Why Do My Hips Hurt When I Squat? Femoral Acetabular Impingement: Part 1

Have you or your loved ones ever had a pinching feeling at the bottom part of your squat?  Does it kind of feels like it’s deep in your groin?...

source: www.stronglifts.com

source: www.stronglifts.com

Have you or your loved ones ever had a pinching feeling at the bottom part of your squat?  Does it kind of feels like it’s deep in your groin?  Do you really have to warm-up a lot to make it go away?  If so call…

Seriously though if you have this feeling you might have some type of impingement going on in your hip known as femoral acetabular impingement (FAI).   This is a common problem in young athletes and is often misdiagnosed (1).  It can eventually cause a more serious condition known as a labral tear of the hip.  Research shows us that patients visit on average 3.3 healthcare providers over a period of 21 months before being correctly diagnosed with a labral tear (2).

Here’s the deal.  Your hip is a ball and socket joint.  The head of the femur (long bone in your thigh) comes to a head and fits into a socket called the acetabulum. The acetabulum is part of your pelvis, a bone that sits between the hips and attaches to the base of your spine. (3).

source: www.mayoclinic.com

source: www.mayoclinic.com

At the bottom position of the squat we can sometimes get the head of the femur (ball portion) to butt up against the acetabulum (socket).  This can be pretty uncomfortable to say the least.

Unfortunately, you’ve got a structure that encapsules the hip joint known as the labrum.  The labrum can become trapped between the femoral head and acetabulum and become “impinged” during a deep squat.  Some individuals can get this same impingement during other activities like running and jumping.  This is the phenomenon known as femoral acetabular impingement (FAI) and in the long run it can lead to labral tears in the hip.  There are a few good clinical tests to see whether or not you’ve got this problem (4).

FABER and FADIR tests

If these tests reproduce the same pain you’ve been getting in your hip, you might have some impingement going on.

Unfortunately this pinching is sometimes the result of a boney abnormality that can’t be corrected easily.  The two types of deformities are CAM deformities, Pincer deformities or a combination of both (Mixed) (1).

Cam Pincer deformity, femoral acetabular impingement, FAI

source: orthoinfo.aaos.org

Cam deformity: This boney deformity is from the femoral head (ball).

Pincer deformity: This boney deformity is from the acetabulum (socket).

As you can see from the images, having these boney deformities is really going to increase the amount of impingement we get when doing something like a deep squat.  In fact, those with these deformities have limited pelvic and hip motion during squats when compared to normal hips (5)

The way we can rule these conditions out is with an X-ray.  If you’ve got symptoms of femoral acetabular impingement( FAI) it would be wise to consult your physician to see if you’ve got one of these boney abnormalities.  On top of that, having these boney deformities and a subsequent flexibility limitation at the hip (internal rotation deficit) can lead to pain in the lower back (6) and at the pubic symphysis (7), more reason to go see your doc.

The issue with having chronic femoral acetabular impingement is that over time this can lead to a labral tear.  Once your labrum is torn we can only repair it through surgery.  What do you think that means for you if you continue to push through your pain?

An interesting dilemma: What came first, the chicken or the egg?

Bones in our body grow when they are stressed.  This phenomenon is known as Wolf’s Law.  This means that if I chronically put pressure on my bones they will become stronger and more dense.  It also means that if I put an abnormal stress on my bones I can grow some bone in a place that isn’t meant to have any bone.

The question to ask is whether or not people are born with a boney abnormality of the hip or they develop a boney abnormality because they are chronically stressing an area and as a result develop a boney abnormality.  ie:  If you keep impinging your hip, your hip might grow some bone in the area where it is getting stressed.

What I mean by that is that if we chronically move in a way that promotes impingement of the hip, our body could respond by growing one of these pincer or cam deformities.

We might not be born with these boney problems, we may be creating them.  So it is of the utmost importance to take care of these issues as they come up because we may be developing permanent boney abnormalities by continuing to exercise with pain and discomfort.

