat,


especially compared with the wall squat long. In addition,
it may be prudent to use smaller knee angles (e.g., 00500) before progressing to larger knee angles (e.g., 50'1000) because PCL forces generally increase as knee angle
increases. In contrast, wall squat exercises may be a better
choice compared with the one-leg squat early after ACL
reconstruction due to ACL forces generated during the oneleg squat. However, because peak ACL force during
the one-leg squat were only approximately 60 N, it is not
likely that the one-leg squat will produce forces that
would be injurious to the healing ACL graft, and mild
strain to the graft may enhance the healing process (13).
Nevertheless, after ACL reconstruction, it may be safer to
start with wall squat exercises and progress to the oneleg squat and use larger knee angles (e.g., 500-1000)
before progressing to smaller knee angles (e.g., 00-50')
because ACL forces may be generated at smaller knee
angles less than 500.
As hypothesized, ACL forces were greater in the oneleg squat compared with the wall squat long and occurred
at knee angles between 00 and 400 with a peak magnitude
of approximately 60 N at 300 knee angle. During the oneleg sit-to-stand, which is similar to ascent phase of the
one-leg squat, Heijne et al. (15) reported a peak 2.8% ACL
strain (calibrated to approximately 100 N) at 300 knee
angle. Moreover, Kvist and Gillquist (19) reported a peak
anterior shear ACL force of less than 90 N at 300 knee
angle during the one-leg bodyweight squat, which is similar
to the results in the current study. Butler et al. (5)
demonstrated that the ACL provides 86% of the total
resistance to anterior drawer (caused by an anterior shear
force) and the PCL provides approximately 95% of the total
restraining force to posterior drawer (caused by a posterior
shear force). Therefore, the anterior shear force is resisted
primarily by the ACL, and posterior shear force is resisted

http://www.acsm-msse.org

primarily by the PCL. Moreover, ACL forces as a function


of knee angle in the current study are similar to ACL forces
and knee angles in the squat literature (3,15,25,32).
However, both the ACL and the PCL forces that are
generated while performing squatting exercises are dependent on which exercise technique is used and whether
external resistance is used. For example, in Beynnon et at.
(3), it appears that the subjects may have squatted using a
more upright trunk position with relatively little forward
trunk tilt, which suggests that these subjects may use their
quadriceps to a greater extent than their hamstrings (26).
This is important because hamstrings force has been shown
to unload the ACL and to load the PCL during the weightbearing squat exercise (11,21,26). Ohkoshi et at. (26)
reported no ACL strain at all knee angles tested (15', 30',
60', and 90') while maintaining a squat position with the
trunk tilted forward, with 300 or more forward trunk tilt
being optimal for eliminating or minimizing ACL strain
throughout the knee range of motion and recruiting
relatively high hamstrings activity.
The exercises that had the greatest amount of anterior
knee movement beyond the knees, the one-leg squat (10
2 cm) and wall squat short (9 2 cm), also generated the
greatest ACL forces and least PCL forces. These exercises
may be preferable to the wall squat long during PCL rehabilitation. In contrast, as hypothesized, the wall squat
long, in which the knees did not move beyond the toes,
generated the highest PCL forces and no ACL forces and
may be problematic during PCL rehabilitation. Anterior
knee movement beyond the toes can influence quadriceps
activity and patellar tendon force, which in turn can influence cruciate ligament loading. Zemicke et al. (40) estimated the force in the patellar tendon at approximately 17
times bodyweight in a subject that used a considerable
external load during a squat descent with excessive anterior knee movement beyond the toes. Although 17 times
bodyweight may be an over estimate of the actual force in
the patella tendon, large patellar tendon forces tend to load
the ACL at smaller knee angles less than approximately
600 (primarily between 0' and 30') but load the PCL at
larger knee angles greater than approximately 60' (9,17,18).
Although patellar tendon force from quadriceps activity
can load either the ACL or the PCL depending on knee
angle, it is difficult to make definite conclusions regarding
how quadriceps activity and anterior knee movement may
influence cruciate ligament loading while performing squat
exercises, and additional research in this area is needed.
Although the wall squat short and one-leg squat both
resulted in similar amounts of anterior knee movement at
maximum knee flexion, PCL forces were significantly lower
in the one-leg squat compared with the wall squat short
between 90' and 700 knee angles during the squat ascent
(Table 1 and Fig. 6). One explanation of the greater PCL
forces between 90' and 700 knee angles in the wall squat
short compared with the one-leg squat is greater quadriceps
forces that are generated during the wall squat short because

