Squats and squat-based moves are the foundation for many workouts. They’re great for burning calories, as well as toning and building strength to improve other lower body exercises. But it’s easy to slip into bad habits with squats, which can lead to injuries in the lower back, knees, or hips. As you hit the gym again in 2021, make sure you’re not making these mistakes as you squat.
Why are squats so important?
Squats encourage a full range of motion and help build lower body strength. They’re a go-to move for burning calories, but squats also improve the performance of running or jumping exercises.
A basic squat will involve the following muscles:
Hamstrings
Glutes
Abdominals
Abductor
Quadriceps
Calves
Hip flexors
Unfortunately in the clinic we frequently treat injuries stemming from squats. If you’re too focused on one element of the squat movement, like depth or dorsiflexion, you may be sacrificing important technical aspects which could prevent injuries.
But what do squatting-related injuries feel like? How do you know if you’re squatting the wrong way?
Injuries from squatting
Lower back
Lower back pain from squats may start as an aching pain which, left unresolved, may become sharper as discs and facet joints are impacted. Increased pressure and tension can compress the spinal joints.
Eventually, this tension will become painful and some of the spinal structures (like the discs or facet joints) can become strained, inflamed and irritated.
This injury can be caused by too much flexion or extension of the lower back, or by unintentional shifting the hips to one side.
Hips
Pain in the hips after squatting could be caused by hip impingement, or be referred from the sacroiliac joint (which links the lower back and pelvis). Pain could start as aching or feeling ‘tight’ but this will become sharp pain as it worsens.
Hip impingements can be caused by an alteration in the shape of the head of the thigh bone, at the point where it meets the pelvis to create the hip joint. But it can also be caused by a lack of external rotation of the thigh bone (femur) during hip flexion or the lowering phase of the squat.
External rotation of the hip creates joint torque to stabilise the area. If you’re not controlling your squat movement enough, the hip muscles can overcompensate to regain stability. This over-activity can also cause muscular pain.
Knees
Our knees are designed to allow a small degree of rotation and side bending to create stability. Often, the knee injuries we see in the clinic stem from an inability to use this side bend and rotation movement.
The head of the fibula bone (in the lower leg, behind the shin) is designed to move up and down during any knee rotation. This movement is connected to the feet, so any restriction here can limit knee movement and cause more pain.
Over time these issues could create wear and tear on the knee joints and result in over-use injuries like patella tendinopathy (jumper’s knee).
How can I squat better?
The keys to optimal joint health and movement are stable joints with good mobility.
For the lower back and hips, focus on healthy sacroiliac joint mechanics with strong obliques, glutes and iliopsoas muscles. Controlling these through the full range of motion will improve lower back health and squat mechanics.
You can also improve this by taking the tension off the piriformis, a small band-like muscle in the buttocks near the hip. The piriformis helps stabilise the hip joint and rotates the thigh.
Knees also need healthy joint mechanics, along with strong hamstrings to control the forward movement of the tibia (shin bone) and fibula.
Each of these things can be achieved through mobility work and exercises focusing on each muscle. From these exercises with individual muscle focus, build into a series and increase difficulty and joints involved to build back up to a squat.