How to Modify the Squat With Hip Pain

By djpope

July 4, 2019

FAI, femoral acetabular impingement, hip, hip pain, modification, pain front of hip, pain in the bottom of a squat, scale, scaling, squatting

When you’ve got some hip pain, the squat can be the most painful movement in the gym. Usually the pain occurs in the bottom of the squat and is felt right in the front and or inside of the hip.

A huge part of getting out of hip pain is unloading the painful injured area to allow it to calm down and heal. If you keep squatting through a painful pinch in the front of the hip you risk making it worse over the course of time.

My boss and mentor Mike Reinold has a saying, “addition by subtraction”. Basically if you subtract the movements that are creating pain we end up making progress (addition) where we weren’t before.

That doesn’t mean we have to stop squatting when the hip hurts. Quite the contrary, continuing to squat in a modified fashion can actually help the hip to heal (and continue promoting those squat gainz we want). The magic is in finding the right modification to use to accomplish this.

To help you navigate through the modification process I’ve created principles for the squat to help you find the right squat modification for you when the hip hurts. I’ve also created handy dandy modification infographics to help you navigate the modification waters as well. Before we check that out, here are some basic principles to understand that effect stress in the hip during squatting.

Squatting and Hip Pain Principles

Here are 7 principles that increase stress in the hip during the squat:

  1. A Narrow Stance With No Toe Out – Increased hip flexion (deeper squats), internal rotation (more knee in) and adduction (narrow stance) are all movements that can increase impingement of the hip.
  2. An Excessively Wide Squat Stance with a Lot of Toe Out – Just as having a narrow stance can cause problems, the same can be said about the other extreme. 
  3. Increased Depth of Squatting – Deeper squats are generally more stressful than more shallow variations.
  4. Increased Torso Inclination – The more the torso is pitched forward and the hips are sent back the more hip flexion occurs and stress on the hip is increased
  5. Ankle Mobility Restrictions – Having less mobility in the ankle will force more movement to the hip and increase impingement.
  6. Anterior Pelvic Tilt –  Anterior pelvic tilt combined with excessive lower back extension increases impingement at the hip
  7. Dynamic Valgus or “Knee In” – If the knee travels inward during a squat (in relationship to the 2nd toe) the hip joint is going into internal rotation and adduction which are the two movements that increase impingement of the hip. 

6 Pro Tips For Reducing Pinching Hip Pain in the Bottom of the Squat

  1. Attempt to modify squat stance to eliminate symptoms
    • Increase or decrease toe out
    • Narrow or widen stance
  2. Limit depth of squat variation
    • Exercise examples: Box Squat with limited depth or 1/2 squats
  3. Pick more upright squat variations – A more upright torso requires less hip motion and can alleviate impingement
    • Front squats as opposed to back squats
    • High bar back squats over low bar
  4. Add ankle mobility – More ankle mobility will decrease the need for additional hip mobility in a deep squat
    • Mobilize the ankles
    • Add a heel lift or wear olympic weightlifting shoes
  5. Modify pelvic position
    • Extending the lumbar spine excessively and anteriorly tilting the pelvis will bring the socket portion closer into contact with the femur
    • Ensure athletes aren’t overextending in the bottom of the squat
  6. Don’t allow “knee in”
    • Ensure the knee is aligned over the toe especially at the bottom of the squat

Squat Modification Ladder for Hip Pain – When you are unable to eliminate pain by slowing down reps, attempting a higher rep range or modifying technique, use the ladder below to find a pain free squatting variation.

So now you have a plan for your painful hip when squats pop up in your training program. As your pain slowly improves over the next several weeks and months you can also work your way back up this squat modification ladder to get back to your previous squat routine.

Who Doesn’t Love Hip Pain?