264

ORIGINAL ARTICLE

Biomechanical analysis of the single-leg decline squat

J Zwerver, S W Bredeweg, A L Hof
...................................................................................................................................
Br J Sports Med 2007;41:264–268. doi: 10.1136/bjsm.2006.032482

Background: The single-leg squat on a 25˚ decline board has been described as a clinical assessment tool
and as a rehabilitation exercise for patients with patellar tendinopathy. Several assumptions have been made
about its working mechanism on patellar load and patellofemoral forces, but these are not substantiated by
biomechanical evaluations.
See end of article for
Aim: To investigate knee moment and patellofemoral contact force as a function of decline angle in the single-
authors’ affiliations leg squat.
........................ Methods: Five subjects performed single-leg eccentric squats at decline angles of 0˚, 5˚, 10˚, 15˚, 20˚ and 25˚
Correspondence to:
(with/without a backpack of 10 kg), and 30˚ on a board that was placed over a forceplate. Kinematic and
J Zwerver, Center for Sports forceplate data were recorded by the Optotrak system. Joint moments of ankle, knee and hip were calculated
Medicine, UMC Groningen, by two-dimensional inverse dynamics.
PO Box 30.001, 9700 RB Results: Knee moment increased by 40% at decline angles of 15˚ and higher, whereas hip and ankle moment
Groningen, The
Netherlands; j.zwerver@ decreased. Maximum knee and ankle angles increased with steeper decline. With a 10 kg backpack at 25˚
sport.umcg.nl decline, the knee moment was 23% higher than unloaded. Both patellar tendon and patellofemoral forces
increased with higher decline angles, but beyond 60˚, the patellofemoral force rose steeper than the tendon
Accepted 27 force.
November 2006
Published Online First Conclusions: All single-leg squats at decline angles .15˚ result in 40% increase in maximum patellar tendon
15 January 2007 force. In knee flexions .60˚, patellofemoral forces increase more than patellar tendon forces. Higher tendon
........................ load can be achieved by the use of a backpack with extra weight.

P
atellar tendinopathy is a common overuse injury, especially To our knowledge, no studies about the decline squat have
in jumping athletes.1 Management of patellar tendino- been published that validate these assumptions and recom-
pathy is hampered by lack of valid and reliable diagnostic mendations. Therefore, we conducted a study on the bio-
and reassessment tools. Exercise-based conservative treatment, mechanics of the single-leg decline squat. The objective of this
including specific eccentric-strengthening exercises, is consid- study was to investigate knee moment and patellofemoral
ered to be useful in a rehabilitation programme in patients with contact force as a function of decline angle.
patellar tendinopathy.2–4
The single-leg squat performed on a decline board (fig 1) has METHODS
been described as a method to maximally load the knee Subjects
extensors in an eccentric manner. This functional test is Two male and three female subjects participated in this study.
considered as a useful clinical assessment tool for patients Their ages were between 19 and 24 years (mean 22), their
with patellar tendinopathy.5 6 Furthermore, it is used as an easy height ranged from 1.68 to 2 m (mean 1.8), and weight from 58
and effective rehabilitation exercise for patients with patellar to 84 kg (mean 72). They were all moderately physically active
tendinopathy.7–9 Both Purdam et al8 and Young et al9 hypothe- in sports (2–5 h/week), healthy and had no actual or previous
sised that the superior effectiveness of the eccentric decline problems with the knee, ankle or hip joint. All subjects gave
squat, compared to a normal eccentric squat on a flat floor, may their informed consent for the procedure of the study.
be the result of the fact that standing in the decline position Participation was voluntary and in agreement with the local
reduces the contribution of the calf to the squat. In this way, medical ethics committee guidelines.
knee extensors and the patellar tendon are maximally loaded.
Indeed, in a recent study, Kongsgaard et al10 demonstrated that Procedure
the use of a 25˚ decline board increases the load and the strain Two decline boards with the angle adjustable at 0–40˚ were
of the patellar tendon during a single-leg squat. However, this constructed. The board for the dominant leg was placed on the
could not be explained by a decreased calf muscle activity, force plate (Bertec 4060-08, Columbus, Ohio, USA). Kinematics
assessed by surface electromyography (EMG). Joint stop angles in sagittal view were recorded by an Optotrak (Northern
of ankle and hip changed significantly. They assumed that the Digital, Waterloo, Canada) optoelectronic system. Light-
less-flexed ankle and hip joints during the decline squat emitting diodes were attached at the ankle (lateral malleolus),
displaces the body’s centre of mass further behind the knee knee (lateral femoral condyle), hip (trochanter major) and
joint axis, thereby increasing the knee extensor moment and shoulder (acromion). Kinematic and force plate data were
thereby the load on the patellar tendon. Moreover, it is also recorded at 100 Hz by the Optotrak system. Joint moments of
unclear why a decline angle of 25˚ is considered to be the most ankle, knee and hip were calculated by two-dimensional
effective. inverse dynamics13 in Excel.
Based on the results of previous biomechanical studies,11 12 After a 5 min warm-up on a cycle ergometer (Lode Excalibur,
Purdam et al6 recommended not to flex the knee over 50–60˚ Groningen, The Netherlands) at 75 W, the subject performed
during the decline squat in order to maximise the patellar two pretest single-leg squats on the decline board to get used to
tendon force while balancing against excessive patellofemoral
compression, which occurs at 70˚ of knee flexion and beyond.6 Abbreviations: EMG, electromyography; GRF, ground reaction force

