Low Back Pain from Squats
Whether you are learning to squat for the first time, or are a seasoned weight lifter, low back pain can put a wrench in your plans if you have goals for the 2024 season. This blog will go over the mechanics of a squat to help you find out if physiotherapy is right for you.
Let’s start first by describing the pain itself and where it is located.
Where does it hurt?
One of the more common areas for people to feel pain is in their low back from squatting. Local pain means that the location of the pain is restricted to one body area. However, there are some that report referred pain. Referred pain is when the pain is located in one area, but the source is somewhere else. For example, you may have thigh pain, but the source of the problem could be a compressed nerve in your low back.
Here are some variations of low back pain presentations that I commonly see:
Local lower back pain across the back
Right sided lower back pain +/- right leg pain
Left sided lower back pain +/- left leg pain
Squat mechanics
Corey displaying the hip, knee, and spine angles in a squat.
When analyzing a squat, physiotherapists will look at the entire body to see what could be causing the pain being experienced. Depending on the type of squat being performed, your physiotherapist will analyze the movement and break it down to its smaller components. I will list some of the most common areas assessed to help you troubleshoot your injury.
Low back and the entire spine
Hips
Ankles
Low back and the spine
To help us understand squatting mechanics, we’ll use some physiotherapy terminology to help us describe movement. Bending forward to touch our toes is described as low back flexion. When bending backwards with our hands on our buttocks, this is extension.
One reason why people experience back pain from squatting is that their spine is in excessive flexion or extension during the squat. This can add increased stress to the spine, especially when you are holding a weight. Over time repetitions of the same movement with poor form can result in a lower back injury. It’s important to recognize what position our spine is in when we are squatting, which leads us to talk about the neutral spine.
In previous blogs, I’ve mentioned that a neutral spine is the most common position of safety when lifting. Our spine is naturally strongest in neutral.
But what does neutral look like?
Neutral does not mean a straight spine, but in fact a spine with normal natural curves. In the diagram below, you’ll see that there is a natural curve in the lower back that reverses in the upper back and again in the cervical spine. These curves in your spine are healthy, but if there is excessive curve in one area it can lead to problems in lifting. For those who are curious, I have an exercise that can help you find spinal neutral.
Corey displays a neutral spine with and without a stick
Find a wooden dowel or a broomstick and place it behind your back. Ensure that the stick is making contact with the back of your head, between your shoulder blades and your tailbone. Have one of your friends or family members take a picture so you can see what it looks like. Then, try to recreate that position in the mirror without the stick!
Maintaining spinal neutral during a squat will put your spine in its strongest position so that there is even distribution of weight throughout the spine. If you’re having difficulty maintaining spinal neutral, your physiotherapist can provide corrective exercises to address muscular imbalances. If you are stiff in certain areas of your spine, physiotherapy can provide a mobility program to help keep you limber and stay in neutral during your squats. Click here if you’re interested in booking with one of our certified physiotherapists today.
Hips don’t lie
The hips are very close in proximity to the back and they play a major role in the squat. If the hip region is tight, this may cause low back pain from squatting. But to understand this, we need to know more about hip mobility and its connection with low back pain.
Corey demonstrating hip flexion on his back
Let’s use physiotherapy terms again to help us understand this problem. Hip flexion describes the motion where we are decreasing the angle between our upper thigh and the front of our trunk. In the picture below, I’m demonstrating hip flexion lying on my back. When I am bringing my knee to my chest, I am demonstrating hip flexion. This motion is important for a deeper squat. When our hip is limited in flexion, other areas like our back have to compensate resulting in more strain in the lower back.
But what causes a tight hip?
Tightness is the word my clients use the most, but the phrase limited range of motion would be more accurate. Range of motion is a physiotherapy term describing how far a joint can move. Limited range of motion of the hip can be limited due to the:
Shape of your hip joint
Ligaments and the joint capsule
Muscles surrounding the hip
Nerves
A lot of these issues can be addressed through physiotherapy.
I’ll go into more detail around the different reasons why you might have limited range of motion in your hip.