A large variable in preventing hip injury is choosing the correct programming.   I spend copious amounts of time creating competitive crossfit programming for those who wish to minimize risk of injury and promote longevity.  Learn more about the program by clicking HERE:

In part two we’ll discuss some fixes to these problems and some modifications for athletes who have pinchy hips when they squat.

Until next week try some box squats,

Dan

P.S. If you enjoyed this article then sign up for the newsletter to keep up to date with new information as it comes out and exclusive deals and offers from new products and offers from yours truly.  

References:

1. Roling MA., Pilot P, Krekel PR, & Bloem RM, (2012). Femoroacetabular impingement: frequently missed in patients with chronic groin pain. Ned Tijdschr Geneeskd51(156), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23249508

2. Burnett RS, Della Rocca GJ, Prather H, et al. Clinical presentation of patients
with tears of the acetabular labrum. J Bone Joint Surg Am 2006;88:1448–57.

3. Behnke, R. S. (2006). Kinetic anatomy. (2 ed., pp. 35-56). Champaigne, IL: Human Kinetics.

4.  Reiman, MP, et al. Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-­analysis. Br J Sports Med. 2012

5. Lamontagne M, Kennedy MJ, Beaule PE. The effect of cam
FAI on hip and pelvic motion during maximum squat. Clin Orthop
Relat Res. Mar 2009;467(3):645-650.

6. Reiman MP, Weisbach PC, Glynn PE. The hips influence on low back pain: a distal link to a proximal problem. J Sport Rehabil. 2009;18(1):24-­‐32.

7. Verrall GM, Hamilton IA, Slavotinek JP, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. Mar 2005;8(1):77-84.

Categories
HipInjury PreventionsquatUncategorized
36 Comments on this post.
  • Adam
    27 February 2013 at 10:26
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    Solid article DJ, you’re putting out good info and I’m sure it’s helping a lot of people, keep doing what you’re doing. You mention surgery as the only way to recover from a torn labrum, but it should be pointed out that prolotherapy has successfully treated torn labrums, Lord knows it did with mine.

    • djpope
      28 February 2013 at 10:26
      Leave a Reply

      Adam, thanks for the input! I’m glad to hear prolotherapy has helped! I tore my labrum as well back in 2003 and have worked my way back to full capacity since then sans surgery. I think the location and severity of the tear has a lot to do with whether or not therapy will work. Thanks for your kind words and for the input.

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    5 March 2013 at 10:26
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  • jason tom
    19 May 2013 at 10:26
    Leave a Reply

    very useful and spot on. i just had surgery for a torn labrum and cam/pincer boner spurs. WORD OF ADVICE!! i was misdiagnosed by Dr. Jeffery Chain at Carillion Hospital in Christiansburg, VA. He told me it was only arthritis and to deal with the pain unless i wanted to get a hip replacement. wow, was he off. I tried to do what the “doctor” said which lead to making my condition worse. the labrum tear ended up being a re-construction to repair it.

    • djpope
      20 May 2013 at 10:26
      Leave a Reply

      Thanks for the input Jason!

  • Karen Haluza
    15 July 2013 at 10:26
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    Hi! I’ve been doing CrossFit since September 2012 and I’ve been practicing yoga since December of 2011. When I began yoga I noticed that I had terrible hip flexibility, but it seemed like my right hip actually had something mechanical keeping it from doing things like a lotus pose or even just a butterfly. It felt like it was catching. I thought I just needed more stretching, so I did that a lot. I also started seeing a chiropractor and a deep tissue massage person. It helped some. Eventually my right hip flexor area started to hurt off and on. Lunging poses were very painful, but I just kept at it. I began doing CrossFit and really liked it, but was still bothered by pain in my right hip flexor and inner thigh. I went to see my doctor who sent me to a podiatrist who prescribed custom orthotics, which made the pain even worse, so I stopped wearing them and it got better. Then I started working with an Olympic weightlifting coach and the pain has gotten worse. Now it’s a sharp pain on the inside of my right thigh. It hurts all the time now. I have another doctor’s appointment and I’m wondering if I should ask about being tested for impingement? I was glad to find your website. Thanks!