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Single-leg decline squat 265

during the downward movement. Subjects came back to

starting position by placing the contralateral leg on the second
decline board and extending this leg. They were instructed to
keep their trunk in an upright position and to avoid lateral
weight shift.
With the board at a decline angle of 25˚, some additional
exercises and measurements were carried out: (a) the subject
was loaded with an extra weight of 10 kg in a backpack, (b)
raising up to starting position with the dominant leg, and (c)
keeping the contralateral leg backward instead of forward.

Data handling
To account for differences in weight and stature of the subjects,
biomechanical variables were normalised as:
normalised force

F
F= (1)
mg

and normalised moment

M
M= (2)
mg h

where m is body mass, g is the acceleration of gravity and h is

leg length from the trochanter to the floor.14 All moments are
presented with extension as positive.
Knee flexion angle w is defined as 0˚ at straight knee and
ankle plantar flexion angle y as 90˚ at upright standing. When
the subject stands with the hip vertically above the ankle and
when the upper and lower parts of the leg are about equally
Figure 1 Eccentric decline squat (informed consent was obtained for long, it holds for the ankle angle (fig 2A):
publication of this figure).

the procedure and to check whether the force plate and ␸

y =90˚_ +a (3)
positioning system worked correctly. Each subject performed 2
two single-leg decline squats at 0˚, 5˚, 10˚, 15˚, 20˚, 25˚ and 30˚.
Declines of >35˚ proved impracticable because the subject slid where a is the decline angle. (If the hip is not above the ankle—
downwards and could not stand upright. All subjects per- that is, when normalised hip and ankle moments are
formed the decline squat standing on their dominant leg different—this relation is approximate.)
and flexing their knee, starting from complete extension As all knee extensors act by way of the patellar tendon,
to maximal flexion. The contralateral leg was kept forward (normalised) patellar tendon force equals:

Figure 2 (A) Diagram to show the relationship between decline a, knee joint angle w and ankle angle y. Note that y2a = 90˚2w/2 (the angle with the dot).
(B) Vector diagram to show the relationship between patellar tendon force Fp, quadriceps force Fq and patellofemoral contact force Fp-f. The ratio between Fp
and Fq, and the angle between them, were obtained from the model of Buff et al.11 (C) In a static approximation, the moments of hip (H), knee (K) and ankle
(A) equal the ground reaction force (GRF) multiplied by the perpendicular distance from the joint to the GRF (dashed lines).

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266 Zwerver, Bredeweg, Hof

Figure 3 Sample recording of knee, hip

and ankle moment (M) as a function of time
in two squats.

Statistical analysis
All data were analysed using Excel 2003 (Microsoft, USA).
M
Ftendon = (4) Comparisons were performed with use of the unpaired t test.
d The level of significance was set at 5%.

where d̂ = d/h is the normalised moment arm of the patellar

RESULTS
tendon. For d̂, experimental data of Krevolin et al15 were used,
Figure 3 shows a recording of knee, hip and ankle moment. Hip
which could be fitted by:
and ankle moment were low during the movement, whereas
the knee moment increased strongly with knee flexion during
~ 0.022 + 0.03sin(2␸)
d~ (5) the squats. It was verified that the squatting movement was
performed so slowly that contributions to the moments due to
Assuming that there is no cocontraction by the knee flexor accelerations of the limb were always negligible (,4 Nm for
muscles, the patellofemoral contact force Fp-f can be estimated the knee, and ,8 Nm for the hip). In addition, the ground
by means of the model of Buff et al,11 which gives the ratio reaction force (GRF) vector ran perfectly vertical. Figure 4
between the quadriceps force Fq and the patellar tendon force shows the average of the maximum normalised moments, at
Fp, and the angle between them. The patellofemoral force can maximal knee flexion. Knee moment increases, and hip and
then be found from the vector diagram (fig 2B). ankle moments decrease by up to about 15˚ of the decline
board. The differences in knee moment at 0˚ and 15–30˚ were
statistically significant (p = 0.035).
Maximum knee angle (fig 5) increased from 67˚ without
decline, up to about 83˚ at declines of >15˚. Maximum ankle
angle increased from 56˚ (= 34˚ dorsiflexion) to 81˚ at the
Knee Ankle Hip steepest decline.
0.4

0.35
120
Knee Ankle
0.3
100
0.25
Normalised moment

0.2 80
Joint angle (°)

0.15
60
0.1

0.05 40

_5 0 0 5 10 15 20 25 30 35 20
_0.05

_0.1 _5 0 0 5 10 15 20 25 30 35
Decline (°) Decline (°)

Figure 4 Normalised moments at maximum knee flexion as a function of Figure 5 Maximum knee flexion angle and minimum ankle plantar flexion
decline (bars indicate the range of the measured values). angle versus decline (bars indicate the range of the measured values).

