Squats with your toes on plates (but heels in the air)

[ReboundReps]

I recently saw a physio about some knee problems I've been having. He said my patellar is maltracking and getting pulled out to the side due to a muscle imbalance.

One of the exercises he gave me was to do bodyweight squats on a step (like one of those Reebok ones) but with my toes on the step and my heels off the edge and with a ball in between my knees... I think he said it was mainly to strengthen my ankles.

I have a few questions about this:

1) is there a name for this kind of squat? As I'd like to look at some videos online and read up on it a bit, but I can't find ANYTHING that matches the description. I can only find 'heels elevated' squats

2) is it okay to use a couple of plates instead of a step? As I cant get to the gym due to the coronavirus lockdown nor can I go out and buy a step... I have a couple of small plates at home that I can put under my feet but they don't feel very stable as they are pretty small

3) is squatting in this way a good way to target my VMO? as I feel like this exercise is helping me, but I feel more like its because its hitting my VMO pretty hard rather than what my physio mentioned about it strengthening my ankles

[Heisman2]

I'm trying to understand. Do you essentially stand on a stair with the balls of your feet on the stair, your heels off the stair, similar to when someone may want to do a calf raise? But instead of doing the calf raise you are doing a squat which is forcing you to maintain the weight on the balls of your feet? Is that what you are doing?

[Cazken]

were not ur doctors. this is bodybuilding not physical therapy.

it’s rly ez to find what u were looking for, heel elevated but ur toes are elevated so..toe elevated squats

[ReboundReps]

I'm trying to understand. Do you essentially stand on a stair with the balls of your feet on the stair, your heels off the stair, similar to when someone may want to do a calf raise? But instead of doing the calf raise you are doing a squat which is forcing you to maintain the weight on the balls of your feet? Is that what you are doing?

Yep that's exactly it, so the stance would be the same as calf raises on a step... but doing a squatting movement instead

[WolfRose7]

were not ur doctors. this is bodybuilding not physical therapy.

it’s rly ez to find what u were looking for, heel elevated but ur toes are elevated so..toe elevated squats

Except some of us are.

Also doctors as in GPs are less likely on average to have a vested interest in gaining knowledge of lifting specific injury/issue, because it's a tiny tiny section of what they see people for.

Physical therapists obviously are more appropriate, however the physical therapy field can be... A little iffy in regard to how much a therapist values staying up to date with research, and how much they like inventing their own rather random theories and therapies... Like with many fields, some are excellent and many are quacks, or at least.. Poorly informed/self educated.

It's perfectly reasonable for OP to ask for more clarity here, even if most of us won't be able to help much it will improve his own ideas of his situation.

As it is, I can't help OP much myself, but would suggest checking out Barbell Medicines free content on YouTube and Spotify on Pain Management with regards to lifting, and their pain/injury discussions(or, importantly maybe Not injury).

[Heisman2]

Yep that's exactly it, so the stance would be the same as calf raises on a step... but doing a squatting movement instead

Got it. So it's kind of like Peterson step ups; those are known to preferentially act on the VMO so it make sense for you to feel it there. If you have any books you can use books instead of plates for a more stable base. Strengthening the VMO is a common recommendation for patella tracking issues. I don't see this doing anything for your ankles other than an isometric contraction but not with enough weight to be really meaningful, but that doesn't mean it's a bad idea to do it. If you feel yourself getting strong with it and it's not causing any pain then it's probably a reasonable exercise to continue.

[ReboundReps]

Got it. So it's kind of like Peterson step ups; those are known to preferentially act on the VMO so it make sense for you to feel it there. If you have any books you can use books instead of plates for a more stable base. Strengthening the VMO is a common recommendation for patella tracking issues. I don't see this doing anything for your ankles other than an isometric contraction but not with enough weight to be really meaningful, but that doesn't mean it's a bad idea to do it. If you feel yourself getting strong with it and it's not causing any pain then it's probably a reasonable exercise to continue.

Perfect, thank you!

I just checked out Peterson step ups, they do seem like a similar idea.

I was also looking into tiptoe squats, might these have a similar effect? I like how I wouldn't need any equipment to do them

Also for these kinds of exercises, is it okay for your knees to go past your toes slightly? or is that still a no-no?

[GeneralSerpant]

Also doctors as in GPs are less likely on average to have a vested interest in gaining knowledge of lifting specific injury/issue, because it's a tiny tiny section of what they see people for.

Physical therapists obviously are more appropriate, however the physical therapy field can be... A little iffy in regard to how much a therapist values staying up to date with research, and how much they like inventing their own rather random theories and therapies... Like with many fields, some are excellent and many are quacks, or at least.. Poorly informed/self educated.