    • djpope
      15 July 2013 at 10:26
      Leave a Reply

      Karen, thanks for the post! Yes, I would definitely ask. Have you tried some of the tests on yourself from the article? It really does sound like you’re having some hip pathology for sure. What exactly the hip problem is will be the doctor’s findings. Deep squats and deep hip stretches can definitely be a trigger and could be making things worse, not better. Good luck and keep me posted.

  • Robin
    23 July 2013 at 10:26
    Leave a Reply

    Hey Karen
    I started doing CrossFit a few months ago and recently started having hip pain – same idea.. like something catching. I went to my Chiropractor and he said Femoral Acetabular Impingement. Of course I left my appointment and went right to Google.. in a list of aggravating activities I found power lifting!
    Make sure you get your hip looked at! (and treated!)

  • Patricia Korican
    28 July 2013 at 10:26
    Leave a Reply

    Will dextrose injections to the hip help with a torn labrum?

    • djpope
      29 July 2013 at 10:26
      Leave a Reply

      Good question! A quick search on pubmed to see if I could find any research on prolotherapy and hip labral tears resulted in 0 returns. I couldn’t find any research that showed a link between the therapy and healing but that doesn’t mean it might not be helpful. I really am not the best person to ask and it would definitely be something to talk about with your doc! Sorry for the vague response!

  • Jay
    20 August 2013 at 10:26
    Leave a Reply

    Can you describe in detail in a future post what you did to recover from a torn labrum in your hip without surgery?

    • djpope
      23 August 2013 at 10:26
      Leave a Reply

      Jay! I apologize but I had a labral tear in my shoulder. I was also very lucky, I ended up going back to my regular lifting schedule a few weeks afterwards and things seemed to heal up. This was when I was 16 years old. I’ve been seeing a lot of hip issues in the clinic lately and I might be making an article that goes over rehab shortly.

  • mike
    28 August 2013 at 10:26
    Leave a Reply

    hi dan. thanks for this great article..
    i am a 40 year old active male.. had a btb acl surgery for my ruptured acl last july.. before the surgery they did a full lower torso xray.. that particular orthopedics’s face when he saw my hips was worth a thousand words.. i had no idea my hips were shot let alone there was a problem, i always thought i was just a bit stiff and inflexible..
    anyway cutting to the chase, after multiple xrays, cat scan, mri and mra over the past 12 months, i have fai mixed in both hips, labral tears in both hips, severe cartilage erosion and cartilage loss in both hips (beck type 5), subchondral sclerosis and cysts in both hips, para labral cysts in both hips, mild trochanteritis in both hips and finally just to complete the grand slam i have osteoarthritis in, yes, both hips.
    i am ok, i walk ok a bit cowboyish if i have sat for an hour or so.. but to be honest my hips hurt far less than my right shoulder, where i have a ac joint arthritis, a supraspinatus tear and a slap tear.. not operating that yet either.. 🙂
    getting to the point, all the specialists want to operate, having seen 5 now. i am holding off because after the acl surgery and rehab, trying to mentally face 2 consecutive long rehabs, is a bit tough..
    if possible i was hoping if you could point me in the right direction for cardio exercises that i can do without causing more damage to the labrum and cartilages.. running i am not allowed to do, i thought the elliptical machine i could but have read somewhere that that is bad for hips as is cycling, rowing machines i am not sure about.. swimming can’t because of the shoulder..
    so was hoping that you might be able to suggest some possibilities..
    sorry for the long winded message!!
    thanks again for the great site and article..

    • djpope
      28 August 2013 at 10:26
      Leave a Reply

      Mike! Thanks for the reply.

      Sounds like you’ve got a big hip issue going on huh? One thing to keep in mind is that people can have boney deformities and labral problems without ever having any pain at all. Don’t let the MRI scare you too much. That being said it does sound like you have some damage that’s serious enough to be causing pain. I’d try to give it a trial of physical therapy to see what a well designed rehab program would do for your hips. What are you trying to get back to?