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Single-leg decline squat 267

What is already known on this topic

N The single-leg decline squat is used as a clinical

assessment tool and as a rehabilitation exercise for
patients with patellar tendinopathy.

What this study adds

N This biomechanical analysis provides validation for the

use of the single-leg decline squat.
N Decline angles between 15˚ and 30˚ can be used to
increase the patellar tendon force.

Figure 6 Calculated force (F) in the tendon (Fp; solid line) and
N Knee flexion .60˚ should be avoided to prevent
excessive patellofemoral load.
patellofemoral contact force (Fp-f; dashed line) as a function of knee angle.

The additional exercises did not give significant differences, is in fact more than expected: 10 kg is 14% of the average body
except for the situation in which the subject was loaded with a weight of 72 kg. This is because the load is located posterior to
10 kg backpack. In that case, the mean knee moment was 23% the unloaded body centre of mass, and thus has a larger
(SD 10%, p = 0.02) higher than unloaded, and the maximum moment arm relative to the knee.
knee angle was 5˚ smaller (p = 0.04).
Patellofemoral contact force
DISCUSSION The aim of the single-leg decline squat is to achieve a maximal
Knee moment/patellar tendon force patellar tendon force. A point of concern is that the
This study clearly demonstrates that performing a single-leg patellofemoral contact force should not become excessive, as
decline squat on a decline board of >15˚ results in a 40% higher this may lead to the patellofemoral pain syndrome.19 When
knee moment, and thus patellar tendon force, compared to the ankle and hip moment are assumed to be zero, it holds for the
same exercise on a flat floor. The hip moment is low at all decline normalised knee moment.
angles and the ankle moment decreases with decline (fig 4).
From the mechanical viewpoint, these findings can be
~ 0.5sin (2␸)
M~ (6)
interpreted as follows. As the GRF vector ran vertical, and
inertial components to the moments were negligible, joint
moments are closely equal to the magnitude of the GRF The theoretical tendon and patellofemoral forces can be
multiplied by the horizontal distance from the joint to the GRF calculated with the estimated moment arm (equation 5) and
vector (fig 2C). With greater decline angles, the GRF is moved the model of Buff et al11 (fig 6). Both increase with higher
further from the knee joint, thus increasing the knee extensor decline angles, but beyond 60˚, the patellofemoral force rises
moment. In addition, the knee can be flexed more in a decline steeper than the tendon force. At 60˚, the patellofemoral contact
position (fig 5). force is already nine-times the body weight, a further increase
In our opinion, the higher knee moment and better knee seems undesirable. Knee flexion .60˚ should thus better be
flexion on a steeper decline can be explained by properties of avoided. When a higher tendon force is required, it may be
the ankle. At 0˚ or 5˚ decline, the ankle is in extreme better to give an additional backpack load.
dorsiflexion, around 56˚. In this position, the passive ankle
moment is considerable, in fact of the order of the measured Practical consequences
values.16 This high ankle moment implies a more anterior Our experiments demonstrate that performing single-leg squats
position of the GRF, and therefore the knee moment will be at decline angles .15˚ all result in a significant increase in the
lower as a consequence of the extreme dorsiflexion. In addition, maximum patellar tendon force. Any decline board between 15˚
this is uncomfortable to the subject, who can experience a tight and 30˚ can thus be used, whichever feels most comfortable to
feeling in the calf. The second reason is that the ankle, knee and the patient. To prevent patellofemoral pain syndrome, we
decline angles are related according to equation 3. When, recommend avoiding knee flexions .60˚. In case a higher
therefore, ankle dorsiflexion is restricted, the knee cannot be tendon load is required, we recommend the use of a backpack
flexed maximally without a decline. with extra weight.
Although Kongsgaard et al10 also found that patellar load
increased during a decline squat, they discussed that this could ACKNOWLEDGEMENTS
not be explained by a decrease in the ankle moment, as they We thank A Kingma, M Slotman and M Uitman for executing the
had found equal EMG values for gastrocnemius and soleus experiments.
with and without a decline. In our opinion, this argument is not
convincing because research shows that a passive ankle .......................
moment exists at relevant dorsiflexion angles.16 In addition, Authors’ affiliations
the active force–length relation of the muscle changes with J Zwerver, S W Bredeweg, A L Hof, Center for Sports Medicine, University
ankle angle, and hence also the ratio between EMG and ankle Center for Sport, Exercise and Health, University Medical Center
Groningen, University of Groningen, The Netherlands
moment.16–18
The additional exercises with different postures of the Competing interests: None.
contralateral leg showed no advantages. Only the addition of Informed consent was obtained for publication of the patients’ details
a 10 kg backpack showed a 23% increase in knee moment. This described in this report and for publiction of figure 1.

www.bjsportmed.com
268 Zwerver, Bredeweg, Hof

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