Save Knees When Squatting

29 Comments:

• At Sunday, January 28, 2007 3:06:00 PM,  Anonymous said…

  Have you seen this study, from Boston U? Please comment, David Brochin
  
  Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: The Beijing osteoarthritis study
  Auteur(s) / Author(s)
  YUQING ZHANG (1) ; HUNTER David J. (1) ; NEVITT Michael C. (2) ; LING XU (3) ; JINGBO NIU (1) ; LUI Li-Yung (2) ; WEI YU (3) ; ALIABADI Piran (4) ; FELSON David T. (1) ;
  Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
  (1) Boston University School of Medicine, Boston, Massacusetts, ETATS-UNIS
  (2) University of California, San Francisco, VENEZUELA
  (3) Peking Union Medical College Hospital, Beijing, CHINE
  (4) Brigham and Women's Hospital, Boston, Massacusetts, ETATS-UNIS
  
  Abstract
  Objective. To examine the association between squatting, a common daily posture in China, and the prevalence of radiographic osteoarthritis (OA) in different knee compartments among Chinese subjects from Beijing, and to estimate how much of the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in Framingham, Massachusetts is accounted for by the impact of squatting. Methods. We recruited a random sample of Beijing residents age ≥60 years. Subjects answered questions on joint symptoms, and knee radiographs were obtained. Subjects were also asked to recall the average amount of time spent squatting each day at age 25 years. Radiographic films (weight-bearing anteroposterior and skyline views) were read for Kellgren/Lawrence (K/L) grade and individual radiographic features. Medial disease was defined when radiographs showed a K/L grade of ≥2 at the tibiofemoral joint and a medial joint space narrowing score of ≥1, and lateral disease was assessed in a comparable manner in the lateral compartments. We examined the association of squatting with the prevalence of tibiofemoral OA as well as with the prevalence of patellofemoral knee OA, while adjusting for age and other potential confounding factors. We used the same approach to assess the relationship between squatting and tibiofemoral OA in the medial compartment and in the lateral compartment. Finally, we estimated the impact of squatting at age 25 on the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in the Framingham OA Study. Results. Squatting was very common among the Chinese subjects: ∼40% of men and ∼68% of women reported squatting ≥1 hour per day at age 25. The prevalence of tibiofemoral OA increased as the time spent squatting at age 25 increased in both the men and the women. Compared with subjects who squatted <30 minutes per day at age 25, the multivariable-adjusted prevalence odds ratios of tibiofemoral OA were 1.1 for time spent squatting of 30-59 minutes/day, 1.0 for 60-119 minutes/day, 1.7 for 120-179 minutes/day, and 2.0 for ≥120 minutes/day among the men (P for trend = 0.074), and the respective odds ratios among the women were 1.4, 1.3, 1.2, and 2.4 (P for trend = 0.077). A weaker association with patellofemoral OA was found. Prolonged squatting in daily life was more strongly associated with medial knee OA than with lateral disease in the men, but had a similar effect on both knee compartments in the women. After adjusting for the impact of squatting, the age-adjusted difference in prevalence of tibiofemoral OA was reduced from an excess of 14.4% to 9.5% in the Chinese women, but the difference in prevalence of tibiofemoral OA in the Chinese men increased after adjustment for age and squatting, from 2.9% lower to 7.0% lower as compared with their white counterparts. Conclusion. Prolonged squatting is a strong risk factor for tibiofemoral knee OA among elderly Chinese subjects in Beijing, and accounts for a substantial proportion of the difference in prevalence of tibiofemoral OA between Chinese subjects in Beijing and white subjects in Framingham.
  Revue / Journal Title
  Arthritis and rheumatism (Arthritis rheum.) ISSN 0004-3591 CODEN ARHEAW
  Source / Source
  2004, vol. 50, no4, pp. 1187-1192 [6 page(s) (article)] (27 ref.)
  Langue / Language
  Anglais
  
  Editeur / Publisher
  Lippincott, Hagerstown, MD, ETATS-UNIS (1958) (Revue)

   

• At Monday, January 29, 2007 4:33:00 AM,  Anonymous said…

  Dear Dr Bookspan,
  This seems a good spot to post a big thank you. I have been looking for years for the information you so generously provide, to correct my poor posture and recurrent back/neck problems.
  