      My thing for prescribing aerobic exercise is to simply try the exercises and see if they give you any pain. Bicycling is usually the least problematic for hip problems, especially if impact activities(running/jumping) give you your symptoms. I wouldn’t avoid the elliptical either. If you can get moving that’s going to help with the arthritic condition in your hips and might even give you some pain relief.

      Thanks again for commenting, keep me updated!

  • mike
    28 August 2013 at 10:26
    Leave a Reply

    cheers for that dan!

    will give the elipitical machine a go tomorrow to see how it feels..

    have another appointment with the ortho’ on friday, so will try and get him to give some concrete programs..

    don’t have anymore aspirations for high level sport, those days have finished sadly.. used to be a rugby player.. would like to keep playing in the seniors and social tours but it appears as though that has been ruled out..

    but i do not want to become a couch potato either.. so am trying to find the sports and exercises that are not impact containing..

    thanks again for your site and very prompt reply..

    will let you know what the doc says on friday..

    hope you have a great day and look forward to your next article!

    • djpope
      30 August 2013 at 10:26
      Leave a Reply

      Definitely Mike, keep me updated and let me know if there is anyway I can help.

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  • Chris Dickson
    13 January 2014 at 10:26
    Leave a Reply

    And if we have some of this impingement and pain what can we do to improve it and continue to squat?

    I’m a competitive weightlifter who has been dealing with some chronic hip pain for 2 months now. After a number of chiropractor visits which then led to a visit with an orthopedic specialist, I’ve been diagnosed with a subchondral cyst in the acetabular roof. It worries me that (a) if I continue squatting I may worsen than condition and (b) that there is no real way to “rehab” my way through this to get back to squatting pain free.

    • djpope
      18 January 2014 at 10:26
      Leave a Reply

      Have you read through to parts 2 and 3? Definitely some more helpful information later in the series.

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  • Adrian
    15 May 2014 at 10:26
    Leave a Reply

    Hi
    so glad i found this on the net..
    I feel i have the same issue. I started to get similar pain issues when i was doing deep heavy 45deg leg press and abb roll outs on the floor.. its slight pain when i first stand up from sitting and i cant doo deep squats or roll outs any more..
    It been 2 months and simptoms have not disapeared at all

    • djpope
      26 May 2014 at 10:26
      Leave a Reply

      Have you seen a doc/therapist/chiro?

      • adrian
        26 May 2014 at 10:26
        Leave a Reply

        i saw the Doc a couple of days ago and recomended i see a Physio and may be get a scan done.

  • nathaniel hardin
    4 September 2014 at 10:26
    Leave a Reply

    Hi

    I have been going to the gym with my wife for some time now and she has been experiencing pain on the right side of her hip, she brought the pain to my attention while we were squatting. After asking a couple things she has also told me that it hurts while running occasionally, we did the two tests and she told me she could feel the pain in both tests I don’t know exactly what this means or what I could do next because of it but if you could help in any way it would be great

    • djpope
      7 September 2014 at 10:26
      Leave a Reply

      Hey Nathaniel, have you read parts 2 and 3 of the post? This should give you some ideas. Also would be smart to talk to a doc.

  • LCrumley
    1 April 2015 at 10:26
    Leave a Reply

    Hello – It sounds like I have this same issue. I really struggle with squats even with just my body weight. When I go all the way my right hip gets a deep pain and my knees buckle from the pain to where I can almost not even bring myself back up with just my own body weight. I weight 120lbs so Im not heavy. Sometimes its feels like my hips dont roll back naturally. even when I warm up before squatting I have great weakness in my legs I have been working out for almost a year and Im still struggling. I have done body squats for days and still that same pain in my right him. I showed my Chiropractor how I squat and she mentioned Femur weakness?? HOW do I get that stronger – What do you recommend I should at this point – FYI i am a very active 41 yr old 🙂

    • djpope
      14 June 2015 at 10:26
      Leave a Reply

      Did you get a chance to read the rest of the article series? Should be some ideas towards the end. Find a smart therapist who works with people who want to train the squat hard and get a thorough evaluation.

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