Back pain when squatting is a common complaint amongst active people who enjoy working out at the gym. Sometimes the pain is at the base of the spine (SI joint), across the spine, or in the muscles on the sides of the spine. Common diagnoses related to low back pain include degenerative disc disease, disc herniations, spinal arthritis, stenosis, and lower back strains.
To obtain an accurate diagnosis, an examination would be needed. Although there are differences in how you should treat each of those conditions, there are common limitations that exist when it comes to squatting and back pain. In some cases, imbalances at the ankles, trunk, and buttock muscles can result in faulty squat technique. A common technique error due to these imbalances is poor bracing at the top of the squat. If you're not braced well when you lockout, you could put your spine in an overextended position.
On the other hand, if you're missing ankle mobility or quad strength, you will have difficulty staying upright at the bottom of a squat position. This could put stress on your back by compressing your spinal joints and overloading your low back muscles. This may result in back pain.
Another technique error is excessively rounding the lower back at the bottom position of the squat. In a fitness setting, this is commonly referred to as "butt-wink." The most common cause for this is poor abdominal and hip bracing before initiating movement. The lack of bracing will affect your hip and pelvis alignment. When you enter the bottom of the squat, your pelvis will rotate backward to make room for your hips. If you have back pain that radiates or causes weakness in your legs, this compensation could make your pain worse.
Considering that back pain when squatting may be due to a number of different factors, the best way to know what is contributing to your back pain is to have a movement assessment performed.
Once you know what your specific limitations are, the first recommendation common sense recommendation is to take a short break from squatting. This will allow your pain and irritation to subside. If your pain persists, recieving hands-on therapy can be effective to expedite pain relief. Pain improvements can be made very quickly with soft-tissue mobilization, joint-mobilization, and/or dry needling of the thoracolumbar, lower back, and quadratus lumborum muscles. In addition, exercises like the "Angry Cat" can provide relief to tense spinal muscles. Extension oriented exercises like a prone press-up can provide relief if you have radiating back pain.
Once your pain is under control, your next step should be to address the root causes of your back pain. If you have weakness, learning how to activate muscles that are not firing well is key. Common muscle groups that don't fire well if you have back pain include the hip flexors, glutes, trunk, quads, and low back. Exercises that can be effective to activate these muscle groups include the triple flexion for the hip flexors, the bridge with adduction for the glutes, prone hollow for the abdominals, Spanish squats for the quads, and superman poses for the lower back.
Once you have developed muscle control, the next step is to restore normal spinal movement. The fundamental movements of the spine are to bend forward, bend backward, and rotate from side-to-side. Exercises that can be effective to restore normal spinal movement include diagonal crunches, Jefferson curls, and tall-kneeling kettlebell rotations.
Once you have developed good muscle control and normal movement, you need strength to keep back pain from becoming a recurring problem. Being able to deadlift while generating tension through your hips is a prerequisite for squatting. The deadlift builds a foundation for low back and hip strength which will help you maintain a good squat technique. Pole assisted squats and heel elevated squats can help you work on the squat pattern and develop prerequisite thigh strength.
If you have a good foundation, you should be able to squat without back pain. To squat well, you need to be able to create tension in your abdominals, hips, and thighs before initiating movement. When you do initiate movement, it should begin with a slight hip hinge. As you approach the bottom of the squat position, you should actively "pull" with your hip flexors. To generate even more tension through your hips, you need to drive your knees wide when you're at the bottom of your squat. When you return to standing, you should shift tension back to your thighs, buttock, and abdominals right before you lockout at your hips and thighs. If you can generate tension and maintain good technique, you should be able to squat without pain and use the squat exercise to build strength through your trunk and lower body.
Most of the aforementioned exercises can be found in our video libary.
When addressed with a specialized physical therapy program, squatting without back pain is possible. However, ignoring pain and engaging in repetitive activity can result in a further decline of your back health. If you're worried about back pain, the physical therapists at Movement Solutions would be glad to help you.
We invite you to request a back consultation with one of our specialists. This is an opportunity to ask questions, obtain clarity about your back pain, and foster confidence that we can help you. If you’re certain that we’re a good fit to work together, you can decide on the next step.
If you’re in pain but unsure about what you should do, call us at (864) 558-7346 and ask how we can help.