  Having just "put my back out" through a rather silly accident, I started searching again and came upon your websites. The least I could do in return was buy a book, so I'm now reading through the ab revolution (the only one I could find as an ebook).
  
  Anyway, even with your most simple exercises I have made extraordinary progress in just two days and look forward to more, with your help and that of my excellent McKenzie-trained physio.
  
  BTW, came across this humourous film of the asian squat that you might have seen (or not) - thought it was apt for this blog post :) (Please delete the link if it's not appropriate to link to other sites here)
  
  http://www.danielhsia.com/m_squat.php

   

• At Monday, January 29, 2007 9:30:00 PM,  Anonymous said…

  The study that David Brochin quoted is interesting.
  
  A quick google search showed that as part of the same overall research program (The Beijing osteoarthritis study), the researchers found a much lower prevalence of hip osteoarthritis in elderly residents of Beijing than expected based on prevalence in elderly residents of Framingham. Would have been interesting to do a similar analysis of squatting habit with the hip cohort.
  
  Of even more interest in the context of back pain would be a study of relationship between squatting vs bending with back pain and damage.

   

• At Tuesday, January 30, 2007 1:30:00 PM,  Healthline said…

  Hi everyone,
  Jolie has asked me to leave a comment on her behalf. Jolie is currently in Malaysia where reliable internet access is spotty. She will continue to try to answer your comments once a good connection is found.
  
  She wanted me to convey to all of you to keep up the good work with reading and learning and not to worry - doing the squat right will work. "The real numbers do not show a problem. People who are inactive show far higher knee arthritis problems, normal wear is not a sign of damage from squatting, and squatting properly prevents far more problems like disc herniation from bad bending and knee problems from kneeling (studies of Western monks who spent years on knees... and washerwomen, etc.) Most important is to stop bad squatting like those exercises with heel up which cause all kinds of injuries. I see instructors of these methods all the time in my office for knee injury from it."

   

• At Thursday, February 01, 2007 1:35:00 PM,  Rhiannon Miller said…

  Interesting idea, but I find that when I squat with both feet fully on the floor, I have to throw my upper body forward to ensure that I don't fall over backwards. This means rounding my shoulders and sticking my head forward and arching my back and doing all the things you say I shouldn't be doing. I note that the chappie in the photo is doing these things too. So how do you reconcile these two ideas?

   

• At Friday, February 02, 2007 1:09:00 AM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Mim, great work fixing your pain quickly and easily, and posting the great link to the fun squatting video. i hope everyone takes a look. e-mail your own photos to me for posting, if you want, of your before and after success.

   

• At Friday, February 02, 2007 1:25:00 AM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Dave, thanks for looking up cool stuff. I am ordering the full study to see how they define arthritis and other points before commenting fully. You can't tell from an abstract what they really measured, left out, or how they ran the stats on the data. Results (and the interpretation and subsequent quoting and misquoting of conclusions) turn out differently based on these.
  
  - I have many patients with terrible knee x-rays but the pain is not from arthritis. We can easily stop pain either way.
  - One hour squatting is low compared to what I see all around me in Asia.
  - I see too many patients who are teachers of yoga and martial arts who do bad squatting (heel up, pistols, eagles, Hindu squats...) with injuries to the knee in addition to arthritis.
  - For other readers just joining us, know that we are talking about full sitting with heels near or on the tushy, not just good bending covered in many previous posts where you bend both knees, heels down, body upright to use for household and work bending instead of bending over at the waist or hip to lift and bend "wrong." Both kinds of squatting can strengthen legs, and protect knees.
  - You don't have to choose between hip or knee arthritis. Good body ergonomics prevents early wear and gives built in strengthening for both hip and knee.
  - There are several studies that do not find what the above quoted one says.
  
  Most important, from watching people on a daily basis here in Asia, and in all the patients I see every day for knee, back, and other pain and injury from bad movement and disease, it is not the ones who squat well for daily life who have the problems.
  
