Why Do My Hips Hurt When I Squat? Femoral Acetabular Impingement: Part 2

By djpope

March 5, 2013

cam, FAI, femoral acetabular impingement, femoral retroversion, hip, labral tear, pincer
source: sportsciencelab.com
source: sportsciencelab.com

In part 1 we discussed what femoral acetabular impingement (FAI) is and how squatting can be causing pinching and pain in your groin and hip.  In part 2 we’ll start troubleshooting the squat to figure out why you’re getting the pain.

Our good friend the brain doesn’t give us pain for absolutely no reason. If squatting is painful it’s our brain trying to tell us that there is something potentially damaging going on in the hips when we squat.

If we want a fighting chance of fixing our hip and groin pain while still continuing to squat, we’re going to have to troubleshoot our technique and figure out how to fix it.

Remember the tests I spoke about that can rule in FAI or labral pathology?  Here’s another special test for femoral acetabular impingement and hip pathology.

Do you notice how this test for hip labral pathology is eerily similar to the bottom position of a squat when things go wrong?

source: www.nunnsperformancetraining.com
source: www.nunnsperformancetraining.com

No offense to this incredibly powerful gentleman here but he’s got a good deal of hip internal rotation going on in the bottom position of his squat.  Notice how his knees are not over his toes?  That’s the dead give away.  He’s placing himself into the same provocative and painful position that physical therapists test for in the above video.  If we’re going into this position with weight constantly we’re setting ourselves up for femoral acetabular impingement.

Contrast that with the hips of this Chinese weightlifter in the bottom position of the squat…

source: www.crossfit55.com
source: www.crossfit55.com

He’s got a lot more external rotation going on in his hips at the bottom of the squat.   Notice how his knees are forced out and and his knees are aligned with his toes.  Achieving this position is how we’ll keep our hips healthy and avoid impingement.

Now I want everyone to be completely honest with themselves and ask if they ever deviate from the picture perfect overhead squat position seen by the gentlemen in the picture above.  I find most people can’t even get into this position without weight let alone with hundreds of pounds overhead!  No wonder why our hips hurt.

So our next goal is to troubleshoot why our squat form falls apart.  I’m going to establish a shotgun approach for now.  Hopefully in the future I’ll get around to writing an article about how to evaluate where your specific limitations are in the squat so we can be a bit more targeted in our corrective approach.

Perfect Overhead 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
source: t-nation.com
source: t-nation.com

Now, given that our body is a system of joints, if you’ve got a limitation in any one of these areas it’s going to affect what goes on with your hips.  Everything up and down the chain needs to be addressed including the hips themselves.  Before we take a joint by joint approach to fixing the squat keep 2 things in mind.

1) When you fatigue or when you use too much weight, you’ll naturally fall into a position that is going to wreak havoc on your hips.  If you’re interested in learning why, click HERE:

2) It takes time to learn how to squat properly.  On top of that your technique will be changing as you get more and more flexible.  Work on your technique with every rep of every set.

Here are the Cliff notes:

  • Foot – Train to maintain a short foot position
  • Ankle – Mobilize it
  • Knee – Keep it over the toe when squatting
  • Hips – Strengthen and stretch the hip external
  • Lumbar Spine – Learn to move from the hips and keep the spine flat during squats
  • Thoracic Spine – Mobilize it into extension and strengthen it so it doesn’t flex (round) during squats
  • Shoulders – Mobilize them and train the shoulder to stay retracted and externally rotated

Next we’ll go over some ideas to go about addressing these deficits.

1) The Feet – Your feet are the only thing that comes into contact with the floor and will therefore help to set the rest of your joints in the proper place for squatting.

Learn how to use the “short foot”

Now apply it to your squat:

You can practice this foot position during deadlifts and lunges also.

2) The Ankles – A lack of ankle mobility can cause internal rotation of the hips at the bottom position of the squat and end up causing impingement.

My favorite ankle mobility drill

Some additional mobility drills from Kelly Starret

3) The KneesThe knees are a slave to the joints directly above and below them.  The important thing to keep in mind is that the knees need to stay in line with the toes during a squat.

source: wg-fit.com
source: wg-fit.com

If your knees are aligned with the toes during a squat it’s also a sign that your feet and hips are in an optimal position.   The cue “knees out” creates external rotation at the hip and that’s what we want.  External rotation of the hips is going to decrease impingement in the bottom of a squat.

4) The Hips – As discussed previously, excessive internal rotation of the femur in the bottom position of the squat is the mechanism of injury in femoral acetabular impingement.  If you have your toes pointed out slightly and your knees are aligned over your toes, then your hips are going to follow suite and externally rotate into a healthy position.

The hips need a balance of mobility and stability to achieve this position.

5) The Lower Back (Lumbar Spine) – It’s vitally important to learn how to keep the spine in a neutral position and move from the hips during the squat.  Individuals with femoral acetabular impingement tend to have decreased range of motion in their hips and can end up compensating to get deeper into a squat by rounding the lower back.   This can lead to what has been termed “butt tucking” or “butt wink” during the squat.  Now you’ve got hip and lower back pain.  So on top of getting your hips more mobile, learn how to use the hip hinge and move from the hips while keeping a neutral spine.

6) The Upper Back (Thoracic Spine) and Shoulders – Limited flexibility in the upper back and shoulders can decrease your ability to get your arms overhead into an overhead squat.  If you lack flexibility here, your body will try to gain flexibility from another joint and if that joint ends up being your hip, you’ll end up with groin and hip pain.

My 6 favorite thoracic spine mobility drills

Remember that there is more to injury prevention and longevity then having a good looking squat.   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:

Want to learn more about how to assess yourself and your athlete’s motion to keep their hips healthy and find the best exercises to correct their movement problems?  Check out my product with Dr. Dave Tilley:

Monkey Method – Movement Essentials

The Ultimate Guide to Understanding and Fixing Technical Flaws in the Handstand, Muscle-up and Olympic Lifts

I think this is where we’ll call it for today.  Next time we’ll discuss the concept of joint centration and which exercises to use to help clean up your hip problems.

I love overhead squats,

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.


Macrum, E., Bell, D., Boling, M., Lewek, M., & Padua, D. (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sports Rehabilitation, 21(2), 144-150. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22622377

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