Common Squat Injuries: Low Back Pain Pt 6 (The Joint-By-Joint Approach)

Today we’re going to continue our series on low back pain during the squat by applying a novel concept to help us understand WHY back pain occurs. Physical Therapist Gray Cook (author of the book Movement and creator of the FMS screen) along with strength coach Mike Boyle coined the Joint-by-Joint approach as a simple and straightforward way to understand how each joint should move in relation to another.

The way we move is extremely complex. It’s so complex that it lends itself to the illustration of a finely tuned sports car. These amazing machines only run well when all of their parts are working properly. If a wheel is out of alignment or a spark plug isn’t firing, the car won’t perform as it was designed.

The same goes for our bodies. We have hundreds of muscles and joints that all have a specific job to do to keep the body moving efficiently.

First let’s define two terms that describe the way our body functions.

  • Mobility: the ability of the joint complex to move freely in an unrestricted manner through full range-of-motion.
  • Stability: the ability of a joint complex to maintain position while motion takes place somewhere else. This is simply the ability to control the motion at a certain area of our body. Stability can also be synonymous with the term motor control.

The Joint-by-Joint concept breaks down the different areas of the body as either a “mobile joint” or a “stable platform”. What we see is that athletes who develop injuries often present with similar problems. Joints that should be mobile end up developing stiffness and areas that should be well controlled become unstable. When this happens, movement breakdown occurs and injury eventually occurs.

Joint By Joint

The low back (lumbar spine) as a whole, is an area that requires stability during squats. When we squat, a stable back allows us to keep our spine from buckling in two. In other sport movements, the stiffness of the spine allows for proper transfer of power from the lower body to the upper body.

Unfortunately, the low back has a tendency to become unstable. When this happens our body develops compensations that lead to stiffness, decreased power production and eventual pain.

If you did a quick ‘Google Search’ for help with your low back pain today, you would likely find a number of different exercise recommendations. A large majority would probably explain the best core exercises to strengthen your low back. In the end, however all of these exercises are aimed at addressing the site of pain (your low back!).

Unfortunately, many rookie therapists or coaches will hone in on the core and lumbar spine too much. They will often prescribe core exercises without examining the joints above and below the low back.

In order to effectively treat low back pain, one has to look beyond the low back and examine the hip, ankle, knee and thoracic spine. Look at your athlete/patient as a whole rather than just a body part. The joint-by-joint concept will allow you to easily identify which joints should be mobile or stable.

Check Your Hips!

The hips are an area of the body that shows a tendency to benefit from increased mobility due to its inclination to become immobile and stiff. As we get older, our hips tend to stiffen due to lack of use and oftentimes from a sedentary lifestyle. If you don’t use the mobility, you lose it. If the hip stiffens up it will affect the role of the joint complex directly above (the low back) and below (the knee).

HipRangeofMotion

In fact, research has shown that low back pain can be attributed to a lack of hip mobility (1). For this reason, it wouldn’t matter how much strength and stability work you perform on the core. If hip mobility is never addressed, no significant long-term improvements will be found. To check out our few of our favorite ways to improve hip mobility, check out the article “The Squat Fix: Hip Mobility Pt. 3.”

Check Your Ankles!

The ankles are an area of the body that also shows a tendency to benefit from increased mobility (specifically in the ability of the knee to move over the toes, called dorsiflexion). When the ankle becomes stiff, the rest of the body must compensate. This is especially true during a deep squat.AnkleSquatDiag(End)During the descent of the squat, the knees must eventually move forward past the toes in order to let the hips descend to the greatest depth possible and the chest to remain upright. If an athlete has stiff ankles, the entire movement pattern will be affected. During the descent, the knees will eventually hit a ‘wall’ causing the chest to move excessively forward.

This excessively inclined trunk position instantly places harmful forces on the smaller structures of the spine. After many reps and sets, this could easily lead to the development of pain over time. For this reason, it is imperative to screen for ankle mobility with an athlete complaining of back pain during the squat. To check out a simple way to screen your ankles, check out the blog article “The Squat Fix: Ankle Mobility Pt 1”.

Check Your T-Spine!

The mid back (thoracic spine) is an area of the body that also shows a tendency to benefit from increased mobility due to its inclination to become immobile and stiff.

As we sit all day and use poor posture, our mid back stiffens. If we don’t have adequate mobility in this area, the joint below (the low back) will be forced to move as compensation. This problem is often seen with overhead barbell lifting (snatch, jerk, and the overhead squat).

clean-press

To check out a few of our favorite ways to improve the mobility in this area, check out “The Squat Fix: Overhead Mobility“.

Final Thoughts

Back problems rarely develop ONLY because of poor core stability. When addressing instability of the low back, I urge you to always consider areas elsewhere in the body. Stiffness will always compromise stability. Three common areas that are often stiff is the ankle, hip and thoracic spine.

You can train your core all you want but you will never truly get rid of back pain without addressing other joints. Always prioritize fixing stiff joints before addressing core endurance/stability.

Until next time,

SquatBottom
Dr. Aaron Horschig, PT, DPT, CSCS, USAW

With

Kevin Photo
Dr. Kevin Sonthana, PT, DPT, CSCS

References

  1. Roach SM, San Juan JG, Suprak DN, et al. Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. Int J Sports Phys Ther. 2015 Feb; 10(1): 13-20

 

Published by

Dr. Aaron Horschig

Doctor of Physical Therapy, CSCS, USAW coach and athlete.

3 thoughts on “Common Squat Injuries: Low Back Pain Pt 6 (The Joint-By-Joint Approach)

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