  We are on the road without a lot of internet access. I have many wonderful videos of elder people jumping in and out of trucks, squatting to wash and eat, people in rice fields squatting to talk on cell phones, and more. Simple message - live, bend, stretch, carry loads, and have a fun active life. Will post more next chance I get. People are waiting for this computer now.
  
  hey - does your study convince you not to do those Hindu squats now?
  :-)

   

• At Friday, February 02, 2007 12:24:00 PM,  Anonymous said…

  Hey Rhiannon,
  Check out Jolie's post Achilles Stretch in the Bathroom on how to prevent your back and shoulders from arching forward. Hold on to something until your achilles become flexible enough to allow your heels to touch the ground.
  Cheers!

   

• At Wednesday, February 07, 2007 1:52:00 PM,  Healthline said…

  Hi Riannon,
  Jolie is traveling right now, so replying to comments has been a challenge to say the least. She wanted me to convey to you that she will be addressing your comment when she gets better internet access. Basically, she agrees with you about the photo and is planning on covering that issue in her blog. Thanks so much for sharing your comment with others!

   

• At Sunday, February 18, 2007 7:46:00 PM,  Anonymous said…

  I have only great respect for Dr. Jolie Bookspan. But I'm still confused.
  
  The US National Ski Team uses a Chinese-based flexibility program by Adrian Crook called Inflex (www.inflex.com) which uses a "Hindu-squat" style squat, initially on the toes then goes flat-footed. Also used by Karch Kiraly, US Volleyball Champion and described in his book.
  
  US Marine Corps Lt. Col Bristol makes a big fuss over the effectiveness of Hindus Squats taught to him by Matt Furey, a man surrounded by marketing controversy but generally respected for his coaching and conditioning skills.
  
  Most Chinese Qi-Gong that I've seen, including www.chinese-health-exercises.com uses heels-up squats,etc.
  
  On the other hand, Pete Egoscue, the noted 'exercise anatomist'and author of the Egosuce Method uses a flat-footed static squat. Pavel Tsatsouline employs his 'pistol' or his Face-the-Wall squat where one juts out the butt to create greater depth over time. Both are flat-footed, though I noticed you criticized the Pistol as well as a 'bad' squat.
  
  So, with respect, I'm not sure I understand Dr. Bookspan's contention that Hindu Squats are bad. (Note: I have personal reasons for asking, they are fine on my knees, but my sacroilliac joint on one side takes a beating the next day. Others I know do them without complaint.) Just looking to improve my knowledge, please educate me, thanks Dave Brochin, Chicago.

   

• At Sunday, February 25, 2007 7:42:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Dave, hi, we like you too.
  
  Thanks for asking this question. The answer is simple. I like simple:
  Many people use various exercises, machines, products, etc., that produce the desired effects, and at the same time, are still not good for you. They use the heel-up squat. It is hard on the knee. It works the leg, yes. It is also hard on the knee. Smoking "works" to calm nerves and lose weight. Yes. It is also hard on the lungs and other parts.
  
  I see many practitioners and teachers of these heel-up squat exercises as patients for knee pain. They have muscles, yes. And knee damage. Often they have to quit the sport they were using the squats to train for, because of shot knees. I give them other exercise for the legs, for example Exercising With A Friend - Partner Leg Press, and others, which are fun, work the leg muscles functionally, and are not hard on the knee. The people get better. You can have it all.
  
  As far as the military using heel up squats, last year at a Special Ops military medical association conference, it was released that 62% of all our injuries in Iraq are coming from the gym - "Disease NonBattle Injuries." I was brought in to show different training ways that are effective without the joint trauma. When they first invited me I said, "No. You don't want me to lecture." They replied, "We didn't before, but we do now."
  
