One of the most important early rehab exercises for anyone with lower back pain or sciatica is the squat, which is why it features so early on in the Back In Shape Program. This comes at a time of crisis in the mind of those with lower back pain, a time when the prospects of exercises like a squat are worrying to say the least!
“I’m not ready to do those sorts of exercises, my back is too vulnerable!”
This belief leaves the holder unaware of the difficult position they find themselves in, and makes for probably one of the most frustrating perspectives we have to overcome, but more on this later.
Let us first take a look at why squatting could be a serious factor in the back pain and sciatica of many individuals – of all ages!
Is your squat causing back pain and sciatica?
This might be a peculiar place to start our journey today, but bear with me. The squat is a vital movement of day to day life, short of the period at the very beginning and end of life, the squat will feature in every single day you live, multiple times a day. Looking at a small child in the first year of life with poorly developed muscles and incomplete joints, they steadily start to learn how to squat, getting up from the floor to take their first steps. At the other end of life, the squat features again, perhaps pulling oneself from the bed or armchair aided or otherwise, is one of the last movements we will lose. A little morbid i know, but only to illustrate the fact that this movement is vital to our lives as mobile living organisms, we’re not a static tree, as much as modern life might be trying to convince us otherwise.
When we’re young and developing, we squat in a natural way, moving our legs through a full range of motion, collapsing our hip,knee and ankle joints completely, then standing all the way up. This helps develop our joints, muscles and tendons optimally. The incorporation of chairs and less and less free movement as we move through the schooling system and into the workplace finds us with fewer and fewer reasons to move these joints of the lower limb through a full range of motion. We become weaker and our joints less healthy.
We begin to first notice this in the knees and hips, as the ability to generate power in these muscles from the flexed positions of the deep squat starts to diminish. Look at how easily a 1 year old can almost sit on their heels, and then pop up to standing, and back down again. It is a scarce sight to see anyone over the age of 20 able to perform such actions with such ease and technical prowess. And so the process has begun.
Steadily through our life the use it or lose it phenomenon begins to unfold. Blissfully unaware, our joints, tendons and muscles begin to weaken and stiffen up. What’s worse is modern life is geared up in a way that we hardly notice this happening!
Now we find that we’re gravitating to higher and higher chairs, finding that the low sofa we once used is no longer as easy to get out of, we’re getting old.
We’re getting weak.
Age, to a significant degree, is irrelevant.
We steadily find ourselves having to lean forward to get out of chairs, rounding our lower back to pick things up, and involving that lumbar spine more and more. That same lumbar spine that is being worn down from hours of sitting every day, at work, at home, during the commute, out with friends socializing, the list goes on.
Steadily the great squat we once had, that utilized all our joints and muscles effectively, has been neglected to such a degree the thought of squatting to the floor is enough to trigger joint pain! This is where our back’s begin to come in.
The stiffness and weakness that’s developed, the loss of muscle mass in the lower body, has led us to be unable to perform such an essential movement of life, without inappropriately stressing our lower lumbar spine. Whether or not we are in pain in the lower back, we continue to squat with poorer and poorer form as we stumble through life unaware of the reversibility of this slow onset of “dis-ability”.
You might think disability is a bit extreme here, but is it? Clearly if we cannot effectively get up from a low chair, we could hardly consider ourselves able. It’s a scale, not binary, we steadily become less able.
Taken from the disability and equality act of 2010 in the UK, the definition of disability: “if you have physical or mental impairment that has a substantial and long term negative effect on your ability to do normal daily activities.”
A squat is a normal daily activity on which so many other normal daily activities depend.
To hit this final point home, consider this, thus far we have discussed the gradual degradation of the muscles and joints of the lower limb. As we age, the cost of a fall increases dramatically. We can all point to older family members who’ve had a fall and were never the same afterwards often as a result of their unsteadiness when standing, walking and getting up out of a chair. Although there may well be many reasons for specific falls, a lack of confidence and competence walking or getting up will undoubtedly play a role. Although I cannot point to specific research here on the validity of this, I do hypothesize that the decreases in muscle mass and decreases in strength in the legs and lower body in general plays a role in increasing the likelihood of these falls.
With this in mind, keeping active, strong and competent in the lower body is one of the simplest things we can do to preserve our longevity, and a squat is a simple and hugely effective exercise that can be employed to achieve this goal.
Squatting before back pain
Suffice to say that the loss in ability to squat properly often precedes lower back pain, when we are unlucky enough to injure our lower back, our inability to squat becomes more consequential – immediately. When we injure our lower back, one of the important early steps to take is the ability to isolate the spine from moving and brace it well. In combination with this, we seek to use our hips, knees and ankles more to get out of chairs, taking some of the burden off the damaged lumbar spine. When our hips are moving better we can keep our torso more vertical – a helpful adjustment in the early days. However, like so many with back pain, if our squat has degraded so significantly, we are unable to make this effective adjustment.
