The Overhead Squat and Why There’s Pain in the Wrist, Shoulder, Hips, or Low Back
The overhead squat is an incredibly demanding movement on the body. It requires extensive mobility from virtually every joint as well as stability and coordination. Most often, we hear individuals complaining of wrist pain with overhead squats, but we also hear individuals complaining of shoulder, hip, or low back pain. (Knee pain with overhead squats is possible too, but typically is due to different issues that aren’t specific to overhead squats).
The reason wrist pain with overhead squats is so common is because it’s the easiest joint to “take up the slack” if other joints lack mobility. There’s a certain amount of mobility from various joints that you need to complete an overhead squat. If you lack the mobility at one joint, you’re going to have to get that mobility from somewhere else. That somewhere else is usually the wrist.
The wrists are rarely the true cause of wrist pain with overhead squats. Instead, wrist pain with overhead squats is most commonly due to limited thoracic spine or ankle mobility. It can also be due to a myriad of other factors such as –
- Limited overhead shoulder mobility
- Limited rotational shoulder mobility
- Latissimus dorsi (lat) tightness
- Limited rotational hip mobility
- Limited hip flexion mobility (thigh towards chest)
As a heads up, this blog post is a bit dense. We’re going to go through how to know if you have enough mobility in all the joints and muscles that are necessary for an overhead squat. When clients complain of wrist pain (or any other type of pain) with overhead squats, it’s not a quick assessment. As such, this isn’t a short blog post. However, we can promise if you make your way through it, you’ll know a lot more about overhead squats at the end!
Shoulder Mobility for the Overhead Squat
Shoulder mobility is typically more limited for males than females. Females tend to lack sufficient shoulder stabilization instead of shoulder mobility. Lacking shoulder stabilization is a bit more tricky to test, so we’re not going to go over that here.
However, if you pass all the mobility tests with flying colors and still have pain with overhead squats, we’d encourage you to work on shoulder stability. Here’s a great blog post going over some shoulder strengthening exercises to get you started.
Overhead Shoulder Mobility
Limited shoulder mobility is a fairly common contribution to wrist pain with overhead squats. There’s two ways to test overhead shoulder mobility – laying on your stomach and laying on your back. In the clinic, we’ll apply a bit of extra pressure at the end range to determine what the end of the motion feels like. This gives us more information to know whether it’s muscle tightness, joint stiffness, or muscle guarding out of instability that is causing the restricted motion.
At home, testing on your stomach versus testing on your back can help you discern what’s going on. If you have substantially more motion on your back (above 5 degrees), it means that while you have the motion, you struggle to have the strength or coordination to move through that motion. This means that your problem is better solved with motor control drills such as prone lift offs or prone swimmers rather than mobility drills.
How Much Shoulder Overhead Mobility Is Enough?
The gold standard for these movements is 180 degrees. This means that your arm is directly in line with your torso. An important compensation to watch for is arching the back. Yes, your arm will go further if you compensate, but it doesn’t matter how far your arm goes if your back arches. Arching the back doesn’t change the amount of motion available at the shoulder joint.
While the gold standard is 180 degrees, practically we’ve seen individuals get by just fine with at least 170 degrees. We’ll say 168 is “good enough” but anything lower than that, we encourage individuals to work on improving their shoulder mobility. Some shoulder joint mobilizations such as inferior glide and posterior glide are great at improving the shoulder joint’s mobility.
Rotational Shoulder Mobility
To ensure there’s enough mobility at the shoulder, you’ll also want to look at shoulder rotation out to the side. Full motion here is 90 degrees. Your upper arm should be supported and your forearm should be off the side of the table here. In the photo below, Dr. Sarah is a tiny bit shy of 90 degrees, but close enough to consider sufficient so long as she has extra mobility elsewhere.
If you lack motion here, the fixes are the same as the shoulder joint mobilizations discussed a few paragraphs ago.
Checking Latissimus Dorsi (Lat) Tightness
Latissimus dorsi (lat) restriction is another reason individuals can get pain with overhead squats. The best way to assess this is to measure shoulder overhead motion on your back with your thighs firmly hugged against your chest with the arm that isn’t being measured. You’re looking for the degree of the angle between the arm that is reaching overhead and the torso.
After you get this number, you’ll compare it to your shoulder mobility (shoulder overhead motion on your back with your legs flat). If there’s a significant difference (above 5 degrees), your lats are tight. It’s important to measure this on both sides because sometimes one side is tight and the other is not.
If your lats are tight, a great corrective exercise is a supine lat eccentric or slow pull-up negatives with a pause at the bottom.
The reason we measure lat tightness like this is because the lats originate on the pelvis and insert on the shoulder. They are fully stretched when the lower back is rounded and the arm is raised overhead. If there’s a difference in shoulder mobility when the lats are put on stretch compared to when they are not, the lats are the limiting factor.
Wrist Mobility for the Overhead Squat
If you scrolled down here to check your wrist mobility first, we don’t blame you. After all, if it’s the wrist that hurts and wrist wraps help, then fixing the wrist issue should solve the problem, right? Not necessarily.