  You can feel the difference in your knees for yourself. Try this:
  
  - Stand with feet side by side, and bend both knees.
  - Let your heels lift and shift your weight so that your knees come forward. Hold. You may feel your weight press on your knees.
  - Now put both heels down and use your thigh and hip muscles to deliberately shifts your weight back over your heels and pull your knees back over your ankles.
  - Keep your upper body as upright as you can.
  - Shifting your weight back keeps your weight on your leg muscles and off your knee joints. The knee pressure should disappear. You get more leg and hip muscle exercise. People with active knee pain really notice the difference.
  - Don't stick your behind far out in back - another topic in spine health. Many people are taught to stick out in back - it lets you lift more by shifting weight to your spine and off the muscles. It "works" but with a big price tag. Just like lifting the heels.
  
  This reply is getting long. I will write you a post with more info. Let me know how this all works. As far as "criticizing" the heel-up method, no, of course, no criticism is intended. I just give the facts so that you can do what is best for your body. Do all the heel-ups you want, with the knowledge that it can eventually grind your knee cartilage, and with the promise that if it does, you'll come to the office and pay my bill :-)

   

• At Sunday, May 13, 2007 4:48:00 PM,  Anonymous said…

  Hi I injured my knee badly years ag and developed mild OA. It was fine till it lked when getting up from squatting and now the lateral menisus is jumping in and out and often locks the knee. Also the whole joint has suddenly beome much bigger and the lateral cndyle looks really large. I'e seen consultants who say the lateral compartment is badly worn but noone has explained the sudden enlargement of the bone. They said all they can do is remove the menisus and give me a partial joint replacement but they dont recommend it as I'm nly 45. I am desperately depressed at the situation up until it locked I had very good function and was able to run up and down stairs with no problems. Is there ANY way that I can try and get the excess bone t reabsorb? I find that if I contract my calf muscle the joint visibly moves forwards and the cartilage doesnt lk does this suggest that I hae a ligamentous instability rather than a cartilage tear? The MRI reports no tear but joint degeneration.

   

• At Sunday, May 20, 2007 4:17:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  gj, sorry to hear. I could use more information, but from what you say, it can get better. Don't be sad. If the MRI says no tear, then let's choose that good news to start with.
  When you say "the lateral menisus is jumping in and out" how do you know that? If you can see something moving, it is not likely the meniscus, and that's good. Removing a meniscus is not always needed. The meniscus is a needed shock absorber and cushion, good to retain to prevent more wear on the cartilage covering the knee bones. Are you referring to full squatting down to your heels holding a weight, or half-bending to make the bed?
  
  When you say "sudden enlargement of the bone," is there x-ray or scan that confirms it is bone which is "enlarged" rather than swelling or something other than bone?
  
  When you say "the joint visibly moves forwards" do you mean with straight knee, or bending knee, weightbearing, or non? Do you mean the upper leg bone or lower one (which part of the joint?).
  
  You made a good observation about not locking when you contract the muscle. Instability does not have to be permanent and can be retrained by the same simple good knee placement and leg muscle. If you bend your knees with both feet side by side, and keeping knees over feet - not sliding forward or inward, is there pain or locking?
  
  Joint replacement is extreme and not needed for something like this. Let's get some more answers and see about fixing it up in a simple manner without extremes, how is that? Good knee use using normal lifestyle bending is good stability and functional exercise:
  Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
  and
  Bending Right is Fitness as a Lifestyle.

   

• At Sunday, June 03, 2007 4:17:00 PM,  Anonymous said…

  Hi. Your description of proper bending sounds exactly like the way bending is described and taught by Alexander Technique teachers. Are you familiar with this?

   

• At Monday, June 04, 2007 2:18:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Reply to above question from Anonymous - It is similar to what some Alexander Technique teachers say and different from what others say.
  
  Some say to shift weight forward onto the knee joints and off the leg muscles in order to "relax" the muscles and "hang weight on the skeleton." I have heard similar instructions for the upper body to hang weight on the spine and off the back muscles to reduce "tension." These will increase muscle strain, decrease good exercise, and increase joint wear and tear over the long run. People with faulty muscle-use patterns do tense their muscles when they use them, however, it is not a solution to not use them.
  
  I see too many Alexander technique instructors as patients for back pain, neck and shoulder, and knee and hip pain, so I get a chance to learn what they are doing to cause it.