Literally every time we get up, with back pain, it’s a chore, painful and the rounding of the back and general instability in the spine is a major obstacle to recovery that we must do multiple times a day.
Something we’ve seen in over 95% if not 99% of clinical patients over the years, and more recently members in the program is an inability to even squat down to bring the thighs parallel to the floor. This means that pretty much every single chair, bench, stool, bed or toilet seat is out of reach for them – and probably was before their back was a problem. As a result, rounded lower backs, and parachuting into low chairs have become a fundamental practice in day to day life – insidiously.
A squat: essential to life
Please excuse this little section as it is something of a rant. But perhaps if you know someone struggling, you can relay this message more eloquently and persuade them not to make such a foolish misjudgement. Over the years if there is one thing that has been a great source of frustration as an Osteopath it is this. The person struggling with a lower back injury, unable to do things and in serious pain. This individual will have some sort of procedure lined up, be it an appointment with the GP, an injection, a surgery, an MRI the list goes on, but it’s often 6 weeks or more away. And they’ll say something like:
“I don’t want to do anything till I’ve done X”
The issue with this is that this person is continuing to do a plethora of things on a daily basis that are making things worse. They are certainly squatting every day – in our experience, badly. Another variation of this would be the person that thinks they need to make more progress with stretching before they do a squat, as the squat sounds dangerous.
If there is one message to take away from this if you or someone you know is in trouble, it is that you are squatting everyday, and chances are, you’re doing it badly, in a way that’s doing your back no good at all! At least take the time to learn how to squat correctly, and become more aware of how you are moving and how you should.
What’s worse is that by recoiling from movement and waiting weeks on end, you’re likely to be moving backwards, losing more muscle mass in the lower body from disuse and falling further into a hole that becomes more and more difficult to climb out of.
Certainly in the UK under current strains and circumstances with the NHS these wait times are partly to blame for individuals who need help falling further behind. However, if this is you, know this: there are no circumstances where learning to squat correctly will be a bad thing, you’re squatting every single day whether you’re going to do it formally or not. Learn to get it right and do it now!
You might just find it changes everything for the better.
What do you do from here?
This week we’ve been doing squatweek for our members, where we’ve been reviewing and critiquing videos of their squatting form. The most important step you can make is to establish a current baseline. With good form and a neutral spine, how low can you squat? Record it! This change and degradation of your ability to move through the world is something that has taken a long time to set in, so don’t put yourself under too much pressure to make instant changes. It takes time and repetition with conscious effort to rebuild what has been lost, but know that you will be able to rebuild successfully.
The benefits of this will be plentiful, improved muscle mass and reduced “dis-ability” as mentioned earlier, improved competence in your low back, your hips, your knees and ankles. Not only will your improved squat improve the muscle strength in your lower body, these particular muscles, for example the glutes, will help guard against common squat issues like the knees rolling in towards one another – straining the knees and causing damage long term. This common faulty movement pattern also drives the arches of the feet to collapse, altering the pulling angle of the achilles tendon and straining the plantar fascia. It is not uncommon for those with more long term back pain to have less than satisfactory hips, knees and ankles and you see the root cause of these issues play out clearly when a person squats.
Don’t let comments like this affect you, they have little impact on what you need to do to get your back in shape!
Comment of the week – Anthony
“ I’m pleased to say that not only is my back better but I’m now able to walk 10miles to the next village and back on foot using a combination of walking and jogging.”
3 Steps To Start Squatting Safely!
- Watch a video with good instructions!
Start out copying what works, there is a simple video here that will get you started with this essential movement but the first part of any successful plan is to see exactly what you’re supposed to be doing, identify the goal, clearly!
- Begin with the most comfortable range you can do safely!
Starting out conservatively is the key, you want to make sure that you’re observing good form, the spine neutral, the hips moving backwards as the knees bend without moving towards one another. The toes pointing the same direction as the knees, either parallel or a touch open. Even if you only go down in the squat a couple of inches, the important thing here is that you establish what depth of squat can you do safely. This might well be an eye opening experience.
- Evaluate with recordings!
There’s no excuse not to do this these days, everyone has a smartphone or knows someone who does. Back pain and sciatica are serious, in so much that you want to resolve them. Don’t make excuses, make a movie! Seeing what you look like doing the squats can allow you an external perspective that often is so enlightening and helps you have a standard with which you can compare future endeavours. Not to mention the fact that for those of you with a longer journey ahead of you, being able to reflect on past recordings can be quite motivational and rewarding!