You’ll measure wrist extension by placing your hand on a hard surface with your fingers off the edge. Then, rock forwards and see what the angle between your fifth metacarpal (long bone that goes to your pinky finger) and your ulna (outside of your forearm). If you have at least 90 degrees here (your elbow passes in front of your hand), your wrist mobility isn’t the issue.
If your wrist mobility is limited, a banded distraction is a great way to get the joint to loosen up.
One caveat that is important to note here is that if you have too much wrist mobility, you can get wrist pain by having your wrist too far back. While overhead squatting, you don’t want the bar to “hang out” at end range on your wrists. Your hand and forearm muscles should be actively keeping your knuckles aimed towards the ceiling. If you aren’t actively using those muscles, you can also have wrist pain regardless of how much wrist mobility you have.
Thoracic Mobility for the Overhead Squat
Limited thoracic mobility is one of the most common reasons we see wrist pain with overhead squatting. This is also the easiest mobility test to accidentally cheat on, so take extra care if you’re self-assessing!
In the mid-back, or thoracic spine, rotation and extension are coupled. This means that measuring rotation gives us a window into how much extension (arching) that an athlete has. A certain degree of arching is necessary to perform an overhead squat. To conceptualize this a bit better, slouch and move your arm overhead. Then, sit up straight and move your arm overhead. Which got further? That difference between slouching and sitting up straight is what we’re going to assess.
Above is how we assess thoracic rotation. The first photo is the starting position and the second photo is the ending position. At the ending position, we’re looking for an angle of 45 degrees between the shoulders and the floor. You’ll want to measure both directions and see if there’s a difference in either side.
If both sides are limited, thoracic extension drills such as thoracic extension over a foam roller or mobilization with a peanut on the wall will be helpful. If only one side is limited, you’ll want to work thoracic rotation. Assisted or resisted thoracic rotation with a band are two of our favorites.
Ankle Mobility for the Overhead Squat
This is the other big limiter when it comes to wrist pain with overhead squatting. To test for ankle mobility, take off your shoes and place your hand between your toes and the wall. Then, lean your knee forward, while keeping your heel on the ground, and see if your knee can touch the wall.
One important thing to watch for while you are doing this is that you go directly towards the wall. If you shift your hips to either side to get to the wall, you’re compensating. If your knee doesn’t touch the wall, it doesn’t touch the wall. We don’t recommend forcing it (although we certainly see plenty of individuals who do).
To work on improving your ankle mobility, we recommend a banded distraction.
One other way to assess dorsiflexion is to complete an overhead squat with each heel on a change plate and see if that version of overhead squatting is easier to do. An important thing to note is that doing this will change how the weight is distributed, so this corrective will fix coordination issues as well as ankle mobility issues. It, however, can be a useful quick fix in a group class environment when trying to teach people how to overhead squat if they are new to the movement.
Ankle Mobility – Part II – Lateral Tibial Glide
This is a fancy term for “how far out can you get your knee to go while your foot is planted on the floor. You’ll measure it by stabilizing your foot as shown below and then using your hip to drive your knee away. You’re looking for at least 20 degrees of motion here, but anywhere between 20-30 degrees is ideal.
If you are lacking motion here – and most folks are – a lateral tibial glide stretch can be a nice way to stretch this area out. We do recommend doing this barefoot rather than with shoes on.
Hip Mobility for the Overhead Squat
We’re almost there – the last joint (and least common) to cause pain with overhead squats is the hip. To assess this, you’ll want to look at hip rotational mobility and hip flexion mobility.
Rotational Hip Mobility
At least 45 degrees outwards and 45 degrees inwards is recommended for rotational mobility. While you can move your leg yourself, this one will be hard to measure and get an accurate result. Because of that, we recommend having someone else measure.
This is also a test where the other person can move your leg for you. Most individuals will have a few degrees more of mobility if someone else moves their leg for them. In this case, it’s perfectly fine to have someone else put a little extra pressure on the leg. This isn’t like the shoulder where we want to know the difference between active and passive movement. Here, we simply want to know how much movement there is.
Hip Flexion Mobility
Lastly, checking out hip flexion mobility is important. Hip flexion simply means can you get your thigh to your chest and push on it a little? There shouldn’t be a gap between your thigh and your chest and there shouldn’t be pain. If it sounds simple, it’s because it is. This isn’t something most folks do not struggle with unless they have had previous hip injuries or hip impingement.
Overhead Squats & Pain
There you have it – everything you’ll need to check to determine why you have an ache or pain with overhead squats. Overhead squats are an incredibly demanding movement where large amounts of mobility, stability, and coordination are needed throughout the body. If one area is slightly lacking, oftentimes another area can make up for it.
However, if too many areas are lacking or if the mobility restriction is too significant, your body won’t be able to make up for it. When this happens, wrist pain is often what is felt; although it is possible to also get shoulder, hip, or low back pain depending on where the restrictions are.