   

• At Monday, June 11, 2007 7:42:00 AM,  Anonymous said…

  I studied Tai Chi with C K CHu in NYC. The heels down squatting and the pelvic tilt are integral to his method of moving. It's also the second exercise in his Nei Kung. You can check out his Eternal Spring DVD and this video clip on "tucking in". http://www.chutaichi.com/taichivideos.shtml
  Also, here's his general website.
  http://www.chutaichi.com/
  You're doing great work. Not many people understand the body this way. RE from Pittsburgh

   

• At Tuesday, June 12, 2007 1:01:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Hi RE, thank you. Just make sure not to round your back as much as shown in the video, when you lift weight overhead or during sitting or bending. Rounding pressures discs outward. The mechanism of why rounding puts herniating forces on discs is shown in
  The Cause of Disc and Back Pain.
  
  The post What is Neutral Spine shows that when you tuck until neutral spine, a small inward curve still remains. You do not want to completely remove the small inward curve during certain activities.
  
  Here are some posts about over-rounding during activities:
  Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs
  shows about rounding when doing kicks
  
  Don't Fall for "Don't Sit Up Straight"
  and
  Does an Exercise Ball Make You Sit Straight?
  shows the rounded position that hurts discs when sitting.
  
  Good that you can tell the movement of tucking the hip to avoid overarching. Just tilt until you get to neutral spine, not until rounding like a turtle. For info to help your Tai Chi, try Healthy Martial Arts.

   

• At Tuesday, June 12, 2007 1:05:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  RE, even better - here is the working link for the book: Healthy Martial Arts.

   

• At Thursday, June 14, 2007 1:17:00 PM,  Anonymous said…

  One thing I like about Hindu squats is that they can quickly get me huffing and puffing, especially if done in Tabata style intervals. But the potential for knee damage in the long run is enough for me to drop them. If I keep my heels flat, but still go low enough to brush the floor with my fingertips--is that version safe to use?
  
  - Al

   

• At Sunday, June 24, 2007 4:02:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Al, yes, keep your heel down.
  
  If your goal is just to quickly "get huffing and puffing" you can do pushups, play with toddlers, or rearrange the furniture. Examine your goals and then move accordingly. It is smarter and healthier than just doing set exercises that may not be the most healthy. Any time you rise from the floor when sitting, try it without hands for functional exercise during the normal course of the day, for example, Quick and Easy Strength and Balance Exercise.

   

• At Wednesday, July 04, 2007 9:14:00 AM,  Anonymous said…

  I have found your article and all the comments very interesting. I was wondering if there are similarities to bad squatting and the movements required in rowing. Moving forward on a sliding seat with feet in a foot plate facing forward then pushing away from the foot plate using the balls of the feet using the thighs while keeping the body forward and the back straight. I'm a novice rower and avergae fitness at 40 and have in the last year or so developed crunching and grinding noises in my knees especially when going up stairs. I'm concerned rowing could be making my knees worse for the future with OA. Maybe my rowing career is over!-)

   

• At Thursday, July 05, 2007 3:29:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Katy, yes, good thinking. It is similar. You're in luck, since I love rowing and used to row on the river in college. Do not push off the balls of the feet. Push off the whole foot, feeling the push-off through the heel. You will love the more muscular strong push, and the effort will shift off the knees. Good rowing pushes with the heels, so your career is not over. Remember not to round forward for the catch to prevent ruining your lower back discs. Upper body is upright. Lean back during the pull, not rounded.
  
  More good news. Use the same heel-down push off for ascending stairs. I will cover stairs in future posts. My Fix Your Own Pain book covers all of this. Send photos and keep me posted.

   

• At Tuesday, July 10, 2007 12:10:00 PM,  Anonymous said…

  I have now, after yourexcellent advice, changed all my bending to squatting/lunging, however, I'm worried aboutmy knees. When doing a full squat, such as to rest, I can feel a slight pain in the knee joint, which kind of feels like I'm crushing something, an achey feeling down the centre, plus I quite often have my knee crack and it feels like my kneecap is moving slightly with it. Like something just under the base of my knee cap is popping into place, which is worrying, there's also occationally a slightly achey feeling just under the bottom of the knee cap and slightly to the outside of the leg.
  
