As a physical therapist, every day I treat women who say that they leak urine when coughing, sneezing and exercising…
“Hi Ann! I try to squat to full depth, but I can’t seem to do it comfortably or with good form. I keep hearing the term “butt wink.” What is it and what causes it?”
Hi there! Thank so much for submitting your question. It’s a great question, and ties in nicely with last month’s article about hip flexors. Let’s start by defining the term “butt wink.”
Butt wink is a common term for losing proper spinal positioning when squatting to depth (in gym terms, “in the hole” or “ass to grass”). Instead of maintaining a neutral or slightly extended lumbar spine, the lifter experiences posterior pelvic tilt and lumbar flexion at the lowest point of their squat.
This makes the butt “wink” or tuck under (the photo below left shows proper form, photo on the right shows butt wink).
As with any other dysfunctional movement pattern we see, there are many factors that contribute to this compensation. I’ll just state for the record that not everyone should be squatting to full depth from the start.
It is far more important to groove proper motor patterns and develop joint mobility and stability in a progressive manner than to be able to brag that you squat to full depth. I like to quote Senior Strong First Instructor Franz Snideman when I say to my patients,
“You have to earn the right to do the next progression of the movement.”
This could be due to bony articulation or abnormal growth of the femoroacetabular joint, commonly called Femoroacetabular Impingement (FAI). In the healthy hip, the ball (femoral head) fits perfectly into the socket (the acetabulum).
Bone overgrowth can lead to three types of FAI: Cam, Pincer, and Combined.
Many people have this condition and don’t know it; but, in very active people who lift heavy weights, the condition may become painful over time as the bony overgrowth can cause cartilage degeneration and labral tears.
FAI can be problematic when the lifter attempts to go to full depth in the squat and the bony anatomy of the joint prevents full hip flexion.
This leads to lumbar spine flexion as a compensation, and we see the butt wink.
One way to test hip range of motion (ROM) is the quadruped rock back test, as described by Tony Gentilcore:
“I’ll have someone start in the quadruped position with a neutral spine. Slowly, I have him or her sit back towards their heels to see if or when their spine hinges. As you’ll notice, as I sit back, my spine stays relatively neutral the entire time. As such, it’s safe to assume that squatting “deep” probably won’t be an issue.”
See a demonstration here:
Conversely, if you notice the client going into thoracic and lumbar spine flexion as they rock back, it may indicate issues with hip mobility. As Tony says, “if it’s this bad with no spinal loading, can you imagine how much of a ‘walking ball of fail’ they’d be if I placed a barbell on their back?”
See here for demonstration:
In order to perform a full depth squat with good form, the lifter must not only have full hip ROM, but also full knee and ankle ROM.
If you lack the necessary 10-20 degrees of dorsiflexion at the ankle, you will not be able to squat to depth without compensations, one of which is thoracic and lumbar spine flexion.
Using plates or a block under the heels is one way that people get around this; but, like everything else, that only works until it doesn’t.
Many people favor Olympic Lifting shoes because the raised heel compensates for some loss of ankle dorsiflexion, but when it comes down to it, t’s much better to address the cause of issue.
Mike Reinold, PT has some great information about assessing and addressing ankle mobility in this article.
Even though the squat may look simple, it requires a high level of motor coordination to execute with good form. The glutes, quads, hamstrings, adductors, and deep central stabilizers must all work together to keep the ball centered in the socket (see here for more info), the spine in an upright position, and to balance the body to prevent falling.
Certainly strengthening the glutes is an important part of this equation; but, equally important is developing proper coordination of the deep central stabilizing muscles: the diaphragm, the transversus abdominus, the multifidus, and the pelvic floor. (You knew I had to mention the pelvic floor, right?)
I wrote an article recently about the importance of pelvic floor and deep central stability, with a video on how to begin to coordinate your breath with your activation of the pelvic floor (this is important for both men and women, and even for those lifters who do not experience incontinence).
If you do not have hip pain or signs of FAI, then working on hip and ankle mobility drills may benefit you.
Starting to groove proper squat mechanics with box squats, basic TRX assisted squats or goblet squats can help clean up your issues with butt wink. If you have hip pain or any issues with incontinence, your first step should be an appointment with a physical therapist for a full assessment and treatment of these issues, and referral to a physician if necessary.
Dealing with an injury or chronic pain can be frustrating and scary. You feel helpless and out of control, and just want your body to function like it used to.