Why Your Squat Hurts: Mobility vs Stability Problems Explained by a Physiotherapist
- Folarin Babatunde PT PhD
- Nov 30, 2025
- 7 min read
Updated: Dec 2, 2025
Cogent Rehab Blog
Folarin Babatunde PT PhD MScSEM MScPT BScPT
November 28, 2025
INTRODUCTION
Squatting is one of the most fundamental human movements and essential for many acttivities of daily living including sitting, toileting, lifting, getting into or out of a car or chair and many athletic activities. Research has shown that both unilateral and bilateral squat training can improve lower body strength, sprint speed, and agility in individuals. This explains why the squat exercise is often used in physical rehab and sports performance training to strength the hip extensor and knee extensor muscles of the lower extremities.
Unfortunately, many patients we see at Cogent Rehab, Burlington tell us: “My squat hurts— what am I doing wrong?”, "Why do I struggle to do a ful squat?"
The truth is: Most of the pain felt during is not only due to “bad form.” It can also be caused by hidden mobility or stability issues in the ankle, hips, spine, or core.
At Cogent Rehab Burlington, we use detailed movement assessments and slow-motion analysis to identify the real problem—so you’re not stuck avoiding squats forever. Below, we break down exactly why your squat hurts, what the research says, and how physiotherapy can help you return to strong, pain-free movement.
Why Your Squat Hurts - Common Mobility & Stability Issues in Weight Lifters and Runners
Many people assume squat pain is due to poor technique, but that’s rarely the full story. Squatting is a multi-joint movement that relies on:
Ankle mobility
Hip rotation & alignment
Thoracic spine extension
Core stability
Hip and knee control
A limitation in even one of the areas highlighted above can cause pain in the knees, hips, lower back, or ankles.
Mobility Restrictions That Are a Leading Cause of Squat Pain
Mobility issues change how your joints move under load. Even small limitations force compensations that increase stress on your knees, hips, or spine.
Below are the top mobility problems that we see at Cogent Rehab Burlington in people with squat-related pain.
Limited Ankle Dorsiflexion
The ankles are the bedrock for squats. To descend into a deep, comfortable squat, your shin needs to move forward — a motion that depends entirely on how much the ankle bends (dorsiflexion). When this motion is limited (often due to tight calves, stiff ankle joints, or compensations from injury), the body must find other ways to reach depth.
When the ankle can’t bend forward properly, you’ll often see compensations such as:
Lifting the heels,
Leaning the torso forward excessively,
Knees collapsing inward (dynamic valgus),
Reduced squat depth, or
Increased stress on the knees, hips, or spine.
These compensations are not technique errors — they are biomechanical adaptations caused by mobility restrictions.
Key Supporting Research:
Zawadka et al., (JMPT, 2025): Individuals with limited ankle dorsiflexion exhibit greater pelvic and lumbar spine flexion and increased trunk forward lean during squats — compensation strategies that may increase joint stress and contribute to pain.
Macrum et al., (JSR, 2012): Limited ankle dorsiflexion reduces double-leg squat depth and increases the tendency for the knees to collapse inward (increased knee valgus and medial knee displacement) — two key factors associated with patellofemoral pain.
Restoring ankle mobility is often a critical first step before trying to correct squat form or increase load
How physiotherapy helps:
Joint mobilization (posterior talus glide)
Calf/soleus soft tissue release
Ankle dorsiflexion mobility drills
Heel-elevated, tempo and assisted squats
Soleus and gastrocnemius strengthening
Hip Mobility Restrictions (Pinching, Limited Depth, Asymmetry)
The hips also play a major role in how deep and comfortably you can squat. Squatting requires coordinated hip flexion, internal rotation, and external rotation. Restriction in any of these motions forces the body into compensatory patterns that increase stress on the knees, lower back, or pelvis.
People with limited hip mobility commonly report:
Pinching at the front of the hip,
Difficulty reaching depth,
Shifting to one side during squats,
Knee alignment problems, or
A feeling that “something is blocking the hip.”
These issues aren’t usually caused by poor technique — they’re caused by reduced hip mobility, capsular stiffness, muscular tightness, or even anatomical factors.
Key Supporting Research:
Endo et al., (JPTS, 2020): Research shows that restricted hip flexion mobility limits squat depth — even in healthy young adults — and contributes to compensatory patterns such as increased forward lean or knee valgus.
Stickler et al., (PTS, 2015): Furthermore, impaired hip strength or flexibility (especially in the glute and hip-rotator group) is strongly associated with poor knee alignment during single-leg or bilateral squat tasks.
How physiotherapy helps:
Hip joint mobilization
Capsule mobility techniques
Modified stance width and toe-out positioning
Glute activation
Limited Thoracic Spine Extension
A stiff thoracic spine (mid-back) is an often overlooked reason why squats feel uncomfortable, unstable, or “off.” The thoracic spine needs to straighten (open up) during a squat so the torso can stay upright, with the pelvis staying centered while the load is distributed evenly through the hips and knees.
When thoracic extension is limited, the body compensates in predictable ways such as :
the lower back arches excessively,
the hips shift backward,
the torso collapses forward,
and the lumbar spine takes on more load than it should.