ONE-LEG SQUAT AND WALL SQUAT

quadriceps forces at knee angles greater than 60' load the


PCL (9,17,18). Between 90' and 700 knee angles during the
ascent, the estimated quadriceps forces in the current study
were approximately 30-50% greater in the wall squat short
compared with the one-leg squat. Although hamstrings forces
between 90' and 700 knee angles also load the PCL, hamstrings forces were only 20-30 N greater in the one-leg squat
compared the wall squat short. In contrast, quadriceps force
magnitudes were approximately 150 N greater in the wall
squat short compared with the one-leg squat, therefore loading the PCL to a great extent compared with the hamstrings.
Although hamstrings forces were greatest in the one-leg
squat between 0' and 300 knee angles, the hamstrings are
not effective in either unloading the ACL or loading the
PCL due to a small insertion angle into the tibia that results
in most of the hamstrings force being directed parallel
instead of perpendicular to the tibia. Hamstrings force is
most effective in generating posterior shear force and in
loading the PCL when the knee is flexed approximately
90' (20). The relatively low hamstrings force (typically
less than 50 N) generated during the wall squat exercises
throughout the knee range of motion implies that wall
squat exercises primarily target the quadriceps and not the
hamstrings, whereas the one-leg squat is more effective in
recruiting the hamstrings. One reason for greater quadriceps
force and less hamstrings force in the wall squat short
compared with the one-leg squat is because the trunk is
erect in the wall squat short (greater knee extensor torque
and less hip extensor torque needed to overcome the effects
of gravity) but tilted forward 30'-40' in the one-leg squat
(less knee extensor torque and greater hip extensor torque
needed to overcome the effects of gravity).
The friction and the normal forces that the wall applied to
the subject may also help explain why quadriceps forces
were greater in the wall squat short compared with the oneleg squat during the squat ascent. Although friction was
minimized during the wall squat by using a smooth wall,
the normal force that the wall exerted on the subject's back
during the wall squat exercises resulted in an increased
friction force on the subject as they slid down and up the
wall. Because the friction force opposes motion, it acted
opposite the force of gravity during the squat descent but
in the same direction as the force of gravity during the
squat ascent. Therefore, the friction force made it easier for
the subject to control the rate of sliding down the wall by
producing a knee extensor torque but made it more difficult
for the subject to slide up the wall by producing a knee
flexor torque. Because the one-leg squat did not have a
friction force compare to the wall squat, this provides one
plausible explanation why quadriceps force and PCL force
were greater in the ascent phase of the wall squat exercises
compared with the one-leg squat.
The friction force also differed between the wall squat
long and short. Because during the wall squat long the heels
were twice as far from the wall compared with the wall
squat short, the normal force must be greater in the wall

