RSM-DPA-003
Written by Hironori Ikeda, MSc Sports Medicine
RSM International Academy · Chiang Mai, Thailand
What Should You Compare When a Squat Shifts to One Side?
A client feels that one leg does all the work when standing out of a squat. Another shifts only near the bottom, where the hip pinches. Those complaints can look similar from the front while requiring different assessments.
At RSM, I first identify the phase and symptom, then compare forward ankle travel, hip rotation and the relationship between trunk and tibia. A change in stance or heel support helps test a working idea without naming a weak or shortened muscle prematurely.
This guide explains the muscle actions behind those comparisons, when local palpation is useful, and how to repeat the original squat. The goal is to choose a relevant next step rather than merely centre the pelvis in a photograph.
In This Article
- What Should You Compare When a Squat Shifts to One Side?
- In This Article
- 1. Squat Shift: Which Phase Changes, and Is It Painful?
- 2. Functional Anatomy: Why the Trunk Changes Hip and Knee Demand
- 3. Ankle Dorsiflexion: Separate the Range Test From Heel Support
- 4. Hip Rotation and Local Contact: Do the Findings Agree?
- 5. Re-Test the Original Squat Before Choosing the Next Step
- Related RSM Clinical Blogs
- Supporting Clinical Notes
- Palpation, Contact and Re-Assessment
- Therapist Position and Movement
- Study Dynamic Posture Assessment at RSM
1. Squat Shift: Which Phase Changes, and Is It Painful?
Start with a comfortable bodyweight squat using the client's usual foot angle and stance. Mark the feet, choose a repeatable depth and watch a few unhurried repetitions. Does the pelvis move sideways while lowering, only at the bottom, or as the knees begin to extend? If the familiar difficulty appears only with a heavier load or later in a set, record that threshold; the unloaded screen has not reproduced the complaint. Any later supervised comparison should change load or repetition exposure separately, without provoking escalating pain just to display the shift.
Ask which foot feels more loaded and where discomfort starts. Keep that report separate from what the camera shows. In athletes after ACL reconstruction, Song and colleagues found associations between sideways hip position and unequal loading; that does not make a visible shift a direct force measurement.
I compare the first repeatable troublesome phase, not the most dramatic still image. A painless, consistent preference may be less relevant than a new shift after injury. Recent trauma with rapid swelling, locking or inability to bear weight calls for assessment before more squatting.
2. Functional Anatomy: Why the Trunk Changes Hip and Knee Demand
The quadriceps lie at the front of the thigh and transmit knee-extension force through the patella to the tibial tuberosity. Gluteus maximus lies behind the hip and contributes to hip extension. During descent these extensor groups resist the external flexion demand; during ascent they help straighten the lower limb.
Soleus lies deep to gastrocnemius and transmits plantar-flexor force through the Achilles to the heel. With the foot planted, it helps oppose forward tibial progression as the ankle dorsiflexes. A blocked ankle and a painful knee can therefore alter the squat without producing the same underlying problem.
Forward trunk inclination generally increases hip-extensor demand relative to a more upright squat, while greater forward tibial inclination increases knee demand. I watch both from the side before interpreting a lateral lean. Forcing the chest upright may change the effort distribution without resolving why the person avoided one side.
3. Ankle Dorsiflexion: Separate the Range Test From Heel Support
Compare knee-to-wall dorsiflexion with a consistent foot angle and the heel down. Record forward knee travel and whether the limit feels like calf tension or familiar ankle pain. Watch for the foot turning outward or the heel lifting to gain distance.
If appropriate, compare the squat with a small stable support beneath both heels, keeping stance and depth comparable. Ask whether the same symptom or shift changes. This changes ankle demand and overall balance; a better-looking result does not prove that soleus is shortened.
Crowe and colleagues placed a wedge beneath one forefoot to restrict dorsiflexion experimentally and found greater force through the unrestricted leg. Our heel-support trial changes the task differently. I use it to decide whether closer ankle assessment is useful, then remove it before judging the original squat.
4. Hip Rotation and Local Contact: Do the Findings Agree?
When the shift coincides with groin or buttock discomfort, compare comfortable hip flexion and rotation with the pelvis supported. In sitting with the hip and knee bent, moving the lower leg outward rotates the femur inward. Note whether the pelvis turns first or the familiar symptom limits the range.
Restricted rotation alone cannot distinguish muscle, capsule or bony shape. Persistent familiar groin pain deserves a joint-focused examination within the clinician's scope; a positive provocation test is only one finding. Do not repeatedly force the hip farther inward to obtain symmetry.
For a reassuring local muscular presentation, I may compare tolerable contact in the superficial gluteal layer with the hip supported, using the greater trochanter as an orientation landmark. Gluteus maximus overlies deeper rotators and the sciatic region. Stop the contact and reassess if new sharp or electric pain, spreading tingling, numbness or weakness appears; tenderness is not permission to press deeper.
5. Re-Test the Original Squat Before Choosing the Next Step
Return to the original foot marks, footwear, depth and pace after one selected cue or contact trial. Compare the familiar symptom and the phase when the pelvis shifts. A shallower squat or a wider stance may help, but it is a different comparison and should be recorded that way.
Stance width and body proportions affect ankle, knee and hip motion during an unloaded squat. An alternative stance may be a practical option rather than a defect to eliminate. I look for comfortable, repeatable performance instead of forcing every person into the same silhouette.
If ankle or hip findings do not explain the troublesome phase, reconsider load tolerance, pain avoidance and task familiarity before adding treatment. An immediate response cannot establish lasting recovery. Persistent pain or instability needs appropriate follow-up, and a comfortable bodyweight squat does not clear the client for heavy lifting or landing.
Related RSM Clinical Blogs
Browse all Dynamic Posture Assessment clinical guides
▷ Knee or Pelvis Shifts During a Lunge: What to Check — Dynamic Posture Assessment · Compare the squat with a lunge, where front-ankle travel and rear-hip position create different demands.
▷ Squat Shift to One Side: Hip, Ankle or Trunk? — Deep Tissue Massage · Connect an assessment finding with a specific calf, adductor or gluteal contact decision.
▷ Limited Hip Internal Rotation: Muscle, Capsule or Pelvis? — Deep Tissue Massage · Explore the distinction between hip rotation, pelvic movement and a joint or neural presentation.
Supporting Clinical Notes
Palpation, Contact and Re-Assessment
▷ Make a Movement Baseline Repeatable Before Treatment
Therapist Position and Movement
▷ Observer Position for a Comparable Squat Assessment
Study Dynamic Posture Assessment at RSM
In Dynamic Posture Assessment & Kinetic Chain Training, practise relating squat phase, foot support and joint motion to an assessment hypothesis. Completion of Trigger Point Therapy provides a clinical palpation foundation.
Deep Tissue Massage develops the next contact decision: which muscle layer to approach, how to support the limb and when the original squat provides a useful re-test. Choose the learning sequence using the current course requirements.
View the course schedule and entry requirements · Ask about course suitability and registration
About the Author
Hironori Ikeda, MSc Sports Medicine
Hironori leads RSM International Academy in Chiang Mai, Thailand. His teaching connects functional anatomy, clinical palpation and kinetic-chain assessment with practical massage decisions.
Read Hironori’s professional background and teaching approach