NASM’s resistance training technique guidelines emphasize maintaining proper lower extremity alignment to prevent injury and maximize movement efficiency. For squatting patterns—including the ball squat—the knees should track in line with the second toe, ensuring the tibia and femur remain in proper alignment and reducing valgus or varus stresses at the knee. This position also promotes balanced foot loading and optimal activation of the glutes, quadriceps, and hamstrings. The Study Guide warns that deviations such as hip adduction, foot pronation, or internal hip rotation during squatting increase abnormal stress through the kinetic chain, leading to compensatory patterns and potential overuse injuries. Therefore, “knee over second toe” represents the correct, safe position for the lower extremities in a ball squat.
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