  Am I doing something horribly wrong?
  Thankyou in advance!

   

• At Tuesday, July 10, 2007 2:09:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Hello Thomas, yes any time you have pain it is wrong. Simple. Without more info, what I can recommend is to stop full squatting for now. There can be a variety of reasons. Someone with bulky thighs and calf, for example, can pry the knee joint when squatting and leaning too far forward, or, depending on the size of the thigh and calf, any time they approximate (press together) upper and lower leg. Sometimes can just be a tightness.
  
  How does the half squat for bending around the house feel on the knee? See Bending Right is Fitness as a Lifestyle.There should be no kneecap pressure when you keep your weight back off the knee and on the thigh muscles. Keep it fun and comfortable and healthy.

   

• At Wednesday, July 11, 2007 11:51:00 AM,  Anonymous said…

  I've never been a fan of pain, and always thought the whole "no pain no gain" was an odd thing to say. It has a purpose... Anyway, I've been investigating, and it seems that my knees hurt in the squat only if I have my knees and feet pointing straight forward and parallel. If I point them both out slightly in a V (still with the foot and knee inline) they are quite easy and pain free.
  
  I think perhaps this could be from always standing in Shizen from Ninjutsu that I've been training in for many years, it's become natural for my legs and feet to be pointing slightly out, so much that I can feel a twisting sensation in my knee if I try and straighten my foot (I origianally though maybe I was duck footed, as it were, but turns out my whole leg was doing the same).
  
  Thus when I was putting my feet straight, my legs try to bend out, putting pressure on my knee joint.
  
  Thanks for all your great advice and hope this helps anyone with a similar problem! Is it okay to have your legs pointing out slightly for squatting as long as your knees are still inline? This is the only painless way for me to do them!

   

• At Sunday, July 15, 2007 5:34:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Thomas, good to hear your good work again. Joints should not hurt. Several simple points help shed light:
  
  Pointing knees and feet in the same direction is a general good way to keep the knee from twisting (with hip also forward not turned). In instances when I mention about facing feet forward, I should remember to write that the foot and knee and hip all align forward. Some groups get angry, saying pointing the foot forward (for squats or lifts or walking) will twist the knee. True if you turn the other segments out. Consider and align the whole leg, as you did. Maybe they can add smiling instead of being angry. Save knees and heart together.
  
  Unfortunately Ninjutsu Shizen is believed to be "natural stance." It even used to be taught in exercise science that a natural stance was turned out - a matter of mixing "natural" with "common."
  
  In your case, it may be that the whole lower kinetic chain is not straight forward so twisting occurred with feet forward. Other factors possible. Good thinking to prevent that. I'd be glad to take a look. Send photos and keep your positive work coming.

   

• At Tuesday, July 17, 2007 11:21:00 AM,  Anonymous said…

  Dear Dr. Jolie Bookspan,
  I would like to ask you:
  
  (1) Do you think people in western society should squat more during their daily activities? For example... reading the newspaper while full-squatting (paper on the floor)? Or typing on a laptop which is on the floor? Maybe the head would be in a bad posture...
  (2) I tried adopting your tuck-in-your-pelvis advice, but then read
  about the possible damage to L4-L5 and L5-S1 - see middle picture. So (too much) tucking in is bad while sitting?
  
  Thank you,
  Daniel.

   

• At Monday, July 30, 2007 5:21:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  Daniel, the tuck is to reduce overarching to neutral spine. Don't overdo the tuck so much that you round. The post Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique covers being too arched, tucking to neutral, and rounding too much.
  
  Probably the more helpful start for Westerners is to use the half-squat and lunge for daily bending. Click the links to see all the functional exercise applications.

   

• At Thursday, September 25, 2008 1:29:00 PM,  Jolie Bookspan, M.Ed, PhD, FAWM said…

  For Katy's question on knee pain and "similarities to bad squatting and the movements required in rowing" - here is the link to the post Prevent Knee Pain When Rowing.

   

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