Associations between anthropometric characteristics, self-reported musculoskeletal and visceral symptoms, and squat movement quality : a cross-section study

Abstract

Background: This study investigated associations between anthropometric characteristics, postural deviations, musculoskeletal and visceral symptoms, and squat movement quality to clarify how individual physical attributes and symptom profiles influence fundamental movement performance. Method(s): A cross-sectional observational study recruited adults aged 18–65 who could ambulate without pain. Anthropometric and body composition measures were collected. Standardized posture images and multi-angle squat videos were obtained, and visual classifications of posture and squat technique were conducted using predefined criteria. Descriptive statistics characterized the sample, and multivariable logistic regression with LASSO regularization examined associations between demographic, postural, and symptom variables and binary squat outcomes. Results: Two hundred participants (57.5% female; median age 26 years) were included. Males showed higher stature, lean mass, and waist circumference, whereas females exhibited higher body fat and reported more neck pain and headaches. Forward head posture was common (62%), while women demonstrated more favorable upper-body alignment. Most participants maintained neutral lumbar posture and grounded heels during squats, with sex differences in foot rotation and knee path. Higher fat mass predicted reduced squat depth (OR = 1.06, 95% CI: 1.00 to 1.11, p = 0.033); heel lift and absent forward knee movement were associated with better spinal neutrality (OR = 0.07 and 0.18, both p ≤ 0.002); and low skeletal muscle mass (OR = 0.87, 95% CI: 0.79 to 0.95, p = 0.004) and heel lift (OR = 7.09, 95% CI: 1.86 to 26.2, p = 0.003) predicted suboptimal knee tracking. Only 8% achieved a fully “perfect” squat. Conclusion(s): Suboptimal squat mechanics were linked to higher fat mass, lower skeletal muscle mass, and compensatory lower-limb strategies, suggesting that squat quality reflects an interaction among body composition, posture, and motor control rather than any single demographic or anthropometric factor.