Are you suffering from lower back pain when squatting? I'm Dr. Scott Gray, the owner and founder of Back in Motion.
I am a specialty trained physical therapist and a sports performance coach. I also have here our fitness and sports performance coach, Chad Anderson with me to help me with demonstration.
Today I want to talk about three different ways that you can prevent lower back pain when squatting. The squat is a movement pattern that's been around for hundreds of years and we need to squat, but it should never be painful.
There are three main reasons why the majority of people will get back pain while squatting.
#1 Avoid The Dreaded Butt Wink
The first reason why someone may be experiencing low back pain while squatting is from going into the “butt wink” position; tilting the pelvis under, which rounds the lumbar (lower) spine.
When you go into this position, your spine is going into flexion. When we squat in this position, we already have what’s referred to as an axial load on our spine and adding this type of flexion causes a lot of problems. It's hard on discs, joints and ligaments. So we really want to focus on the best position for squatting, that eliminates that flexion.
The way we do that is by playing around with different foot and hip positions. When you go in the quadruped position (on your hands and knees) and you rock backward, this is the same motion and position as a squat. So we're just going to tweak Coach Chad’s foot stance a little bit to see if it changes his position when he does a butt wink.
Coach Chad is about two feet wide with his femurs (thigh bone), but his feet are about a foot apart. When we stand up and assume that same position while squatting, it avoids the dreaded butt wink that is loading the spine, which is causing that low back pain.
#2 Don’t Shift When Squatting…
The second reason why people get lower back pain is that they're asymmetrical when they're squatting. Often they're either weak in one glute or they have reduced hip or ankle dorsiflexion flexibility.
So typically when someone lacks mobility, they'll shift over to one side or the other when squatting. In this case, when Coach Chad shifts over to the left, he's got adequate flexibility in his hip and ankle, but not when he shifts to the right.
A quick and easy way to find the source of this imbalance is with an ankle dorsiflexion test. We want to see the excursion of the knees over the toes. If you can do that without the heels coming up, then we know you have pretty good dorsiflexion.
So I’m going to have Coach Chad put one leg forward over the other, he's just going to drive this knee forward. And again, I am checking the mobility of his ankle again, which, as you can see, is getting a lot of excursions.
So a lot of times athletes and clients, if they're right in the ankle, won’t be able to drive their knee forward very far. Often it could be the calf or it could even be joint. If it's the calf, you can do different corrective exercises, like foam rolling that calf. You can also do different stretches, like downward dog, to clean that up.
Now, if it's the hip, this is the way we weed that out. We’re going to have Coach Chad lay on his back. When we squat, the hip goes into hip flexion, abduction, and internal rotation as we bend down.
So we just want to check the difference in the symmetry between the right and left hips. He actually has a bit more mobility in his left hip, compared to the right. So, he may actually shift a bit.
We can also check the hip’s internal rotation, coming in here with the leg and seeing what the mobility is compared to the other side. If the hip internal rotation is tight, there are a couple of things that could be limiting it.
It could be the hip external rotators are tight; it could also be the joint capsule. It might also be other pathologies of the labrum or that structurally, that's the way that hip was built. These are some of the issues that may need to be addressed.
If it’s just muscular and a tight hip joint capsule, you can stretch out the muscles in the hip joint by doing some internal rotation of both hips. That's a good way to mobilize the hip.
We can put a band around the thigh and pull out on the hip joint, and then he can rotate back and forth, in and out, to mobilize that in internal rotation. Lack of ankle flexibility and hip internal rotation or hip flexion will cause a shift of the pelvis when squatting. And that can put a lot of torque on the spine.
#3 Weak Glutes or Quads
Another condition we commonly see is the weakness of either the glutes or the quads. There are different compensations for each. You may see a hip shift when someone has a weak glute.
One way you can determine this is by doing a couple of tests, one of which is called the single-leg bridge. So Chad, go ahead and let's do a single-leg bridge.
So you basically want to load this up. You want to do this to the point of fatigue and see how many reps he can do on the right versus the left. You're just looking for a major difference between the right and left sides. He looks good there. Now we'll go ahead and test the left.
So that's all cleared out. So we'll just assume if his left side was weak, right? He's going to lean more towards the right side again, causing that shift, which can mimic a potential ankle dorsiflexion limitation or a hip mobility issue. But in reality, it could also be the glutes.
Another reason people get back pain while squatting is that they have weak quads. They can't stay relatively erect when they're squatting, so they try to lean forward more and then they try to use their lower back and their hip extensors to extend, instead of using their quads.
They can't keep that relatively vertical posture. That's usually indicative of a weak quad. One test you can do to determine this is a pistol squat.
So Chad, just holds my hands here and go ahead and go into a single leg stance and then come down and back up. Back to the left.
Again, you're just looking for differences, left and right. If you see a big change, then you’re probably barking up the right tree and there may be some weakness in the quads.
So there you have it. Those are the three ways to a healthier back squat without pain. We talked about avoiding the dreaded butt winks; we want to check different foot positions and see if that prevents it.
We also talked about the lack of hip flexibility and ankle dorsiflexion flexibility or asymmetrical squatting.
Lastly, we talked about the weakness of the glute on one side or the other and weakness of the quadriceps, which may cause compensations of the spine, overloading of the hip extensors and the back, pulling you into flexion.
By implementing these tests above and discerning exactly why someone is experiencing low back pain while squatting, we can adjust their squat position and or work on strengthening certain muscles to fix those compensations that are putting stress on the lower back, with some great strategies to reduce or eliminate it!