Pain When Squatting?
-Brittany Kohnke CPT, M.S. Physical Education.
Why does (insert body part here) hurt when I squat?
Ever experience pain when squatting? Maybe it’s a dull ache any time you squat or only comes on as you approach certain weights or percentages. Either way, pain and discomfort is sometimes a part of the process (so DBALB), but other times it’s a by-product of technique errors or faulty movement patterns. In today’s post I hope to shed light on common flaws in the squat that may be contributing to pain during the squat.
As always, I lead this post with the following disclaimer. I am not a medical doctor nor is any of this intended to diagnose or treat any pain, ailment, or condition. Seek medical advice if your pain is beyond the classification of what is described below.
“Why does my knee hurt when I squat”
The knee is classified as a “hinge” joint meaning it is responsible for flexion and extension (i.e. bending and extending), although it does have the capability to rotate slightly (notice the key word being slightly). Often when I see people struggle with knee pain, it is due to the fact their technique is putting the knee in a position where the knee is being asked to rotate beyond this classification of “slightly”. This is usually due to the lifter adopting a squat stance not suitable for their anatomy or mobility limitations. This may be a time to implement a slighter wider stance and/or fix the angle of the feet.
Another common culprit of knee pain is not sitting back on the decent of the squat. The squat is a movement that requires a synergistic relationship between the knees and hips. One joint taking over this movement pattern will most likely result in strain/pain in the opposite joint. A cue I like to use with lifter is to “sit your hips back AND drop down”.
“Why does my back hurt when I squat”
Identifying the root of back pain is not only way beyond the scope of this article, but my scope as a strength coach and trainer; however, back pain during the squat in some cases stem from one of two things: the initial set up or spinal alignment during the lift. Let’s look at both.
Setting up for a squat, whether it be for a casual warm up at 50% for reps or a single rep attempt at a 1RM, should always be the exact same: with intent and vigilance. Bar placement, regardless of the fact if one is using a high bar or low bar placement, should be aligned with the lifters center of gravity. Not only does this allow for efficient, maximum output, but it creates the “safest” (relatively speaking) environment for the spine to take such load.
Neutral spine is another common phrase thrown out by a lot of “gurus” and coaches in the field and the message is always the same: to minimize risk of injury, one must maintain a neutral spine. Well, the take home message isn’t exactly clear if we look at the research. Multiple studies by McGill (2012), Vigotsky (2015), and Potvin (1991) have shown during flexion-extension movements like the squat, kettlebell swings, and good mornings, the lumbar spine will move beyond the previous studies definition of “neutral spine” (which was approximately beyond the 35% threshold as defined in previous studies). Does that mean we should avoid these movements? HELL NO! But, it does mean our room for error, especially for those with previous back injuries, is smaller making the first case in point even more important.
Proper form, technique, AND intelligent training (program design) is key to mitigating these effects. When it comes to form and technique, alleviating back pain during the squat could mean one may need to change their stance, use a depth that minimizes “butt wink” or the rounding of the lumbar/sacral spine at the bottom of the squat, and/or practice the skill of breathing and bracing to help encourage stability during the movement.
Why does my hip hurt when I squat?
The hip is classified as a “ball and socket” joint meaning it can essentially move a full 360 degrees in most cases. When it comes to squatting though, how the hip is articulated in the capsule will directly affect how to optimally perform this lift. Some people will have deep hip sockets, others will have sockets that face various angles, and some will have a femoral/acetabular relationship that is less than ideal for squatting. Whatever, the case may be, my point is, the hip is complicated and “dignosising” pain relies on a number of issues.
Generally speaking though, I find most people experience pain in the hip during squats due to one of two reasons: adopting a squat stance not conducive to their hip anatomy/mobility or inadequately warming up the hips prior to lifting. The aforementioned reason is most common assuming most of us are sitting throughout the greater part of our days. This creates an environment less than ideal for squatting: stiff joints coupled with shortened muscles in the hamstrings. Taking the extra initiative to warm up can pay dividends which is why I always recommend each session begin with activation based exercises such as glute bridges, fire hydrants, hip circles, and bodyweight cossack squats.
These are just a few common reasons why XYZ may be hurting while you squat. As always, if pain persists or does not improve, it is always recommended to get seen by a medical professional.
