Addressing Low Back Pain while Performing a Squat (Weighted or Unweighted)

Athletes around the world regularly perform weighted squats. Research has shown that squatting has a direct impact on your body’s power, which is the ability to overcome a resistance with speed (Loxtercamp, 2018). Therefore, squatting can result in great power and an increase in sprint speed. General benefits include increased flexibility, greater core strength, as well as protection from injury as a result of better coordination of the body. 

However, squats have been known to cause unwanted low back soreness. Although squatting will work the muscles of the lower back, if the low back becomes the most targeted region during the squat, chronic soreness and overuse injury can occur. Previous injury to the lower back, poor technique, as well as weakness of the core or surrounding muscles can contribute to this overuse of the back muscles (Gordon & Bloxham, 2016). Barbell back squats are also the most common for causing back pain as the weight is loaded across the back (Loxtercamp, 2018). If you find this movement difficult, but still want to add weight to your squats, you may want to opt for goblet squats or front squats. 

Goblet Squats

Front Squats

Prevention

  • Proper footwear
  • Progressing weight/load too quickly when squatting
  • Correct stance and posture
    • https://www.youtube.com/watch?v=Q_CuIKf227A
  • Spinal alignment
    • Ensure you’re looking straight ahead or an upward gaze 
  • Joint mobility 

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Gordon, R., & Bloxham, S. (2016). A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare. 4(2). doi:10.3390/healthcare4020022

Loxtercamp, B. (2018). Influence of attentional focus on a weighted barbell back squat among experienced performers. Medicine and Science in Sports and Exercise. 50(1). doi:10.1248/01.mss.0000536504.18312.43

Shoulder Rotator Cuff Strain: Clock Reaches

This is a great exercise for strengthening the rotator cuff and the shoulder complex muscles after straining the rotator cuff.

Kneel with your fists on the ground and keep your spine in neutral posture with your inner core muscles engaged. Imagine there is clock face numbered 9 to 3 O’clock on the ground in front of you.

Begin by reaching the right hand to 9 O’clock and then back to the start position. Proceed to continue to 1O, 11, 12, 1, and then 2 and then 3 O’clock. and then reverse back to 9 O’clock again. Repeat this for your left hand. Perform 3 sets of 5 for each side.

If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Turf Toe Injuries/MTP Sprain

What are Turf Toe Injuries? 
Commonly reported as a sports-related injury, turf toe refers to a condition where there is damage to structures around the big toe caused by hyperextension (bending the toe back too far) (McCormick & Anderson, 2010). Pushing forcefully off the big toe, as people do when they begin to run or jump, places repeated stress on the metatarsophalangeal joints (MTP) around this area. Sports that involve frequent stopping, starting, and sudden changes of direction (e.g. basketball, soccer, etc.) can be a main cause of turf toe. 

Symptoms of turf toe include pain when extending the big toe, or bearing weight upon it, a “popping” feeling in the foot when the injury occurs, swelling and inflammation, as well as instability and limited movement of the big toe. According to a report by McCormick & Anderson (2010), most turf toe injuries are mild and do not require surgical treatment, however in more severe cases, surgical procedures may be necessary. 

Doctors grade turf toe injuries from 1 to 3 depending on the extent of damage to the MTP joint, sesamoids, and surrounding tissues, ligaments, and tendons (McCormick & Anderson, 2010). 

Grade 1: Plantar complex is stretched, leading to tenderness and swelling 

Grade 2: Partial tearing of the plantar complex, resulting in tenderness, swelling, and bruising. Movement is restricted

Grade 3: Plantar complex is torn, leading to severe tenderness, swelling and bruising. The toe is very painful and difficult to move. 

Prevention?

  • Wearing flexible footwear while running on artificial turf, or other hard surfaces
  • Wearing shoes with better support, to stop the toe from bending excessively when a person pushes off of it
  • A physical or sport therapist can work with individuals to correct an problems with their gait, which could enhance their techniques while playing sports
  • Performing exercises and stretches such as the following, to improve body alignment (Jenn, 2016):
    • Shin Dorsiflexor Release
      • Find a stable, firm surface roughly at knee height
      • Place a tennis ball under the front of the shin and kneel onto it
      • Move the ball along the sore spots to target the entire muscle
      • Perform on each leg for 3-5 minutes
    • Soleus Release
      • Sit on the ground with your lower calf on top of a tennis ball or foam roller
      • Place the other leg over the one being released to add pressure
      • Roll yourself up and down over the ball, focusing on the tender spots
    • Big toe mobilization with movement 
      • Stand with one foot in front of you, and one behind, with the weight on the front foot
      • Anchor a resistance band attached to your front foot to a chair behind you
      • Rock your front knee forward as far as you can without raising your heel, pushing your knee outward
      • Repeat for 3 sets of 10

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Jenn, F. (2016). Podiatrist-recommended turf toe exercises for athletes. Retrieved from https://healingfeet.com/sports-injury-2/podiatrist-recommended-turf-toe-exercises-athletes

McCormick, J., & Anderson, R.B. (2010). Rehabilitation following turf toe injury and plantar plate repair. Clinical Sports Medicine. 29(2). doi:10.1017/j.csm.2009.12.010

Shoulder Rotator Cuff Strain Injuries: In / Out Rotation With Resisted Movement

If you have injured your shoulder rotator cuff but can still move it then this might be the right exercise for you.

With a light exercise band tied at shoulder level proceed to take up the slack. Then placing a folded towel between your side and elbow and place your opposite hand onto your shoulder lightly to prevent it from hiking upwards.

