Why Do My Hips Hurt When I Squat? Femoral Acetabular Impingement: Part 4

So in part 1 we discussed what Femoral Acetabular Impingement is why it’s important to fix.  In part 2 we discussed  how the squat can be contributing to this...

source: www.mikemahler.com

source: www.mikemahler.com

So in part 1 we discussed what Femoral Acetabular Impingement is why it’s important to fix.  In part 2 we discussed  how the squat can be contributing to this problem and what we’ve got to do to fix it.  In part 3 we learned all about joint centration and how the hip joint is supposed to operate during the squat.  In this article we’ll try to put everything together.

Disclaimer:  I don’t intend this article to replace medical consultation or treatment.  If you’re concerned you may have a hip labral tear go see a trained medical professional.  The goal of this article series is to point out a common hip problem and ways to prevent it.

So now that we’re educated about FAI and labral tears, how should we go about training to prevent future injury?

  1. Stop each set of squats before technical breakdown
  2. Troubleshoot your squat mobility
  3. Work within a pain free range of motion
  4. Add corrective exercises to your program

1.  Stop each set of squats before technical breakdown

Remember the cues for a good squat:

  1. Feet Flat – Not excessively turned out
  2. Knees over toes
  3. Hips back  with the hip crease below the top of the knee
  4. Flat neutral spine
  5. Upright torso
  6. Externally rotated shoulder
  7. Arms locked out
  8. Bar over your center of mass

http://youtu.be/vy8N8dzhZfg

A good goal would be to try and squat more like this guy.

When our form falls apart we’re putting ourselves into a compromised position.  Over time we’re predisposing ourselves to more serious injuries such as labral tears.  Remember that bone grows when stressed and if we continuously stress our hips by ending in a poor position we might be creating a boney deformity that can’t be fixed without surgery.

Check your ego at the door.  Make sure your squat is on point and you aren’t lying to yourself when those weights start getting heavy.

2. Troubleshoot your squat mobility

It takes a tremendous amount of mobility to get into a safe and efficient deep squat.  Your goal should be to spend some time working on your mobility every time you enter the gym.

One useful tip is to try olympic lifting shoes.  Olympic lifting shoes have a heel lift.  This heel lifts acts like artificial ankle mobility and can make getting into a deep squat much more comfortable.

Remember that stretching is not the only way to get more flexible.  Getting your core more stable and strength training to your end range of motion (particularly focusing on the eccentric or muscle lengthening portion of the lift) will improve your mobility.

3. Work within a pain free range of motion

Deep squats are often the culprit to hip pain.  Until you build the prerequisite mobility to get into a safe and efficient deep squat don’t feel the need to push into a painful or inefficient position.  Feel free to modify or substitute deep squats for other exercises.  Some examples:

  • More shallow squat variations
  • Box Squats
  • Lunge and step-up variations

4. Add corrective exercises to your warm-up

Source: jospt.org

Source: jospt.org

We learned that joint centration is of the utmost importance when we get into a deep squat.  Often times muscle imbalances can lead to a poor position of our femoral head in the acetabulum.  To combat this we’ll mobilize the posterior tissues of the hip and work on strengthening the glutes while minimizing recruitment of the TFL.

Here’s the picture from JOSPT again.  Pick 2-3 of these exercises and throw them into your warm-up for a few sets.

And there you have it!  I hope this gives people a jump off point for understanding why their hips are hurting when they squat.  Let’s not become another health care statistic and wreck our hips permanently.  Although surgeons are getting better and better at hip replacement surgery I’d rather rely on my own hips for now!

Off to the gym,

Dan Pope

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Categories
HipInjury PreventionsquatUncategorized
12 Comments on this post.
  • James Speck
    19 March 2013 at 10:26
    Leave a Reply

    Hi Dan,

    I’ve been following your series on FAI. Really good stuff. There’s always a lot of talking about the knees with squatting but it’s probably equally, if not more important, to pay attention to what the hips are doing.

    Would you recommend continuing to use olympic lifting shoes even after mobility problems get sorted out? I’ve been working on my squat and was wondering if I should pick some up. I don’t want to have to rely on them but I was thinking they might be helpful as the weight gets heavier.

    Thanks,

    James

    • djpope
      21 March 2013 at 10:26
      Leave a Reply

      James, awesome question. I’ve got to say, theoretically it makes sense that if you have adequate range of motion you wouldn’t need the shoes. Every top olympic lifter still uses the shoes though so I think they would still help.

      I personally find it very difficult to improve ankle mobility to the point that overhead squatting and snatching feels comfortable. Oly shoes have really helped me with that. Keeping your trunk more vertical catching a snatch is difficult for me and the oly shoes make it much easier. I honestly don’t like the way they feel on my feet but that may be the type I bought (pendlay do-win). Otherwise I’m happy with the shoes.