These compensations in the thoracic spine can lead to low back pain, pinched hip, difficulty hitting depth, or feeling “unstable” under weight.
Key Supporting Research:
Straub et al, (IJSPT, 2024): Forward trunk lean — often a result of restricted spinal posture — shifts loading away from the knee toward the hip and lumbar spine, increasing stress on back extensors.
Heneghan et al., (BMJ, 2020): Thoracic spine mobility, motor control, and strength are fundamental to optimizing the kinetic chain — and when limited, may lead to compensations that load the lower back, hips, or knees
How physiotherapy helps:
Thoracic spine extension mobilizations
Foam roller and rib cage mobility work
Breathing mechanics and siaphragm training
Postural strengthening (mid-traps, low-traps, serratus)
Trunk control and anti-flexion training.
Stability & Strength Deficits That Affect Squat Mechanics
If mobility is intact but pain persists, stability is the likely culprit. Weakness in key muscle groups leads to poor control and compensation during squats.
Weak Hip Stabilizers (Glute Med/Min)
Everything below the hips has to pick up the slack when your glutes are not doing their job. For example, during a squat, the glute medius/minimus play a key role in controlling the position of the knees and pelvis. When these muscles are weak, delayed, or fatigue quickly, the knees may collapse inward (dynamic knee valgus), the pelvis drops, and the trunk leans unnecessarily to compensate during a squat. IT band irritation and patellofemoral pain has also been linked to this deficits.
Key Supporting Research:
Crossley et al., (AJSM, 2011): Reduced strength in glute medius/minimus and associated stabilizers was strongly associated with greater knee valgus angles — meaning that when hip stabilizers are weak, the knees tend to collapse inward under load.
How physiotherapy helps:
Single-leg glute strengthening
Lateral step-downs
Hip airplane drills
Controlled tempo squats
Core Instability (Poor Load Transfer)
Your core is more than just your abs — it’s a coordinated system that includes the deep spinal stabilizers, diaphragm, obliques, and pelvic floor. These muscles create trunk stiffness, maintain spinal alignment, and allow efficient transfer of force between the upper and lower body during a squat.
When your core can’t stabilize the spine properly, the body begins to compensate. This often results in:
low back pain,
loss of control under load,
excessive forward lean, and
shifting or asymmetry during the descent or ascent of the squat.
These patterns are not random — they are predictable consequences of poor load transfer and a lack of coordinated core stability.
Research:
Myer et al., (JSR, 2014): Poor trunk control during squats (e.g., excessive flexion or extension) reflects underlying deficits in core stability and is associated with knee valgus, poor depth, and increased lumbar load.
Cannon et al., (2021): Individuals with greater core rotational stiffness showed significantly less knee valgus during high-demand landing tasks and shows that core stability is important for hip and knee alignment control during squatting, landing, and other loaded movements.
How physiotherapy helps:
Anti-rotation exercises
Deadbug progressions
Breathing mechanics and bracing
Farmer carries
Motor Control Issues (Your Body “Forgets” the Squat Pattern)
Sometimes your squat doesn’t hurt because of weakness or tightness — but because your brain has lost the coordination needed to perform the movement smoothly and consistently. Squatting is a complex motor pattern that requires timing, sequencing, and control of multiple joints. If this pattern becomes disrupted, the body tends to compensates with inefficient or unstable movement.
Common signs of poor motor control include:
Jerky or uncoordinated movement,
Difficulty finding or reproducing squat depth,
Shifting to one side during the descent or ascent,
Inconsistent reps
Feeling like the movement “never feels the same twice.”
These signs are neurological patterning issues and require retraining rather than simply lifting weights or stretching more.
Key Supporting Research:
Scholtes & Salsich (IJSPT, 2020): Supports the idea that motor control is task-specific since someone may squat “ok” in one context and poorly in another. The reinforces the use of squats and related tasks to assess movement variability and control or strength.
Khuu et al., (IJSPT, 2016): Small changes in task setup (such as position of the legs) change neuromuscular and kinematic demands. The brain must coordinate a specific pattern for each variation, and inconsistency or asymmetry during a single leg squat reflects motor control and not just strength.
How physiotherapy helps:
Slow-motion video feedback
Identify faulty movement patterns
Break movement down into components.
Rebuild movement patterns with external cues (mirrors, tempo,laser lines)
Train unilateral asymmetry
Reduce movement variability
Improve timing and sequencing
Integrate core stability with breathing
Progress functional/loaded patterns
How Physiotherapy at Cogent Rehab Fixes Squat Pain
At Cogent Rehab Burlington, we don’t guess—we assess.
Your squat evaluation includes:
✔ High-speed slow-motion video analysis
✔ Mobility testing (ankle, hip, thoracic spine)
✔ Strength & stability screening
✔ Foot and knee alignment assessment
✔ Movement pattern analysis
✔ Personalized rehab program
Most importantly, your treatment is 1-on-1 with a physiotherapist—no double-booking, no generic programs, no guesswork.
Ready to Fix Your Squat and Train Pain-Free?
Whether you’re a runner, weightlifter, or someone who just wants better mobility, we can help.
Book your 1-on-1 Squat Assessment at Cogent Rehab Burlington and start moving stronger and safer.
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