The squat—a fundamental exercise in most fitness programs. This bread and butter exercise is crucial for increasing thigh strength and size and is one of the most functional human movements. Despite its popularity and a plethora of books and videos demonstrating this exercise, a large number of people have low back pain when they squat. In this article I cover the four most common reasons for low back pain with the squat, how to identify poor movement and how to fix it.
How to Squat-Friend or Phone
When people are learning how to squat they usually take one of two roads—the friend or the phone. The friend method involves working out with a buddy and mimicking their technique. Even if a young athlete has had a coach teach proper squatting technique, most of the time, the athlete will still copy their lifting partner in an effort to fit it. Unless a young lifter has had exceptional coaching, usually outside their high school athletic arena, this is the most common method. This is less common in collegiate and professional athletes, but I still have the occasional high-level competitor who still looks like an air dancer under the barbell!
The phone method seems to be linked to the younger generations and is usually the result of YouTube or Instagram. Don’t get me wrong—there is good content out there, it’s just hard to find when most searches result in information overload! So, what’s the problem with learning the squat by watching another person’s movement? You are watching a different body and movement pattern! The squat is a complex upper and lower body movement requiring skilled muscle control, adequate mobility and stabilization. Everyone is born with a body that’s inherently designed to perform the motion of least effort and follow the path of least resistance. Most people think they need to squat to train legs but sometimes you need to train legs to squat! Now, let’s get to work!
Poor pelvis and trunk muscle control
Proper motor(muscle) control of the pelvis and trunk is crucial during a squat. An old school mistake was to round the back and hunch over during the lift. Although this still occurs, history and all the videos that come with it seem to have pointed people away from this training error. Now, rather than rounding the spine, people are overarching. When I see this, the first thing I ask people when they load their backs in this excessively arched position is, “How does you back feel?” Nine times out of ten, they say it hurts. So why do people start and end each rep with this position if it hurts? They think this pain and tightness is the sensation of stability, when in fact, it’s overkill.
A good starting position for the squat is a neutral spine—not over-arching and not rounding. Another problem that excessive arching creates is too much pelvic motion at the bottom of the squat—commonly known as butt wink. When you arch the back too far you bring the front of your pelvis closer to your thighs, squashing all the soft tissues between the top of your thighs and the stomach. This is a common reason for butt wink. We will cover other reasons in the upcoming sections.
If the answer for true spine and pelvis stabilization isn’t arching the back, then how do you create stability? The answer lies in your ability to hold the pelvis stable in a neutral position throughout the squat. The key isn’t the starting point or the ending point, it’s limiting the movement throughout the whole squat. Notice I said to limit motion, not to avoid it altogether. It’s a fool’s errand to try to prevent any motion at the pelvis during a squat as any video analysis of this lift will reveal some motion. Again, the idea is to minimize this.
You will want to focus on the following muscles when trying to stabilize the pelvis and spine:
- Paraspinals (muscles on the spine)
- Gluteal complex- gluteus maximus, gluteus medius and gluteus minimus
Coordinating these muscles to work together can be a challenge, especially when performing a Valsalva maneuver (holding your breath and bearing down) during the lift. To practice this, hold your stomach firm like your friend is about to punch you. While maintaining this hold, squeeze your butt while pressing your feet apart and rotating them outward against the resistance of the floor. This will maximize your gluteal contraction. If you were on a wooden floor wearing socks your feet would actually move apart and rotate out, but in this case the friction between your shoe and the floor should prevent any foot movement. While holding the stomach and buttocks contractions, adjust your spine by tilting the pelvis anteriorly (forward). If your pelvis was a bowl of water, the water would poor out in front you during an anterior pelvic tilt. This will increase the contraction of some of your paraspinals muscles. Notice I said slightly forward as you should not anteriorly rotate the pelvis to the point of an uncomfortable arch in your spine. Combining the gluteal, abdominal and paraspinal contractions will give you maximal muscle support and allow you to maintain a solid and neutral spine position throughout the squat!
The story of pelvic and spine stabilization would be incomplete without talking about the sacroiliac (SI) joint. A common reason for low back and buttock pain during the squat is SI joint irritation. I have seen dozens of lifters (females more than males) that have this issue and the cause fits right in with what you have just read—poor pelvis and trunk muscle control. When the lifter has a large pelvic tilt at the bottom of the squat (again with the butt wink) this can place more stress on the SI joint’s ligaments and give that sharp, pinching or achy feeling, usually on one side of the low back or higher buttock area. After I teach a lifter to contract their buttocks, low back and abdominal muscles for pelvic support throughout the squat, their pain often decreases or goes away during the lift.
Poor hip mobility
Another primary reason for low back pain with the squat is poor hip mobility. The two hip motions we will review are flexion (knees moving towards the chest with the feet on the ground) and external rotation (pushing the knees apart with the feet on the ground). We just reviewed the importance of minimizing pelvic tilting at the bottom of the squat (butt wink) and discussed movement strategies at the spine and pelvis to minimize this. Now, we have to review the importance of adequate hip motion because if you don’t have enough motion at the hips, you won’t be able to clear the thighs from the stomach and waist. If these soft tissues press together too much, it will cause more pelvic tilting. If you want to see this in action, stand up and place your feet and knees together. Try to squat as low as you can and see how much pelvic tilting and rounding of your back occurs when your thighs run into your stomach and waist!