Medicine & Science in Sports & Exercise 415

squat long. Because friction force is directly proportional to


the normal force, the downward-acting friction force on the
subject during the squat ascent was greater in the wall squat
long compared with the wall squat short, which makes the
wall squat long more difficult to perform. This may partially explain why PCL forces were greater in the wall squat
long compared with the wall squat short.
Cruciate ligament forces tended to be higher in the ascent
phase compared with the descent phase, in part because
quadriceps and hamstrings forces were also greater during
the ascent phase. For the wall squat exercises, significant
PCL force differences between squat descent and ascent
occurred only at higher knee angles between 600 and 900.
As previously mentioned, quadriceps force at knee angles
greater than 60' loads the PCL, and the greater quadriceps
force was greater during the ascent than the descent in part
due to having to overcome gravity and the downwardacting friction force. A different pattern occurred during the
one-leg squat, in which between 20' and 70' knee angles
PCL forces were significantly greater during the squat ascent compared with the squat descent. These findings are in
agreement with the squat literature, in which cruciate forces
have been reported to be greater in the squat ascent compared with the squat descent (11,12).
There are limitations in this study. Firstly, muscle and
cruciate ligament forces were estimated from biomechanical
modeling techniques and not measured directly because it
is currently not possible to measure cruciate ligament forces
in vivo while performing wall squat and one-leg squat exercises in healthy subjects. However, both Beynnon et al.
(3) and Heijne (15), who implanted strain sensors in patients within the anteromedial bundle of an ACL during
arthroscopic surgery for partial minisectomies or capsule/
patellofemoral joint debridement, after surgery had these patients perform one- and two-leg squat-type exercises. These
authors reported a peak ACL strain of approximately 2.84% (approximately 100-150 N) at knee angles between 0'
and 30'. These ACL force magnitudes and knee angles
from Beynnon et al. (3) and Heijne (15) are similar to the
current study. Unfortunately, there are no studies that have
quantified PCL forces in vivo while performing a squat
exercise, so it is not possible to compare the modeled PCL
force results in the current study to in vivo PCL forces.
The current study was limited to sagittal plane motion
only, and only subjects who could perform all exercises

without discernable frontal or transverse plane movements


were used in this study. Future three-dimensional biomechanical analyses of the knee during squatting are needed to
investigate the effects of transverse plane rotary motions
and frontal plane valgus and varus motions on cruciate
ligament loading. Slightly different cruciate ligament loading patterns during squatting may occur between two- and
three-dimensional analyses, although normal squatting is
primarily sagittal plane movements. A normal range of
motion of 50-70 knee valgus and 6'-14' of knee varus has

been reported during the one-leg squat (39), although these


relatively small amounts of valgus and varus may not affect
cruciate ligament loading. However, excessive knee valgus
has been shown to be associated with an increased risk of
ACL ruptures (22,39). Transverse and frontal plane hip
joint motions have also been shown to be associated with an
increased risk of ACL ruptures and are relatively common
in individuals with weak hip abductors and external
rotations (22).
In conclusion, throughout the 0-90' knee angles, the
wall squat long generally exhibited significantly greater
PCL forces compared with the wall squat short and the oneleg squat. There was generally no significant difference in
PCL force between the wall squat short and the one-leg
squat, except at 800 and 90' knee angles, where PCL forces
were greater in the wall squat short. Throughout the 00-900
knee angles, the wall squat exercises generated PCL force
magnitudes ranging approximately from 100 to 790 N, with
PCL magnitudes generally decreasing between 00 and 300
knee angles and increasing between 400 and 900 knee
angles. Moreover, the one-leg squat generated PCL force
magnitudes ranging approximately from 60 to 410 N, with
PCL magnitudes generally increasing between 500 and 90'
knee angles during the descent and 10-90' knee angles
during the ascent. ACL forces were only found in the oneleg squat, which generated relatively small magnitudes of
approximately 20-60 N between 00 and 40' knee angles.
The one-leg squat, the wall squat long, and the wall squat
short all appear to load the ACL and the PCL within a safe
range in healthy individuals.

The authors would like to thank Lisa Bonacci, Toni Burnham,


Juliann Busch, Kristen D'Anna, Pete Eliopoulos, and Ryan Mowbray
for all their assistance during data collection and analyses.

REFERENCES
1. Ariel BG. Biomechanical analysis of the knee joint during deep
knee bends with heavy loads. In: Nelson R, Morehouse C, editors.
Biomechanics IV. Baltimore: University Park Press; 1974. p. 44-52.
2. Basmajian JV, Blumenstein R. Electrode Placement in EMG
Biofeedback. Baltimore: Williams and Wilkins; 1980. p. 79-86.
3. Beynnon BD, Johnson RJ, Fleming BC, Stankewich CJ, Renstrom
PA, Nichols CE. The strain behavior of the anterior cruciate ligament during squatting and active flexion-extension. A comparison
of an open and a closed kinetic chain exercise. Am J Sports Med.
1997;25(6):823-9.

