Our bodies are built to adapt. How else would we ever develop the strength (mental and physical) to meet challenges or compete in sports, let alone recover from them to be stronger, more capable, more resilient than before? That means that our training can be hard. It should be hard at times. But what can you do when you have pain when you squat—especially given the all-too-common and frequently short-sighted advice to avoid all squatting? Here, David Cho, SFG I, Doctor of Physical Therapy, and CSCS shares three simple squat modifications to work around pain.
Preface: The following advice is NOT a suitable replacement for a hands-on assessment by a clinician. If you have pain, please consult a medical professional who understands YOUR goals and (hopefully) strength. Once cleared, an FMS-certified coach can help get you started.
It shouldn’t come as a shock to anyone that training can (and should) be hard at times. It’s important to push our boundaries intelligently especially when we train for events, i.e. an instructor certification strength tests, the snatch test, or the TSC.
Now, what if we have pain? The typical reaction from many medical providers tends to be STOP. Why? They’re concerned about causing an actual injury. That’s good, right? The problem arises when STOP becomes “that movement you did is bad for X and you should never do that again,” and/or “you shouldn’t lift anything heavier than 10lb.” We’ve all heard it, and we know that in virtually all but the most extreme cases, it isn’t true. Avoidance of movement is simply not a long-term success strategy for most. Not moving, not training, and not doing anything are the wrong answer 99.7% of the time.
Ingrain that in your mind. Get it tattooed somewhere—I’m considering it.
But it Hurts When I Squat
Pain with squatting is a common occurrence in the performance field. Once structural damage or a required medical intervention is ruled out, we move on to rehab. Most programs will begin with manual therapy, isolated muscle strengthening, passive modalities (ice, heat, electrical stimulation, etc.), and other pain-reducing strategies. The problem comes when strength progressions are not implemented quickly enough. Rehab must be challenging to create positive change in the body. Current research has shown that our bodies require anywhere from 70-85% 1RM loads to strengthen tissues. This means our “training” weights can actually be our rehab.
Training and rehabilitation should not be considered completely separate. They are simply on different ends of the performance scale.
So How Do we Safely Squat with Pain?
Find a way to perform a different variation of the squat. It can be as easy as using a lighter weight (No duh, right? But how many of us do this?) or doing lower volume. Here are some of my other favorite ways to modify movements:
- Range of Motion
- Body Position
left out finding a proper instructor to assess technique and watch for movement
compensations that you likely don’t know about because this should go without
Tempo refers to the speed of your movement phases in a particular repetition. Most (I could argue every) exercise has a concentric and eccentric phase. In a squat, the eccentric phase happens when you lower yourself towards the bottom: your muscles work to decelerate your descent. The concentric phase is the reverse: you accelerate or rise up from the bottom. Select a weight that doesn’t trigger a painful response (hint: it’s heavier than you might think and remember that tissues strengthen in response to load). For most people, I’ve found that an appropriate starting weight can be anywhere from 50-70% of their training max depending on the severity of their discomfort. Now make the concentric and eccentric portions last longer than normal. I typically stick with the 5-6 sec range. To further clarify, take 6 seconds to lower into a squat and then take 6 seconds to rise back to your starting position. There is a third type of muscle contraction to consider—the isometric—that happens between the eccentric and concentric phases (or vice versa). For the squat, it’s the hold (if you include one in your tempo) at the bottom, between going down and coming back up. Isometric exercises are such a terrific rehab tool that I’ll save discussing them for their own future article.
Range of Motion
Remember when we all judged people doing half squats? Well, there’s some value to them. I use them all the time with people who have knee pain during squats. Again, don’t forget the primary purpose of these modifications: it’s to reintroduce movement patterns and load them in a safe manner where they do not feel pain all the time. If that means having someone squat 70% of their 1RM to a high box, then great! Be patient. You’re still getting stronger and, more than likely, building a better base than you ever had before.
So what if it hurts to do anything standing? Try seated variations. That hurts too? Try lying on our back or stomach. One of my favorite movements to recreate a squat is rocking. It’s very easy. Set yourself up on hands and knees. Keep the eyes looking forward and simply sink your hips back toward your heels.
What does this look like? A squat! We can progress this position by simply placing a swiss ball against the wall and rocking into it.
As you might’ve already noticed, you can use all 3 modifications in conjunction and apply them to nearly any movement.
We can spend hours discussing many of the topics I’ve brought up in this article, but hopefully, I’ve given some actionable techniques that you can keep in your toolbox whenever needed. Please reach out to me if you have any questions.