I would imagine a GP should be somewhat capable of referring you to a suitable professional, even whether your preference be physical therapy or chiropractic. Isn't that kind of a normal practice of their job as it is when they find stuff that's more specific?

[WolfRose7]

I would imagine a GP should be somewhat capable of referring you to a suitable professional, even whether your preference be physical therapy or chiropractic. Isn't that kind of a normal practice of their job as it is when they find stuff that's more specific?

Sure but that's presuming what you think is an issue is actually an issue.
It also relies on having a good GP. Most are, but I'm sure we have all known plenty who failed to refer something on when they should have, or worse thrown medication at the issue with no thought for what caused it.

[SteadyFlexOnU]

Its called twerking

[Heisman2]

Perfect, thank you!

I just checked out Peterson step ups, they do seem like a similar idea.

I was also looking into tiptoe squats, might these have a similar effect? I like how I wouldn't need any equipment to do them

Also for these kinds of exercises, is it okay for your knees to go past your toes slightly? or is that still a no-no?

Do you have books, a stack of paper, or anything else you can stand on? You can definitely try them slightly tip-toed if not. It's never really frowned upon to have knees go past the toes with squats by the way. As long as the movement you are doing is not generating pain it should be ok. Additionally, it would be exceptionally difficult to not have your knees go past your toes while keeping the weight over the balls of your feet.

I would imagine a GP should be somewhat capable of referring you to a suitable professional, even whether your preference be physical therapy or chiropractic. Isn't that kind of a normal practice of their job as it is when they find stuff that's more specific?

All GPs should be capable of referring if needed. Many will say to take NSAIDs/do stretching/etc first and then let them know if not improved, so things may get a bit delayed but if there is no improvement after 2-4 weeks most will refer at that point (and many will refer sooner if requested assuming there is anything slightly abnormal going on). Unlikely to have many refer to a chiropractor as those of us in medicine typically frown upon the practice of chiropractors as while some of them do good work a large amount of the field is predicated on pseudoscience and has no evidence to support it. But referrals to physical therapy, orthopedic specialists, and sports medicine doctors are not difficult if there is an indication.*

*The exception being now with COVID-19 as a lot of clinics are not seeing patients for non-urgent issues... no idea when this will pass.

[Garage Rat]

From what i am reading your PT is recommending this squat for ankle strength correct.
You may want to ask them about doing heel raises(calve raises) off a block.
Many old time bodybuilders /lifters did what the called a deep knee bend basically a squat on the toes(balls of the feet) from the floor,heels up,feet close and turned out at a 45 degree angle.
Doing them like this puts most stress on the quads because you have to stay straight or you'll lose balance.
And because you have to maintain that position the knees travel forward putting stress on the VMO(tear drop muscle).
Bodybuilders use this position on the hack squat machine to hit that area.
You can check pics of Tom Platz doing them in a similar way on the hack machine.
For the other questions it is best as mentioned to ask your PT if it's ok since he knows your medical issues better than we on this forum.
Good luck.

[GeneralSerpant]

All GPs should be capable of referring if needed. Many will say to take NSAIDs/do stretching/etc first and then let them know if not improved, so things may get a bit delayed but if there is no improvement after 2-4 weeks most will refer at that point (and many will refer sooner if requested assuming there is anything slightly abnormal going on). Unlikely to have many refer to a chiropractor as those of us in medicine typically frown upon the practice of chiropractors as while some of them do good work a large amount of the field is predicated on pseudoscience and has no evidence to support it. But referrals to physical therapy, orthopedic specialists, and sports medicine doctors are not difficult if there is an indication.*

*The exception being now with COVID-19 as a lot of clinics are not seeing patients for non-urgent issues... no idea when this will pass.

Logical. With respect to what was said above though, I'm just inclined to ask what the difference is, as you see it I mean. He was saying above that physical therapy can be lousy, so does the differential amount to much? From what I've gathered in the past casually, chiropractic practice can be comparably organized and comprehensive.

Sure but that's presuming what you think is an issue is actually an issue.
It also relies on having a good GP. Most are, but I'm sure we have all known plenty who failed to refer something on when they should have, or worse thrown medication at the issue with no thought for what caused it.

For sure, so it's mostly just another person in the chain you have to rely on.

[Heisman2]

Logical. With respect to what was said above though, I'm just inclined to ask what the difference is, as you see it I mean. He was saying above that physical therapy can be lousy, so does the differential amount to much? From what I've gathered in the past casually, chiropractic practice can be comparably organized and comprehensive.

Good question. ReboundReps, sorry for getting this thread a bit off topic; if it bothers you let me know and I'll stop.