416

Official Journal of the American College of Sports Medicine

4. Brown CH Jr, Steiner ME, Carson EW. The use of hamstring


tendons for anterior cruciate ligament reconstruction. Technique
and results. Clin Sports Med. 1993;12(4):723-56.
5. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to
anterior-posterior drawer in the human knee. A biomechanical
study. J Bone Joint Surg Am. 1980;62(2):259-70.
6. Bynum EB, Barrack RL, Alexander AH. Open versus closed
chain kinetic exercises after anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med. 1995;
23(4):401-6.

http://www.acsm-msse.org

7. Cholewicki J, McGill SM, Norman RW. Comparison of muscle


forces and joint load from an optimization and EMG assisted
lumbar spine model: towards development of a hybrid approach.
JBiomech. 1995;28(3):321-31.
8. Dahlkvist NJ, Mayo P, Seedhom BB. Forces during squatting and
rising from a deep squat. Eng Med. 1982; 11(2):69-76.
9. DeFrate LE, Gill TJ, Li G. In vivo function of the posterior
cruciate ligament during weightbearing knee flexion. Am J Sports
Med. 2004;32(8):1923-8.
10. Epstein M, Herzog W. Theoretical Models of Skeletal Muscle:
Biological and Mathematical Considerations. New York: John
Wiley & Sons; 1998. p. 238.
11. Escamilla RF, Fleisig GS, Zheng N, Barrentine SW, Wilk KE,
Andrews JR. Biomechanics of the knee during closed kinetic chain
and open kinetic chain exercises. Med Sci Sports Exerc. 1998;30(4):
556-69.
12. Escamilla RF, Fleisig GS, Zheng N, et al. Effects of technique
variations on knee biomechanics during the squat and leg press.
Med Sci Sports Exerc. 2001;33(9):1552-66.
13. Fitzgerald GK. Open versus closed kinetic chain exercise: issues
in rehabilitation after anterior cruciate ligament reconstructive
surgery. Phys Ther. 1997;77(12):1747-54.
14. Hattin FIC, Pierrynowski MR, Ball KA. Effect of load, cadence,
and fatigue on tibio-femoral joint force during a half squat. Med
Sci Sports Exerc. 1989;21(5):613-8.
15. Heijne A, Fleming BC, Renstrom PA, Peura GD, Beynnon BD,
Werner S. Strain on the anterior cruciate ligament during closed
kinetic chain exercises. Med Sci Sports Exerc. 2004;36(6):935-41.
16. Herzog W, Read LJ. Lines of action and moment arms of the
major force-carrying structures crossing the human knee joint.
J Anat. 1993;182(Pt 2):213-30.
17. Jordan SS, DeFrate LE, Nha KW, Papannagari R, Gill TJ, Li G.
The in vivo kinematics of the anteromedial and posterolateral bundles of the anterior cruciate ligament during weightbearing knee
flexion. Am J SportsAMed. 2007;35(4):547-54.
18. Kaufinan KR, An KN, Litchy WJ, Morrey BF, Chao EY. Dynamic
joint forces during knee isokinetic exercise. Ant J Sports Med.
1991; 19(3):305-16.
19. Kvist J, Gillquist J. Sagittal plane knee translation and electromyographic activity during closed and open kinetic chain exercises in anterior cruciate ligament-deficient patients and control
subjects. Am J Sports Med. 2001;29(1):72-82.
20. Markolf KL, O'Neill G, Jackson SR, McAllister DR. Effects of
applied quadriceps and hamstrings muscle loads on forces in the
anterior and posterior cruciate ligaments. Am J Sports Med. 2004;
32(5):1144-9.
21. More RC, Karras BT, Neiman R, Fritschy D, Woo SL, Daniel
DM. Hamstrings-an anterior cruciate ligament protagonist. An in
vitro study. Am J Sports Med. 1993;21(2):231-7.
22. Myer GD, Chu DA, Brent JL, Hewett TE. Trunk and hip control
neuromuscular training for the prevention of knee joint injury.
Clin Sports Med. 2008;27(3):425-48.
23. Narici MV, Landoni L, Minetti AE. Assessment of human knee
extensor muscles stress from in vivo physiological cross-sectional
area and strength measurements. Eur J Appl Pl7vsiol. 1992;65(5):
438-44.
24. Narici MV, Roi GS, Landoni L. Force of knee extensor and flexor