With the thumb up, slowly rotate the lower arm and wrist in towards your body making the upper arm and elbow the pivoting point and then bring the arm back to the start position with control. Prevent the elbow from pinching in towards your side or doing a chicken wing coming out. Do 3 sets of 10 repetitions for each side.

Doing the unaffected side will also help with the neuromuscular rehab of the rotator cuff muscles. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Heel Spurs

What is a Heel Spur?
Being the largest of the 26 bones in the foot, the calcaneus, or the heel bone, absorbs a majority of the weight of the body. A heel spur is a bony growth that forms on the bottom or back of the heel bone (“Heel Spur”, 2005). Heel spurs are often related to a condition called plantar fasciitis, however it’s important to not get the two mixed up. A heel spur is a bony projection that occurs from the bottom of the heel along the plantar fascia, whereas plantar fasciitis is caused by an inflammatory process where the plantar fasciitis attaches to the heel due to an abnormal force being placed on it. It is important to differentiate between the two since plantar fasciitis will subside on its own over a period of time, whereas a heel spur will be there permanently, unless surgery is required.

Symptoms of heel spurs can include pain, inflammation or swelling at the front of your heel (“Heel Spur”, 2005). The symptoms can spread to the arch of your foot, and a small bony protrusion may be eventually visible. However, only about 50% of people with heel spurs experience pain from them or even see a change in the soft tissue or bones surrounding the heel. Therefore, heel spurs are often discovered only through X-rays and other tests done for foot ailments.

Prevention?
Heel spurs can be prevented by minimizing wear and tear
· Wear well-fitting shoes with arch support and shock-absorbent soles
· Avoid exercises that involve jumping or repeated stress on hard surfaces, such as pavement or concrete
· Avoid prolonged walking downhill or rocky or uneven surfaces
· Warm up with calf and foot stretches before exercising
  · 1-Legged Squat

  · Wall  Squat On Exercise Ball

  · 1-leg bridges with thera-band isometric
  · Strengthening Ankle Stabilizer Muscles

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Heel spur. (2005). Postgraduate medicine 118(1). doi:10.3810/pgm.2005.07.1689

Hamstring Strain Injuries: Squat Lunge and Squat Lunge Hops

This exercise is great for the more advanced stages in the rehabilitation of your injured hamstring muscles.

Place the ball of your foot on a chair or bench that is knee height and maintain this pressure throughout. Engage and pull your inner core muscles in below your belly button while you squat straight down keeping your body vertical. Do not extend beyond a ninety degree bend in your knee while your knee stays in line with your hip and second toe and above your foot. Perform 3 sets of 10 for each side.

The Squat Lunge Hops is a variation or progression of this exercise to something more challenging. When you come back up from the squat, push up as high as you can comfortably aiming for a soft & controlled landing. Do not extend beyond a ninety degree bend in your knee while your knee stays in line with your hip and second toe and above your foot. Perform 3 sets of 10 for each side.

If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing.

Low Back Pain and Injuries – Inner Core Strength Bent Knee

If you are experiencing low back pain or have injured your back, this exercise is good for activating the inner core stability muscles of the lower back when you have injured it. 

With your feet in the air and your knees up to your chest keep your lower back flat and your inner core muscles engaged below your belly button. Start with slowly lowering one bent knee down to allow the foot to reach the ground, and then return it to the start position above ninety degrees.

Make sure your lower back remains flat and the opposite knee and leg do not move. Repeat this movement for 10 repetitions, doing 3 sets on both sides.

This exercise is good for activating the inner core stability muscles of the lower back when you have injured it. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Low Back Pain & Running: Wall Plank Resisted Knee Highs

Do your running injuries present as lower back pain? It’s possible that your hip mobility is restricted and that your core and hip flexor muscles are weak but you just don’t know it. This exercise may help.

Wrap a closed loop resistance band around your feet. Start by doing a posterior pelvic tilt to flatten your lower back and keep the inner core muscles engaged below your belly button to stabilize this posture and move into a plank position on the wall. Then, bring one knee in a straight line up towards your chest and then lower it back down.

Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions for each side. Perform a total of 3 sets of 10 repetitions for each side.

To Progress this exercise, simply perform the exact same technique faster while you maintain control and stability when lifting and lower the knee back down.

If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Low Back Pain & Running: Wall Plank Knee Highs

Does your lower back get sore from running or sports that involve running? Are your core and hip flexor muscles weak? Is your hip movement altered?

This exercise may be helpful. Start by doing a posterior pelvic tilt to flatten your lower back and keep the inner core muscles engaged below your belly button to stabilize this posture. Going into a plank position on the wall, bring one knee in a straight line up towards your chest and then lower it back down.

Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions for each side. Perform a total of 3 sets of 10 repetitions for each side.

If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing.

Anterior Hip Pain and Weakness: Hip Flexor Strength Straight Knee With Resistance

Place a closed loop light resistance band around your feet. Maintain a flat lower back with your knees straight and legs on the ground.

Engage your inner core muscles below your belly button. Start by slowly raising one bent knee up to your chest and then return it to the start position by straightening out the knee and leg back down to the ground.

Ensure that your lower back remains flat and the opposite knee and leg remains still. Repeat this movement for 10 repetitions, doing 3 sets on both sides.

This exercise is a great progression to the Hip Flexor straight knee to address hip impingement pain with muscle imbalances and weakness coming from your hip flexors. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing.