Why Do My Hips Hurt When I Squat? Femoral Acetabular Impingement: Part 3

One topic that seems to have gotten a resurgence of popularity lately is something termed “joint centration” by Dr. Evan Oscar.   Joint centration is simply the act of...

source: www.kellernational.com

source: www.kellernational.com

One topic that seems to have gotten a resurgence of popularity lately is something termed “joint centration” by Dr. Evan Oscar.   Joint centration is simply the act of keeping the joint aligned in the correct position throughout a joint’s range of motion.   This will help keep the joint healthy and in the case of the hip, may help to prevent impingement.  You can read more about this in Dr. Evan Oscar’s book, “Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction.”

As previously stated, the hip is a ball and socket joint.  The ball portion is known as the femoral head and the socket is known as the acetabulum.  In the bottom position of the squat the femoral head is normally supposed to glide posteriorly into the back of the acetabulum.  The femoral head does the opposite as we come to the top position of a squat.  A balance between muscles helps us to achieve this.

If we have a muscular imbalance or a tightness in the posterior aspect of the hip the femoral head won’t be able to glide posteriorly the way it’s supposed to when we get to the bottom of the squat.  If the femoral head doesn’t glide posteriorly adequately or it glides anteriorly as we hit the bottom of the squat then we’re bringing the femoral head closer to the front of the acetabulum.  If these two structures collide, we’ve got impingement.  Down the line we might have a labral tear.

Source: Diagnosis and Treatment of Movement Impairment Syndromes

Source: Diagnosis and Treatment of Movement Impairment Syndromes

Dr. Shirley Sahrmann, a world reknowned physical therapist, has identified a condition she calls Femoral Anterior Glide Syndrome (FAGS).   In this syndrome, the ball portion of the joint ends up gliding anteriorly and internally rotating both as you flex and extend your hip.

As discussed previously, if our femoral head doesn’t glide properly during squatting we’re going to cause femoral acetabular impingement.  These patients also present with groin pain, which is a classic sign of hip pathology!

Sahrmann states that the main culprits for this are:

  1. Laxity of the anterior capsule of the hip.
  2. Tightness of the posterior element of the capsule
  3. A short and overactive Tensor Fasciae Latae (TFL)
  4. Weak Glute Max
  5. Overactive Hamstrings

A solution to this problem is going to consist of stretching the posterior capsule and tissues that cross the back of the hip as well as picking exercises to preferentially target the glute max without activating the TFL.

Source: jospt.org

Source: jospt.org

Fortunately for us. The Journal of Sports and Orthpaedic Physical Therapy (JOSPT) recently released an article that did an EMG analysis to find the best exercises to target the glutes and minimize the TFL.  Check the photo to the left for the top 5 exercises.

An interesting side note: Lunges and step-ups caused quite a bit of TFL activation.  Squats were a better exercise but not as good as these 5

The next step is to go ahead and stretch the hip posterior capsule and any tight muscles and tissues that cross over the back of the hip.  Here are a few of my favorite stretches:

For the stretch below you can rest your bottom foot against a wall for a better stretch.

source: yoganesh.net

source: yoganesh.net

There you have it guys.  That’s all I have for you today.  Next time we’ll wrap it up and figure out our final game plan for dealing with these pinchy hips.

My hips feel much better,

Dan Pope

P.S. If you enjoyed this article then sign up for the newsletter to receive the FREE guide – 10 Idiot Proof Principles to Crossfit Performance and Injury Prevention as well as to keep up to date with new information as it comes out via weekly emails.

References:

Sahrmann, S. (2002). Diagnosis and treatment of movement impairment syndromes. (pp. 144-146). St. Louis, Missouri: Mosby, Inc.

Selkowitz, D., Beneck, G., & Powers, C. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? electromyographic assessment using fine-wire electrodes. Journal of Orthopaedic and Sports Physical Therapy43(2), 54-65.

Gulick, D. (2009). Ortho notes. (2nd ed., p. 189). Philadelphia, PA: F.A. Davis Company.

Categories
HipInjury PreventionsquatUncategorized
10 Comments on this post.
  • ruthmiller008
    10 March 2013 at 10:26
    Leave a Reply

    First want to say thank you very much for the valuable information. Especially the video is having good explanation. The way he just showed slowly is nice. I was looking for the idea where I can stretch tight muscle and here I found the answer. Thanks once again.

  • Dan
    27 May 2013 at 10:26
    Leave a Reply

    I’m sorry, but this is not how Dr. Shirley Sahrmann advocates stretching the posterior hip muscles in cases with Femoral Anterior Glide Syndromes. This kind of stretch can lead to subluxation of the hip capsule. In all of her sites and textbooks I have NEVER seen her include this as part of her treatment strategies. The Child’s Pose stretch is highly recommended so long as the lumbar spine is not allowed to flex and there is no impingement in the groin. As for the posterior muscle strengthening exercises you have included, yes, they are beneficial, but are typically too far advanced for someone with chronic hip pain. Usually a good start is the prone straight leg raise (with pillow under abdomen) with activation of the gluteal muscles.

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

      Hey Dan. Thanks for the response. Just wanted to report that I never said these were sahrmanns exercises. The exercises were directly from jospt and i put the associated citations. This article was written for a very athletic population. I do agree that every individual must be treated differently. The theme of the site is based around troubleshooting issues in a fitness population. Also not sure where you got the idea that these exercises cause subluxation. If you have some additional info Id like to see it.

  • Julie
    16 November 2013 at 10:26
    Leave a Reply

    Thank you very helpful and clearly explained

    • djpope
      18 November 2013 at 10:26
      Leave a Reply

      No problem Julie!

  • Beth
    21 March 2014 at 10:26
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    I have recently had a hip arthroscope and been told I can no longer participate in squats or lunges, especially heavy ones. What is the likely hood I can continue to crossfit??

    • djpope
      6 April 2014 at 10:26
      Leave a Reply

      Tough question. I’d find a PT and doctor who have experience treating crossfitters and have them eval you. I’d imagine you can return modified at the least.

  • Hollis
    29 July 2014 at 10:26
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    This whole series on the hips is really well done- I go back and forth between wanting to improve my squat so I can be a better runner, and improving my running form so I can be a better crossfitter, and just wanting to be able to be active with my toddlers without hip pain. Scaling back the weight to fix the form has been helping, but anytime I start to push the limits, I get crampy and pinchy in the outside of my hips, and the high hamstring insertion area gets all gnarled up. All the hip opening we do in CF actually HURTS the spots on the outside of my hip…

    That pic from the JOPST is potentially exactly what I need but too small for these old eyes, is there a way you can scan a bigger copy? Or summarize the speicifc movement goals in that series? I think it would be good to add the whole thing to my warmup, no?

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

      Give it a try, best case would be to see someone to evaluate you. Try and google, clamshells, resisted lateral walking, Bird dog and single leg glute bridge. There should be bigger pics. Also you might be able to enlarge the picture by clicking on it also.

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