      Thanks again James.

  • Nick
    2 December 2013 at 10:26
    Leave a Reply

    Hi Dan,

    I really enjoyed this series on FAI, especially as I’ve suffered with it for about 7years, though I was only recently diagnosed ~2years with FAI, CAM impingement with labrum tear (albeit relatively minor.) It’s something which is starting to get more attention but I still feel its missing a LOT of information in the public and your articles will help address that.

    Anyway my question is, I obviously have FAI, CAM impingement and a labrum tear. The damage is minor as I say and I have been looking far and wide for an alternative solution to surgery as I believe I must have been moving incorrectly in the first place for the bony deformity to develop. Therefore if I get the surgery, this clears the symptoms but not the underlying problem. Would you agree with this viewpoint or think I’m not thinking about this correctly? Furthermore if I have hip surgery, I believe this is a precursor to an early hip replacement i.e before 40 and then several replacements after every 10years? Again do you feel this is relatively accurate or do I have my wires crossed?

    I guess to some up, if you were me, what would you do? Surgery? Accept my issue and workaround it? Look for alternative remedies? Do any exist?

    Keep up the good work.

    Kind regards,

    Nick

    • djpope
      2 December 2013 at 10:26
      Leave a Reply

      Hey Nick, thanks for the kind words. If I were you I would definitely try conservative (non-surgical, therapy) treatment first. The first step would be to modify the activities that bother you (what hurts you anyway?). Can you get away with less frequency/volume and modifications of what hurts. Also, I’d look at any specifics that may be causing impingement (technique, mobility etc etc.). The best bet would be to find a good therapist/chiro who has experience in whatever your sport is and has a background treating hips. That being said, the surgical treatments for FAI have been improving over time. I don’t think you’re destined for a lifetime of hip replacements either. Just use your head and don’t get frustrated. It may takes upwards of a year until you can get back to what you enjoy.

      • Nick
        6 December 2013 at 10:26
        Leave a Reply

        Hi Dan,

        thank you for the quick reply! What alternative treatments would you recommend? I’ve mostly dealt with movement experts as my right hip appears to be stuck/jammed in hike and unwilling to move properly during gait! I also had a steroid injection in the area but this didn’t do much for me.

        I only discovered my issue when trying to build up for a new rugby season in school and was trying to squat in the weight room. I got pain right away and on several further attempts I still had this and knew there was something other than a form issue. I’ve been trying to deal with my hip issue to get back to squatting but I think I’ve accepted this just isn’t possible for me and it’s best to work around it.

        I do agree treatment is getting better but still my head says its best to hold off while the surgery remains in its infancy.

        • djpope
          7 December 2013 at 10:26
          Leave a Reply

          Are you painful throughout the entire squat or just part of it(bottom)?

  • Ben
    5 December 2014 at 10:26
    Leave a Reply

    Hi Dan,

    These have been extremely helpful posts. I’ve been deal with hip pain in the bottom of my squat for the last two month. I’ve taking time off of CrossFit to focus on mobility, but it hasn’t improved. Along with the pain in my hip I have been having pain my knee on the same side. Any thoughts on how the two might be connected?

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

      Hey Ben, best case scenario is to go see a doc/therapist. The 2 could definitely be related but it’s very difficult to figure this out online.

  • Al
    6 December 2014 at 10:26
    Leave a Reply

    I am currently in PT for FAI and my therapist is really good! My x-ray was normal so he has focused on hip stability and mobility using similar exercises and drills that you recommend. In about 5 weeks of PT (following about 5 to 6 weeks of unresolved pain before starting PT), I have gotten back my missing range of motion. However, I am still getting the pinching sensation when I squat and this is probably the last painful activity. I love to squat deep and Olympic lift and hope that I will be able to get back to it? Is this a typical experience from what you have seen? What timelines do you observe.

    Thank you, and this series has been really helpful.

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

      Thanks for the response. Have you tried changing your squat stance some? I have had some success with widening the stance, turning the feet out slightly or also trying to change how upright your torso is while you squat. Depending on the injury it could take several months to get back. Start with high box squats and progress yourself lower and lower each month.

  • lorenzo
    20 January 2015 at 10:26
    Leave a Reply

    hi dan, i’m 18 and I started squatting two months ago, but now i think i’ve got a femural acetabular impingement. mi hip hurts on the bottom of squat, in the lateral and posterior part. i was wonering if the exercises you mentioned can be performed now that i’m injuried so i can come back to normal activity, or if they are not useful now that i caused the damage and the only way is the artroscopy… thank you for your help, it is always a lot appreciated 😀

    • djpope
      9 February 2015 at 10:26
      Leave a Reply

      Definitely find a therapist to help you. Everyone is an individual. These are some common exercises I would use for someone who isn’t particularly painful and wouldn’t force these if they hurt.

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