Forgotten Medicine: Squatting and Floor Sitting


In November of 2007, I interned at the Guangzhou Institute for Traditional Chinese Medicine (TCM), in Guangzhou, China. When traveling in China, I observed that Chinese people, young and old, rested in a flat-footed squat. While our upscale hotel boasted western toilets, squat toilets prevailed in every public place that I visited, including the hospital, restaurants, and tourist attractions. Back home in the land of criss-cross-apple-sauce, I rarely, if ever, saw anyone squatting. To my knowledge, no one was using a squat toilet.

Squat NeedlesI lived in Japan and Korea during elementary school, so I was not a stranger to squatting to use the bathroom. During my China internship, however, I discovered a strange phenomenon: squatting to pee took more coordination than I remembered. Truthfully, it felt a little awkward to sit in a deep flat-footed squat of any kind. An epic adventure in a local shop’s restroom, involving me and a tiny squat toilet, which was located partly beneath a sink and nearly flush with a wall, left me plagued with a question…how on earth do they do it?

Shortly after returning to Wisconsin, I became pregnant with my first child. I planned a homebirth with a certified professional midwife. While reading about natural childbirth, I discovered that in traditional cultures, women often squat to give birth. Squatting widens the pelvic outlet and takes advantage of gravitational force.¹ It was on. I began doing squatting exercises regularly, determined to squat my baby out. Ultimately, I gave birth in a supine position, leaning back against the side of the birth tub. Though I squatted throughout my labor, I had little squatting stamina while applying the extreme downward pressure that I found necessary for giving birth.

My recovery from childbirth was difficult. Every part of my pelvis hurt: SI joints, pubic symphysis, hip joints, ischial tuberosities. I delivered my daughter naturally, but my postpartum pelvic pain left me strongly considering taking pain medications. Soon afterwards, I experienced a mild cystocele. The symptoms resolved over several months with the use of acupuncture, herbal medicine, and the Arvigo Techniques of Maya Abdominal Therapy®. At 30 years of age, however, I was a wreck about it. Intuitively I knew that something wasn’t right, and it wasn’t just me. Given that childbirth is imperative to the survival of our species, common sense dictates that healthy young women should be able to vaginally deliver babies without such consequences.

In researching prolapse conditions, the following words, written by biomechanist, Katy Bowman, flashed like a neon sign across my computer screen, “the ‘squat movement’ is going to happen in a big way, once everyone realizes that your Pelvic Floor, Hip, and Knee health require regular squatting”.² Through Katy’s work, I discovered a very simple premise: by not squatting, thus having difficulty squatting, thus no longer trying to squat, I had unequivocally altered my musculoskeletal alignment. Indeed, I had altered the structure of my pelvis itself, since bones are shaped according to the demands placed upon them via loads experienced during movement.³

Squatting passively to rest or work helps to retain range of motion in the hips. The action of descending into and ascending from a squatting position, and the active deep squatting used for toileting purposes utilize the muscles that interact with the pelvic girdle. A squatting deficiency lessens the activity of the gluteal and pelvic floor muscles, and misaligns the attachment points for the muscles and ligaments that support the pelvic floor, the pelvic organs and the abdominal organs.³ Many additional health consequences have been proposed, including incontinence, constipation, hemorrhoids, colon cancer, prostate disorders, endometriosis, sexual dysfunction, osteoporosis of the hip joint, and toileting-related cardiovascular events.4,5

I have since awakened to the idea that the bodies of sedentary women do not function during childbirth as they would have in a traditional setting, where women squat on a daily basis, sit on the floor in a variety of positions, and regularly walk long distances to gather food and water. Like all of the other women around me, I had unwittingly been languorously idle, and that made giving birth while squatting physically impossible. By pushing forcefully despite my limitations (Valsalva maneuver), I generated enough pressure to cause a cystocele.5

Shockingly, it is now known that difficulty rising from the floor, as measured by a sitting-rising test (SRT), is a significant predictor of all-cause mortality.6 Like squatting, the simple act of sitting on the floor maintains musculoskeletal fitness. The quagmire is that our society has become disconnected from the natural movements that accompanied the genetic evolution of our species, yet those very movements remain vital to our health.³ Squatting and floor sitting cultivate Qi, course Qi and Blood, and preserve pre-natal Jing. Squatting is prevalent in many Asian countries. Though China does not, Asian countries such as Korea and Japan have enduring floor sitting traditions. Of course these movements weren’t mentioned in the foundational literature for Asian Medicine, because it was taken for granted that entire populations would be using them on a daily basis.

From a TCM perspective, I tend towards Spleen Qi Deficiency, which predisposed me to a prolapse condition. Retrospectively it became clear that I ate my way into a Spleen Qi Deficiency, and the way that my constitution expressed itself physically was a result of giving birth as a modern mover. This revelation is cause for great inspiration, since both movement and nutrition are aspects of health that are 100% within my control. On my next trip to China, you can bet that I will be squatting alongside the locals. In fact, I’m squatting right now, while I finish up writing this post. I squat because my Jing depends on it! If you’re not doing so already, why not get out of that chair and squat with me?


  1. Mongan, M. (2005). Hypnobirthing: The Mongan method: A natural approach to a safe, easier, more comfortable birthing (3rd ed., pp. 57-61). Deerfield Beach, FL: Health Communications.
  2. Bowman, K. (2010, June 2). You Don’t Know Squat. Retrieved August 19, 2015, from
  3. Bowman, K., & Lewis, J. (2014). Move Your DNA: Restore your health through natural movement. Ventura, CA: Propriometrics Press.
  4. Isbit, J. (n.d.). Health Benefits of the Natural Squatting Position. Retrieved September 18, 2015, from
  5. Bowman, K. (2013). Alignment Matters: The First Five Years of Katy Says. Ventura, CA: Propriometrics Press.
  6. Brito, L., Ricardo, D., D. S. M. S. De Araujo, Ramos, P., Myers, J., & Araujo, C. (2012). Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology.
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