ONE-LEG SQUAT AND WALL SQUAT

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

muscles and cross-sectional area determined by nuclear magnetic


resonance imaging. Eur J Appl Physiol. 1988;57(l):39-44.
Nisell R, Ekholm J. Joint load during the parallel squat in powerlifting and force analysis of in vivo bilateral quadriceps tendon
rupture. Scand J Sports Sci. 1986,8(2):63-70.
Ohkoshi Y, Yasuda K, Kaneda K, Wada T, Yamanaka M. Biomechanical analysis of rehabilitation in the standing position. Am
J Sports Med. 1991; 19(6):605-11.
Race A, Amis AA. The mechanical properties of the two bundles
of the human posterior cruciate ligament. J Biomech. 19 9 4 ;2 7 (j):
13-24.
Schatzmann L, Brunner P, Staubli HU. Effect of cyclic preconditioning on the tensile properties of human quadriceps tendons and
patellar ligaments. Knee Surg Sports Traumatol Arthrosc. 1998;
6(suppl 1):S56-61.
Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior
cruciate ligament reconstruction. Am J Sports Med. 1990;18(3):
292-9.
Shelburne KB, Pandy MG. A dynamic model of the knee and
lower limb for simulating rising movements. Comput kMethods
Biomech Biomed Engin. 2002;5(2):149-59.
Stuart MJ, Meglan DA, Lutz GE, Growney ES, An KN. Comparison of intersegmental tibiofemoral joint forces and muscle
activity during various closed kinetic chain exercises. Ant J Sports
Med. 1996;24(6):792-9.
Toutoungi DE, Lu TW, Leardini A, Catani F, O'Connor JJ.
Cruciate ligament forces in the human knee during
rehabilitation exercises. Clin Biomech. 2000;15(3):176-87.
Wickiewicz TL, Roy RR, Powell PL, Edgerton VR. Muscle architecture of the human lower limb. Clin Orthop Relat Res. 1983;
(179):275-83.
Wickiewicz TL, Roy RR, Powell PL, Perrine JJ, Edgerton VR.
Muscle architecture and force-velocity relationships in humans.
J Appl Physiol. 1984;57(2):435-43.
Wilk KE, Escamilla RF, Fleisig GS, Barrentine SW, Andrews JR,
Boyd ML. A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises. Ant J Sports Med. 1996;24(4):518-27.
Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile
properties of the human femur-anterior cruciate ligament-tibia
complex. The effects of specimen age and orientation. Am J
Sports Med. 199 1;1 9(3):217-25.
Yack HJ, Collins CE, Whieldon TJ. Comparison of closed and
open kinetic chain exercise in the anterior cruciate ligamentdeficient knee. Ant J Sports Med. 1993;21(1):49-54.
Zajac FE. Muscle and tendon: properties, models, scaling, and
application to biomechanics and motor control. Crit Rev Biomed
Eng. 1989;17(4):359-411.
Zeller BL, McCrory JL, Kibler WB, Uhl TL. Differences in kinematics and electromyographic activity between men and women during the single-legged squat. Am JSports Med. 2003;31(3):449-56.
Zemicke RF, Garhammer J, Jobe FW. Human patellar-tendon rupture: a kinetic analysis. J Bone Joint Surg [Ant]. 1977;59A(2):
179-83.
Zheng N, Fleisig GS, Escamilla RF, Barrentine SW. An analytical
model of the knee for estimation of internal forces during exercise.
J Biomech. 1998;31(10):963-7.

Medicine & Science in Sports & Exercise 417

COPYRIGHT INFORMATION

TITLE: Cruciate Ligament Force during the Wall Squat and the
One-Leg Squat
SOURCE: Med Sci Sports Exercise 41 no2 F 2009
The magazine publisher is the copyright holder of this article and it
is reproduced with permission. Further reproduction of this article in
violation of the copyright is prohibited.