Some PTs do not know what they are doing and come up with rather out there ideas, others do know what they are doing. That doesn't mean necessarily they can handle all things out there but most PTs do not need to do this. The vast majority of people who go to PTs do so due to a subset of common/chronic issues (think anyone post-surgery who needs to regain functionality, anyone with back pain/knee/pain/ankle pain/etc). Most of the time most of these conditions will respond to almost anything that is done regularly with some sort of progressive scheme. If things get better (and they usually do at least to a degree) that is great. If things do not get better then they refer back to the physician who will likely do a more thorough workup (ie, expensive imaging) and consider more specialty involvement if needed (ie, for athletes some who has more experience/training, for people with just a lot of pain they will possibly send to a pain clinic). At a pain clinic you may get more "alternative/homeopathic type" therapies (ie, acupuncture, oils, etc) in addition to other treatments. If the issue is loss of function you may get sent to a neurologist if need be to do EMG/NCS to evaluate specific muscle/nerve function directly. Point being there's going to be another escalation step to go to if the conventional PT work does not help. Assuming no red flags none of this will be done initially due to the vast majority of people getting better with simple techniques.

Chiropractors can be different in the sense they will try to do everything themselves (potentially). Obviously not all; there are without question some very good chiropractors out there who understand their role/capabilities and when to refer back to medical doctors. The problem is for the average lay person there is not going to be an obvious way to know if you are going to a "good" one or a "bad" one. Additionally, all the joint manipulation/hammering/etc has very weak evidence for any long lasting benefit. It feels good in the moment just like it does when I crack my knuckles but that doesn't mean there is any long term change this is going to make a difference.

From a "what can I expect to happen if I go to each" standpoint, a decent PT will do some sort of baseline evaluation, come up with a series of exercises/stretches to have you do to work on whatever ails you, give you a home exercise program to follow at home, and have you come back for follow-up appointments to assess progress, give you new exercises, and adjust things accordingly. I am not familiar with chiropractors doing something similar. They may do an assessment of some sort and try to get you back into "alignment" but I'm not aware of them teaching exercises to do at home and providing a home exercise program to work with. If I'm wrong about this someone can let me know.



EDIT: one more point I will make. There are several physicians who are DOs. All of them learn some level of manipulation (similar to what chiropractors stereotypically do when they crack your neck or back) and some even do further training in it. Most of them use it very sparingly in their own actual practice, and that's because it simply is not very beneficial for most things (there are some exceptions where it is helpful).

[ReboundReps]

Do you have books, a stack of paper, or anything else you can stand on? You can definitely try them slightly tip-toed if not. It's never really frowned upon to have knees go past the toes with squats by the way. As long as the movement you are doing is not generating pain it should be ok. Additionally, it would be exceptionally difficult to not have your knees go past your toes while keeping the weight over the balls of your feet.

I have a few books but don't think they are sturdy enough either unfortunately, I think I'll stick with the plates for now and see how I get on then

Thanks for the tips!

[ReboundReps]

From what i am reading your PT is recommending this squat for ankle strength correct.
You may want to ask them about doing heel raises(calve raises) off a block.
Many old time bodybuilders /lifters did what the called a deep knee bend basically a squat on the toes(balls of the feet) from the floor,heels up,feet close and turned out at a 45 degree angle.
Doing them like this puts most stress on the quads because you have to stay straight or you'll lose balance.
And because you have to maintain that position the knees travel forward putting stress on the VMO(tear drop muscle).
Bodybuilders use this position on the hack squat machine to hit that area.
You can check pics of Tom Platz doing them in a similar way on the hack machine.
For the other questions it is best as mentioned to ask your PT if it's ok since he knows your medical issues better than we on this forum.
Good luck.

I 'think' he was recommending it for ankle strength, but to be honest it was hard to understand everything he said as he was constantly cracking jokes and trying (unsuccessfully) to be be funny lol. So maybe he prescribed it more for VMO strengthening but didn't explain it very well.

Unfortunately their practice is closed due to the virus and also couldn't get hold of his email address beforehand either.

I've just googled Tom Platz doing those deep knee bends... jesus! I'm not sure my patellars would still be in one piece if I did them I imagine toe squats would have a similar effect but less extreme?

[ReboundReps]

I would imagine a GP should be somewhat capable of referring you to a suitable professional, even whether your preference be physical therapy or chiropractic. Isn't that kind of a normal practice of their job as it is when they find stuff that's more specific?

I pretty much always skip the GPs and go private when it comes to issues such as this, otherwise I'd be waiting forever

But with the current pandemic I'm not sure I'd even be able to see a GP at all for something like this sadly