The shape of your joint
Our hip is a ball and socket joint. Our leg holds the ball of the joint and the socket is located on either side of our pelvis. However, we are all made differently and are not the same anatomically! This means the shape of our joints are different. Some squat variations may not be comfortable for certain people. Understanding the shape of your joint can help you minimize back pain.
Alex flexing his hips up to his chest, and to the outside, to determine an optimal squatting stance.
Here is a simple test to see whether a wide or narrow stance would be right for you.
Lie on your back, bring your knee to your chest and ask yourself what you are feeling. Some may feel a pinch in their groin, while others may not feel a thing and can go further. Now try pulling your knees to the side of your body and towards your armpit. Some may notice that their knees stop early while others can go further! If your knee is not limited by pulling your knee straight to your chest, a narrow stance squat is optimal. If you hip is more comfortable and travels further when pulling your knee to your armpit – a wider stance squat will suit you better. This self-assessment tool can help you find out whether a wider or narrower stance would be more optimal for your squat. This may help you decrease the amount of low back pain by modifying your squat to match the shape of your hip joint.
But what if I can’t find a hip flexion movement that is comfortable and allows me to go further?
It’s time to see a physiotherapist. Having an extra pair of trained eyes and experience with treating hip related problems may help with your back pain. Physiotherapist can administer mobilizations and provide the right stretches to help you gain your mobility back. Book here to get your full comprehensive consult today.
The joint capsule and muscles
The joint capsule of the hip surrounded by muscle tissue.
Muscles and the joint capsule can cause stiffness in the hips, resulting in back pain with squatting. I’ll share a brief summary of why these can limit your range of motion. The joint capsule is a dense fibrous tissue that surrounds the ball and socket joint of your hip to create joint stability. The capsule also closes off the joint space and holds synovial fluid which lubricates the joints, distributes nutrients, and helps with shock absorption. With sustained postures, repeated movements in one direction, or aging - the capsule of your hip can become more restricted in one area leading to less range of motion.
The Hip Flexor Iliopsoas is a common culprit for individuals experiencing tight hips.
Muscles attach to the surrounding hip region which allows your hip to move. However, muscles can tighten over time causing increased tension. This can result in limited range within the hip. A common muscle that people report feeling tight in their hips is their hip flexor, also known as the iliopsoas.
Nerves
We’ve cited this EXPOSS study many times. It is a study that links extremity pain to the spine. Trained McKenzie clinicians (MDT Blog) used their skills to complete stretches of the lower back to eliminate pain in the hip, thigh, knee, lower leg, ankle, and foot region. They found that 71% of hip problems originated from the lower back. How interesting is that! The reason for this is compressed nerves in the lower back.
In my clinical practice, I find that the hip is restricted due to a problem in the back. When a nerve in the lower back is compressed, it can result in weakness of muscles around the hip and increased tightness of the hip. However, with appropriate stretching of the lower back, this can increase strength of muscles around the hip and improve the flexibility.
You can imagine that if your hip becomes tighter due to a back problem, this can worsen your lower back pain with squatting gradually overtime. Yikes! No fun at all.
The solution
Ultimately, avoiding low back pain from squatting comes down to good form, a strong spine and good hip mobility and strength. Providing a program that is customized for you is extremely important. Instead of guessing which exercises may work and spending hours researching online, it’s often helpful to have a trained professional analyze your squat. Physiotherapists are well trained to find deficits in range of motion and strength in both your hip and back, which can limit your ability to squat pain free. At Break Free Physiotherapy, our clinicians are trained to look at the entire body to help you reach peak physical fitness. Book with one of our clinicians today to get a comprehensive physical assessment to get you back to working out without pain!
Corey Kim
Co-Owner and Physiotherapist
Hey, my name is Corey, and I’m a co-owner of Break Free Physiotherapy and Wellness. I was born in Seoul, South Korea but grew up in London, Ontario. I finished both my Bachelor of Arts in Kinesiology and Master of Physical Therapy degrees at Western University. I’m passionate about helping people find pain relief through movement and believe in self-empowerment by sharing knowledge of the human body and its ability to heal. [full bio]