Here is another test to try if you want a little bonus knowledge . Hold a squat position for 60-90 seconds, when you finally stand up, do the front of your hips feel achy or tight? This is often the psoas major or iliacus muscles (collectively known as iliopsoas) becoming overactive due to a lack of hip mobility. This hip flexor muscle is trying to hold your thighs close to your chest while your lack of mobility is making this a huge challenge. Poor ankle mobility is also a common cause for this, which we will review next!
To correct this problem, you will want to practice opening up your knees at the bottom phase of the squat. You will also want to sit as tall as you can with a neutral pelvis at the same bottom position. You can use your arms for support when you first start this. This will allow your iliopsoas to take a break during the stretch. To accomplish this, you will definitely want to run through a few hip mobility drills. You can find these drills on my Instagram page under. Click on the link to go straight to it: https://www.instagram.com/p/BkOqYiTl3ps/?taken-by=aiphysio
Poor hip stability
Now that we have covered the importance of hip mobility during the squat, let’s talk about hip stability. Poor stabilization of the hip joint can lead to excessive weight shifting and faulty movement patterns. The most common sign of this is a knee valgus position during the squat, typically more noticeable on one side of the body. This may be the most commonly overlooked training error. Even a subtle difference between legs can result in a large weight shift and the lifter may not notice this.
The most helpful way to check for this problem is to record your squat from a front view so you can watch it in slow motion. There is evidence that the human eye won’t pick up these movement errors in real time so make sure to play the video back in slow motion. When watching your squat, keep a eye on the center of your patella (knee caps) and watch to see if they move inward toward the body. The picture above displays an obvious knee valgus position, but your job is to see if one knee moves inward more than the other. You can see what happens at the spine and pelvis when one hip has poor stability if you look at the far-right image above. When you add all this excessive thigh and knee motion, you lose stability and power through the thighs and cause the spine and pelvis to compensate for this.
The most common area to target when trying to improve hip stability is the gluteal complex- gluteus maximus, gluteus medius and gluteus minimus. The reason these muscles are so important is a very large and powerful hip adductor muscle, the adductor magnus, has a higher force production in the deep phases of a squat. This muscle, along with two of your hamstring muscles, will pull the knees together as you stand back up from the bottom of the squat. When this happens, the gluteal complex is supposed to fight the knees from collapsing inward. The problem—the gluteus maximus muscle has less force production in the deep phases of a squat. So, if this muscle is already weak or under-active, which it commonly is, it will lose the battle to the hamstrings and adductor magus, resulting in a knee valgus position.
I have created a series of two tests for you to perform to check your hip stability. This series includes a single leg squat and a single leg bridge. You can use these exercise tests to check your hip stability and compare one leg to the other. Click on the link to watch a video where I walk you through these tests: https://www.instagram.com/p/BnpkUcZHAEm/?taken-by=aiphysio
I have also made a video and teach several exercises which have been shown though EMG testing (measuring electrical activity of muscles) to be effective at targeting the gluteal complex. Check these out to learn some of the best exercises for training the gluteal complex: https://www.instagram.com/p/BjyvVFvlYcm/?taken-by=aiphysio
Poor ankle mobility
You’re almost done! The last area we will cover is the ankle. Believe it or not, a lack of ankle mobility can lead to back pain! If you don’t have adequate dorsiflexion (toes toward your nose) this can result in another abnormal movement pattern requiring more weight shifting at the spine. Image your tibia bone (shin bone) moving forward as you squat down. This allows the knee to travel towards the toes. This is a very important part of the squat as this forward shin bone movement allows the quads to do their job during the lift.
If you don’t have enough forward movement of the shin bone, you will compensate by either rotating your feet outward or sticking the butt back further. If you rotate the feet outward, you are shifting weight onto the insides of your feet. When you do this, you are decreasing the platform you are standing on. Rather than squatting on a solid foot surface where weight is equally distributed all the way up the leg and thigh, this excessive weight shift is like standing and squatting on a wobble board. When you add all this excessive foot and ankle movement, you lose stability and power through the legs and cause the spine to take up the slack.
If you compensate by pushing your butt further behind you this also causes more force production in the spine by taking some of the force away from the quads. The spine is designed to handle large forces during a lift but excessive weight shifting under high loads, especially in the deep phase of the squat when the gluteal muscles are compromised, can lead to low back pain.
A good way to test this is to perform the lung to wall test. This will allow you to see whether you have proper ankle dorsiflexion range of motion. Another tip is to film your squat again and check for the ankle turn out and collapse we just reviewed. If you want to learn how to perform the lung test as well as a few ankle mobility exercises, click the link below and I will walk you through it. https://www.instagram.com/p/BlOwwSlA3kE/?taken-by=aiphysio
If you made it through this article you now understand the top four reasons for low back pain with the squat. After reviewing all the ways the spine has to compensate for poor mobility or stability throughout the lower body I think it’s important to provide some context here. The spine is very stable structure and designed to handle large forces during your lifts. One study showed bending forward to lift a 10 kilogram (22 pound) object from the floor resulted in upwards of 350 pounds of force through the lower spine. There is a reason why people keep trying to lift things with their back and why many power lifters dead lift more than they squat—the spine is a powerhouse.
I have also created a video on my YouTube channel that demonstrates all the information covered in this article. Click the link to watch. https://youtu.be/8pUFyHoiaqg. If you found this information helpful, subscribe to my blog and YouTube channel for more evidence-based rehabilitation tips and training tools.