How to Modify the Back Squat for Lower Back Pain
by Daniel Bonilla, MS, ATC and Guillermo Escalante, DSC, MBA, ATC, CSCS
Personal Training Quarterly
December 2022
Vol 9, Issue 3
This article seeks to provide personal trainers with eight brief modifications that clients can benefit from if they suffer from both acute and chronic lower back pain (LBP).
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This article originally appeared in Personal Training Quarterly (PTQ)—a quarterly publication for NSCA Members designed specifically for the personal trainer. Discover easy-to-read, research-based articles that take your training knowledge further with Nutrition, Programming, and Personal Business Development columns in each quarterly, electronic issue. Read more articles from PTQ »
Related Reading
Trunk Muscle Activation in the Back and Hack Squat at the Same Relative Loads
Knee Joint Kinetics in Relation to Commonly Prescribed Squat Loads and Depths
The High-Bar and Low-Bar Back-Squats: A Biomechanical Analysis
Biomechanical Differences between the High-Bar and Low-Bar Back Squat
A Biomechanical Comparison of Back and Front Squats in Healthy Trained Individuals
Kinematic Differences between the Front and Back Squat and Conventional and Sumo Deadlift
The Benefits and Controversy of the Parallel Squat in Strength Training and Rehabilitation
The Squat Exercise in Athletic Conditioning: A Position Statement and Review of the Literature
References
1. Allegri, M, Montella, S, Salici, F, Valente, A, Marchesini, M, Compagnone, C, et al. Mechanisms of low back pain: A guide for diagnosis and therapy. F1000Research 5: 2016.
2. American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise 41: 687-708, 2009.
3. Bezerra, EDS, Diefenthaeler, F, Nunes, JP, Sakugawa, RL, Heberle, I, Moura, BM, et al. Influence of trunk position during three lunge exercises on muscular activation in trained women. International Journal of Exercise Science 14: 202-210, 2021.
4. Centers for Disease Control and Prevention. Prevalence and most common causes of disability among adults—United States, 2005. Morbidity and Mortality Weekly Report 58: 421-426, 2009.
5. Centers for Disease Control and Prevention. Acute low back pain. January 2021. Retrieved 2022 from https://www.cdc.gov/ acute-pain/low-back-pain/index.html.
6. Clark, DR, Lambert, M and Hunter, A. Trunk muscle activation in the back and hack squat at the same relative loads. Journal of Strength and Conditioning Research 33(Suppl 1): S60-S69, 2019.
7. Contreras, B, Vigotsky, AD, Schoenfeld, BJ, Beardsley, and Cronin, J. A comparison of gluteus maximus, biceps femoris, and vastus lateralis electromyography amplitude in the parallel, full, and front squat variations in resistance-trained females. Journal of Applied Biomechanics 32: 16-22, 2016.
8. Cotter, JA, Chaudhari, AM, Jamison, ST, and Devor, ST. Knee joint kinetics in relation to commonly prescribed squat loads and depths. The Journal of Strength and Conditioning Research 27: 1765-1774, 2013.
9. DeForest, BA, Cantrell, GS, and Schilling, BK. Activity in single- vs. double-leg squats. International Journal of Exercise Science 7: 302-310, 2014.
10. Deniz, E, and Ulas, YH. Evaluation of muscle activities during different squat variations using electromyography signals. In: Aliev, R, Kacprzyk, J, Pedrycz, W, Jamshidi, M, Babanli, M, and Sadikoglu, F (eds) 10th International Conference on Theory and Application of Soft Computing, Computing with Words and Perceptions - ICSCCW-2019. Advances in Intelligent Systems and Computing 1095: 2020.
11. Deyo, RA, and Weinstein, JN. Low back pain. The New England Journal of Medicine 344: 363-370, 2001.
12. Dieleman, JL, Cao, J, Chapin, A, Chen, C, Li, Z, Liu, A, et al. US health care spending by payer and health condition, 1996–2016. The Journal of the American Medical Association 2020.
13. Diggin, C, O’Regan, NW, Daly, WS, McLoughlin, L, McNamara, L and Reilly, A. A biomechanical analysis of front versus back squat: Injury implications. Biomechanics in Sports 29: 643-646, 2011.
14. Escamilla, RF, Fleisig, GS, Zheng, N, Lander, JE, Barrentine, SW, Andrews, JR, et al. Effects of technique variations on knee biomechanics during the squat and leg press. Medicine and Science in Sports and Exercise 33: 1552-1566, 2001.
15. Franklin, B, Whaley, M, Howley, E, and Balady, G. ACSM’s Guidelines for Exercise Testing and Prescription: Testing and Prescription. Lippincott Williams and Wilkins: 2000.
16. Garber, CE, Blissmer, B, Deschenes, MR, Franklin, BA, Lamonte, MJ, Lee, IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports and Exercise 43: 1334-1359, 2011.
17. Glassbrook, DJ, Brown, SR, Helms, ER, Duncan, S, and Storey, AG. The high-bar and low-bar back-squats: A biomechanical analysis. The Journal of Strength and Conditioning Research 33: S1-8, 2019.
18. Glassbrook, D, Helms, E, Brown, S, and Storey, A. Biomechanical differences between the high-bar and low-bar back squat. Journal of Strength and Conditioning Research 31: 2618-2634, 2017.
