Why Do We Look at the Psoas and the Deep Squat When Your Back Hurts?

The place where you feel pain is not always the place blocking your movement

“Why are you asking me to squat when my back hurts?”

Patients often ask this when we assess their deep squat.

The question makes sense. Yet one of the most consistent observations at YOON CLINIC is that the location of pain and the structure preventing normal movement are not always the same.

Patients with low-back pain, groin pain, anterior hip discomfort, or pulling and tingling sensations into the leg often show clear changes during a deep squat. Their body may shift to one side, the pelvis may rotate, or one knee may collapse inward.

When the psoas is a major barrier, treating it can produce two changes at once:

• The pain decreases

• The squat becomes deeper and more symmetrical

That matters because the psoas is not simply a muscle that lifts the leg.

The psoas is a deep connection between the spine and the leg

The psoas begins along the lumbar spine, travels through the pelvis, and attaches to the femur.

It directly connects the lower back, pelvis, and hip. It also helps transfer force between the trunk and lower limbs. Much of the lumbar plexus, the network that contributes to several major nerves of the leg, lies within the psoas.

Because of this location, dysfunction of the psoas may affect more than hip movement.

When the hip cannot move freely, the pelvis or lumbar spine may compensate. That compensation can continue downward through the knee and the rest of the leg.

The patient may feel pain in the back, hip, groin, or knee, while the deeper movement barrier lies within the psoas.

At YOON CLINIC, we have repeatedly observed a significant psoas contribution in patients with:

• Recurrent low-back pain

• Sciatic-type leg symptoms

• Groin or anterior hip pain

• Pelvic asymmetry

• A sideways shift during walking or squatting

• Some patterns of testicular or inguinal-region pain

This does not mean that every symptom begins in the psoas. It means that the psoas can be a highly influential and modifiable barrier within the larger system.

The deep squat is more than an exercise

The deep squat is often treated as a gym exercise. It is also a basic human resting position.

Before chairs and raised toilets became standard, squatting was commonly used for resting and working close to the ground. To settle comfortably into this position, the ankles, knees, hips, pelvis, and lumbar spine must cooperate.

In the absence of an acute injury or significant joint disease, the ability to remain in a deep squat for approximately one to two minutes without substantial pain or strain can provide a useful picture of whole-body function.

This is not a universal medical cutoff. The important question is whether the body can enter and maintain the position without excessive compensation.

When the deep squat is restricted, the body must find another way to descend:

• The lumbar spine may compensate for limited hip movement

• The pelvis may rotate

• Weight may shift toward one leg

• A knee may collapse inward

• The heels may lift

• The trunk may lean excessively forward

A deep squat cannot identify one specific problem by itself. What it does reveal, often very clearly, is where movement is being lost and how the body is compensating for it.

Why we repeat the squat immediately after treatment

When the psoas appears to be a major barrier, we compare the same deep squat before and immediately after treatment.

We are not looking only at a pain score. We ask:

• Has the pain changed?

• Can the patient squat deeper?

• Has the sideways shift decreased?

• Is the pelvis more balanced?

• Has knee alignment improved?

• Is weight distributed more evenly?

When pain decreases and movement improves at the same time, it strengthens the clinical interpretation that the psoas was contributing meaningfully to the problem.

If tenderness around the psoas improves but the patient’s main pain and movement pattern do not change, we need to look elsewhere.

Treatment response is not only an outcome. It is also a way of testing the clinical hypothesis.

Less pain does not mean recovery is complete

Treatment may restore access to a movement that was previously painful, restricted, or asymmetrical. But if that movement is not used, the body may gradually return to its previous strategy.

When patients return months or years later with a similar complaint, we often find that their deep squat has deteriorated again. The squat may be shallower, the pelvis may shift in the same direction, or the original asymmetry may have returned.

When asked whether they continued practising, many give the same answer: “I stopped once the pain was gone.”

Pain can improve before the movement pattern has become durable.

This is why the deep squat is not simply another exercise assigned after treatment. It helps the body practise and preserve the movement that treatment restored.

In our repeated clinical experience, patients who continue deep-squat practice tend to maintain better movement quality and experience fewer recurrences of the same pattern.

The YOON CLINIC perspective

The psoas is not the cause of every case of low-back pain.

Difficulty with a deep squat does not automatically prove psoas dysfunction. The ankles, knees, hip joints, nervous system, pain-related guarding, balance, and movement control must also be considered.

Still, there is a clear reason we assess the psoas early.

It is a deep connection between the lumbar spine, pelvis, hip, lumbar plexus, and lower-limb movement. When it is a major barrier, treating it can create an immediate and meaningful change in both pain and function.

Psoas treatment restores access to the movement. The deep squat helps prevent that movement from being lost again.

We do not look only at where the patient feels pain. We identify the barrier to recovery, test the change through movement, and use repetition to help that improvement last.