Ten Minute Tip #19: Squatting with Back Pain | A modification hierarchy so you don’t have to stop squatting
AS ONE OF THE MOST COMMON MEDICAL CONCERNS, BACK PAIN WILL ARISE WHETHER OR NOT YOU BARBELL BACK SQUAT. KNOWING HOW TO MODIFY THE SQUAT FOR BACK PAIN OF VARIOUS TYPES IS IMPORTANT BECAUSE YOU’LL BE FACED WITH IT AT SOME POINT.
BACK PAIN WITH SQUATS USUALLY PRESENTS ITSELF IN THREE WAYS:
In the hole
At lockout
With the whole movement
There is almost always a way you can continue to train your barbell back squat through an episode of low back pain even if you’re using lighter weight or a squat variation.
In this podcast episode we discuss the three types of back pain while squatting and how to modify your movement to continue to train.
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Dr. Rori Alter, PT, PRSCC, SSC: [00:00:17] Welcome back to the Progressive Rehab & Strength podcast. I'm your host, Dr. Rori Alter, head clinical coach here at Progressive Rehab & Strength. Excuse me, with my lovely co-host, Dr. Alyssa Haveson, also a clinical coach here at Progressive Rehab & Strength. And in this ten-minute tip, we will discuss squatting with low back pain and what you can do about it. So Alyssa, let's say we...
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:00:47] Let's start a timer.
Dr. Rori Alter, PT, PRSCC, SSC: [00:00:48] Oh, that's a good call.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:00:51] Let's say we start a timer.
Dr. Rori Alter, PT, PRSCC, SSC: [00:00:52] Let's say we start a timer. Yeah. So if you don't know the Ten-Minute Tip spiel, we start a timer but usually ignore it because we never finish on time. So anyway, we set a timer for ten minutes. We will discuss a topic, give you some tips and see you next time. So here we go. I'm starting a ten-minute timer, and we will talk about back pain in the squat and what you can do to continue training because we do not recommend stopping training altogether. We also don't recommend stopping the aggravating lift or any variation altogether. So I guess we must first figure out loads and where you're experiencing symptoms. We won't talk about load modulation because we've talked about it in many other episodes. If you go back to the last ten-minute tip or pain and injury series, you can hear our philosophy on modulating the load regarding injuries and the lift you're doing. So first, figure out if you can lift a lighter weight with a squat. But if not, let's discuss where you're experiencing symptoms in the squat and what to do. So tell me about where people experience symptoms in the squat.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:02:12] All right, Rori. So usually assuming we've already gone through exhausted options, you know, and you've listened to last week's episode about what to do with the weight if you can squat lighter and comfortably. But if you're not and you are having symptoms, usually most commonly at the bottom of the squat or the lockout or in that locked-out position. And if those symptoms are happening, even with the bar, we need to make some changes so that you can still do something and continue to move and squat comfortably. So if you're having symptoms at the bottom of the squat, the first course of action will be to shorten the range. We like to use a box squat for that because it helps you know where you're going to and going to that same spot consistently, especially if you're changing the depth from what you're used to and what your normal is. Now you're relearning this other spot that you're going to stop at the bottom. So we want to keep that spot consistent, so you can set up a box right above the range where you will start to have symptoms when you get into that range. So when you do a box squat, you should squat normal and just tap the box, and you're using it as a guide. We're not sitting on the box or losing tension, just gently tapping the box with your butt. I always say that if the box isn't there, you shouldn't fall over, right?
Dr. Rori Alter, PT, PRSCC, SSC: [00:03:39] Yeah. One of the misconceptions about box squats is that you sit down and like "sit, sit down," and that bar comes behind your midfoot like you're actually sitting in a chair. But that is not how we are talking about executing a box squat here at PRS. So you execute the squat as if going down to the regular bottom position. But you lightly touch the box. You can slightly pause, but do not put your weight on the box and then stand up. Why? We don't recommend pin squats regarding squats and back pain. Now, why don't we recommend that?
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:04:23] Because often when people perform pin squats, they kind of unload the weight of the bar onto the pins and lose tension in the bottom position and then regain tension and stand back up. And even if they're not doing that, most people aren't symmetrical. So it's pretty annoying to feel one side of the bar hit a pin and then the other one, and you just feel off. So, um, we don't find them to be generally well executed or beneficial.
Dr. Rori Alter, PT, PRSCC, SSC: [00:04:53] And I think the other non-lifting related thing is that if you're experiencing back pain, setting a pin squat is annoying and can fatigue your back more. It can irritate your back a little bit more. You know, we just have to think about, as coaches and clinicians, not just looking at the execution of the lift. We're looking at the totality of the training session. And we want to consider how much fatigue accumulates within the training session. So it's much easier to set up a box than to set up pins. If there are no boxes and someone's stacking 45s, that's another consideration. So you do want to consider these things, especially with back pain and going back to deadlifting. Also, we want to consider how someone is loading the bar and all that stuff. So we just want to think of, ah, where is that fatigue or stress accumulating in the non-lift movement as well in terms of having back pain throughout the range of motion or with lockout? What would you recommend?