19. Gullett, JC, Tillman, MD, Gutierrez, GM, and Chow, JW. A biomechanical comparison of back and front squats in healthy trained individuals. Journal of Strength and Conditioning Research 23: 284-292, 2009.
20. Hoyt, BW, Pavey, GJ, Pasquina, PF, and Potter, BK. Rehabilitation of lower extremity trauma: A review of principles and military perspective on future directions. Current Trauma Reports 1: 50-60, 2015.
21. Kasovic, J, Martin, B, and Fahs, CA. Kinematic differences between the front and back squat and conventional and sumo deadlift. Journal of Strength and Conditioning Research 33: 3213-3219, 2019.
22. Katz, JN. Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. The Journal of Bone and Joint Surgery, American Volume 88: 21-24, 2006.
23. Kell, RT, Risi, AD, and Barden, JM. The response of persons with chronic nonspecific low back pain to three different volumes of periodized musculoskeletal rehabilitation. Journal of Strength and Conditioning Research 25: 1025-1064, 2011.
24. Knezevic, NN, Candido, KD, Vlaeyen, JWS, Van Zundert, J, and Cohen, SP. Low back pain. Lancet 398: 78-92, 2021.
25. Krause, DA, Elliott, JJ, Fraboni, DF, McWilliams, TJ, Rebhan, RL, and Hollman, JH. Electromyography of the hip and thigh muscles during two variations of the lunge exercise: A crosssectional study. International Journal of Sports Physical Therapy 13: 137-142, 2018.
26. Ladlow, P, Coppack, RJ, Dharm-Datta, S, Conway, D, Sellon, E, Patterson, SD, and Bennett, AN. Low-load resistance training with blood flow restriction improves clinical outcomes in musculoskeletal rehabilitation: A single-blind randomized controlled trial. Frontiers in Physiology 9: 1269, 2018.
27. Laurin, E, Minerbi, A, Besemann, LM, Courchesne, I, and Gupta, G. The McGill approach to core stabilization in the treatment of chronic low back pain: A review. Canadian Military Pain and Rehabilitation Journal 4: 2022.
28. Lorenz, DS, Bailey, L, Wilk, KE, Head, P, Grindstaff, TL, and Morrison, S. Blood flow restriction training. Journal of Athletic Training 56: 937-944, 2021.
29. Lucas, JW, Connor, EM, and Bose, J. Back, lower limb, and upper limb pain among U.S. adults, 2019. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. National Center for Health Statistics Data Brief 415: 1-7, 2021.
30. Mausehund, L, Skard, AE, and Krosshaug, T. Muscle activation in unilateral barbell exercises: Implications for strength training and rehabilitation. The Journal of Strength and Conditioning Research 33: S85-94, 2019.
31. McGill, SM. Low back stability: From formal description to issues for performance and rehabilitation. Exercise and Sport Sciences Reviews 29: 26-31, 2001.
32. McGill, SM. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL: Human Kinetics; 2007.
33. Myer, GD, Kushner, AM, Brent, JL, Schoenfeld, BJ, Hugentobler, J, Lloyd, RS, et al. The back squat: A proposed assessment of functional deficits and functional factors that limit performance. Strength and Conditioning Journal 36: 4-27, 2014.
34. Naamat, KK, Sadeghi, H, Sahebozamani, M, and Nazari, S. Effects of seated leg press exercise on knee extension strength in elderly. Journal of Research in Rehabilitation Sciences 10: 539-548, 2014.
35. Neitzel, JA, and Davies, GJ. The benefits and controversy of the parallel squat in strength training and rehabilitation. The Journal of Strength and Conditioning Research 22: 30-37, 2000.
36. NSCA position paper. The squat exercise in athletic conditioning: A position statement and review of the literature. Strength and Conditioning Journal 13: 51-58, 1991.
37. Pangan, AM, and Leineweber, M. Footwear and elevated heel influence on barbell back squat: A review. Journal of Biomechanical Engineering 143: 2021.
38. QuickStats: Percentage of adults aged 18 or more years who had lower back pain in the past 3 months, by sex and age group. National Health Interview Survey, United States, 2018. Retrieved 2022 from https://nchstats.com/2020/01/03/quickstatspercentage- of-adults-aged-18-years-or-older-who-had-lowerback- pain-in-the-past-3-months-by-sex-and-age-group/.
39. Ribeiro, AS, Nunes, JP, and Schoenfeld, BJ. Selection of resistance exercises for older individuals: The forgotten variable. Sports Medicine 2020.
40. Rubin, DI. Epidemiology and risk factors for spine pain. Neurologic Clinics 25: 353-371, 2007.
41. Sayers, MGL, Bachem, C, Schutz, P, Taylor, WR, List, R, Lorenzetti, S and Hosseini Nasab, SA. The effect of elevating the heels on spinal kinematics and kinetics during the back squat in trained and novice weight trainers. Journal of Sports Sciences 1-9, 2020.
42. Slysz, J, Stultz, J, and Burr, JF. The efficacy of blood flow restricted exercise: A systematic review and meta-analysis. Journal of Science and Medicine in Sport 19: 669-675, 2016.
43. Wilson, S, Goodman, W, Casillas, C, Zavala, L, and Becker, J. Improving posterior chain engagement and forward trunk lean during the front squat. Medicine and Science in Sports and Exercise 50: 430-431, 2018.
44. Yong, RJ, Mullins, PM, and Bhattacharyya, N. Prevalence of chronic pain among adults in the United States. Pain 163: e328-e332, 2022.
