Being involved in the CrossFit community for over 6 years, I have seen that Every PT treating athletes should have a system for assessing and improving squat mobility.
The most common compensations include a wider base of support, increased external rotation of feet, increased external rotation of hips, and increased forward trunk lean. These issues can be due to not learning proper form, having poor core stability, and/or anatomical variations in the angle of the head and neck of the femur, but often times it comes down to lack of mobility in one or more areas. The most common areas with mobility issues that limit the depth and mechanics of a squat are ankles, hips, and thoracic spine.
A number of reasons contribute to lack of ankle mobility, the most common reasons being the shoes people wear and the increased amount of time that people are sitting.
In order to perform a full depth squat, the tibia must translate forward into an adequate amount of dorsiflexion. Due to ankle mobility restrictions, many people are lacking the amount of dorsiflexion required to maintain good squat mechanics.
If an athlete does not have proper ankle mobility, in order to get into a deeper squat (or what appears to be a deeper squat), they will either have to come up onto their toes or have an increased forward trunk lean.
If coming up onto their toes, this will cause increased pressure on their knees, which over time will cause knee pain due to poor mechanics.
If getting into an increased forward trunk lean, any time weight is added to that position, regardless if a back squat, front squat, or overhead squat, the consequences will be a missed rep at best and an injury to the back at worst .
Many factors play into why our hip mobility is limited. The most common cause is sitting. Starting at a young age, we sit most of the day in school and then at home doing homework. As we become adults, we sit to commute, sit for our job, and sit at home to relax. This sitting that we do causes our hips to get tight. They become “happy” at a 90(ish) degree angle. Most chairs are also slightly rounded, which also causes a slight internal rotation of the hips.
If an athlete does not have good hip mobility, the only way to get into what they think is a deeper squat is by compensating somewhere else. These compensations are very similar to those mentioned in the ankle mobility section.
As a coach or therapist, you might observe the athlete getting onto the toes in order to shift the knees forward and change the angle at the hip, making it “feel” like a deeper squat to the athlete. The other compensation likely to be observed is the forward trunk lean, once again making it “feel” like a deeper squat even though the hips didn’t actually drop.
Thoracic mobility is a big issue for nearly everybody. Everything we do on a regular basis is in front of us. Regardless if you are doing computer work, housework, or outside manual labor, your arms are usually in front of you in some way doing the work. Because of this, it is easy to develop a rounded shoulder, forward head, rounded upper back posture.
This posture is not ideal for a number of reasons, one of them being a stiff thoracic spine. Compound that with the fact that most people don’t know to address the stiffness in the thoracic spine and the population loses their thoracic extension and rotation mobility.
For a good full depth squat, besides proper ankle and hip mobility, which I have already discussed, thoracic mobility is also important to be able to keep the good, upright torso. If the thoracic spine does not extend, the lumbar spinal extensors will work harder to compensate for that, increasing the extension forces through the lumbar spine.
It has not been uncommon for me to address thoracic mobility in my CrossFit athletes with hip pain and totally resolve their hip pain. It is important to look at all areas of the body when assessing pain in a squat to be sure you do not miss the true driver of the problem!
Assessing the squat and finding the limitations
Are you now thoroughly confused and not sure how to discern what area(s) need to be addressed? Let me try to clear some of that up for you. I’ll start by saying that it’s usually not just one area!
Start off by determining whether it is just a body control or motor pattern issue rather than a mobility issue. Have the athlete hold onto your hands or something stable and see if they can get into a full depth squat position, with hip crease below knees and torso upright. If someone can get into the position holding onto something, it is an issue of control and motor planning, not mobility. This issue needs to be addressed in a different manner.
Once you have done the previous test and determined it is truly a mobility issue it is time to break it down. This is where your PT skills come in!
Assess ROM and joint mobility in the rearfoot, hip, and thoracic spine as you normally would for any patient.
Treating the limitations
Once you find the limitations, you can address it in a couple of ways.
You can treat based on a “triage” concept. Find the worst limitation and start working on the mobility in that area. By addressing mobility in in just one area, you can improve the entire squat technique. This will be especially useful if one joint/area is significantly limited, such as from a previous surgery or injury.
Or if you find that all are equally limited, you can work on overall mobility in general. I find that most of my clients respond best to this, as most of them are limited in all areas due to years of postures and habits they have gotten into which has caused stiffness and tightness throughout their bodies.
Different squats and specific areas that can limit performance
When talking about squats, we can also break it down into back squat, front squats, and overhead squats. Each of the different squats will be limited more for different reasons. As you change positions, different challenges of mobility are placed on the body, especially when talking front squat and overhead squat.
With the front squat, more thoracic extension is required compared to the back squat. Without good thoracic extension, it will be difficult to keep elbows up and keep the torso upright. Since the weight is in front of the body instead of in back, without the ability to keep the elbows up and torso upright, the weight will fall forward, causing at best a failed rep and at worst an injury to the back.
With the overhead squat, this still requires a significant amount of thoracic extension as mentioned in the front squat, but also requires more ankle mobility. When performing an overhead squat, the position of the torso changes slightly, requiring more dorsiflexion at the ankle. It is not uncommon to find the limiting factor in most athletes’ overhead squats (and squat snatch) being ankle mobility. This lack of ankle mobility either will not allow the athlete to perform a squat snatch or cause them to shift onto their toes if they do, which over time will likely cause knee pain.
Should the athlete stop lifting until form is corrected?
It is not necessary for the athlete to stop performing squats, but you may want to modify them until they can perfect their technique. Start by having them squat to a box in order to control the depth, going as deep as they can and still maintain good technique. As mobility improves and motor planning is corrected, the depth can steadily be improved until a full depth squat is obtained.
Once mobility and technique is corrected, the weight will increase quickly as a result, which ultimately is what the athlete wants.