Hip flexor pain when squatting

weese17

I've been lifting for about a year, but only started squatting heavy multiple times a week (Stronglifts) back in January. So perhaps this is an overuse injury, but I'm looking for info/experience in case it's a matter of form/flexibility or something else entirely.

Anyway! I'm having sharp hip flexor pain during squats. The pain is significant, and it's there whether I do front, goblet, BB or even bodyweight squats, normal or sumo squat, parallel or ATG. I'm extremely flexible - hypermobile, in fact - so it's not a matter of my calves/ankles/hips lacking a full ROM. I have changed my stance several times over the course of the last few months, trying to find the position that will allow me maximum glute activation since I'm naturally more hamstring-dominant. I've been very conservative with the weight progression - currently lifting 60kgs for 5x5 in a wide sumo stance.

I was having some back pain that I thought was twisted vertebrae, but when I saw my PT about it two days ago, she said that my right glute was extremely tight and that it was causing a chain reaction of tightness up my spine. I'm wondering if this is somehow related to the hip flexor pain, since it's all in the same area and both problems started around the same time.

Any thoughts? Thanks!

Crankstr

interested.

Gwyn1969

Hip flexor tendonitis can develop due to a form problem that often occurs in the low bar back squat. You didn't say if you were squatting low bar or not. If you are, you need to check your forward knee travel.

The knees should only travel forward for the first third to half of the descent. When they reach the furthest point forward, you need to sit back and stay tight in the hole. If your knees move forward at the bottom of the squat, you have relaxed your hamstrings. At this point, tension is put on the hip flexors at the point where they attach proximally (that means at the hip, or the ASIS). They get pulled on pretty hard, and you can develop tendonitis there. Once you have it, it's hard to get rid of, but over time, squatting properly will itself rid you of this issue.

BurtHuttz

In to see the responses.

Gwyn1969

Other people with this issue have reported that they had a great result when they found a good ART practitioner. (Active Release Technique - in other words, a vicious massage).

weese17

Hip flexor tendonitis can develop due to a form problem that often occurs in the low bar back squat. You didn't say if you were squatting low bar or not. If you are, you need to check your forward knee travel.

The knees should only travel forward for the first third to half of the descent. When they reach the furthest point forward, you need to sit back and stay tight in the hole. If your knees move forward at the bottom of the squat, you have relaxed your hamstrings. At this point, tension is put on the hip flexors at the point where they attach proximally (that means at the hip, or the ASIS). They get pulled on pretty hard, and you can develop tendonitis there. Once you have it, it's hard to get rid of, but over time, squatting properly will itself rid you of this issue.

Thanks! I actually do high bar squat since I use a manta ray. I checked my form just now anyway and it does look like I'm sitting back far enough, but tendonitis does seem like a possibility. I seem to be prone to it, alas.

weese17

This was a problem for my husband, and even caused IT band and knee problems as well as the hip flexor and back problems.

Combining glute stretches and foam roller massage has been incredibly helpful.

Thanks! I pulled out the foam roller yesterday and have started working. My PT said a few of my quadriceps muscles were extremely tight where they attached to the front of my pelvis, and it was making my IT bands sore, too.

Gwyn1969

This was a problem for my husband, and even caused IT band and knee problems as well as the hip flexor and back problems.

Combining glute stretches and foam roller massage has been incredibly helpful.

Thanks! I pulled out the foam roller yesterday and have started working. My PT said a few of my quadriceps muscles were extremely tight where they attached to the front of my pelvis, and it was making my IT bands sore, too.

My understanding is that the problem I described was endemic to low bar, but not such an issue with high bar or overhead squats, so it's probably related to something else. Can you get in there with a lacrosse ball?

Whoops, I meant to quote your other response, oops. :-)

SueSlick

Bump...didn't hubs talk about this the other day?

weese17

My understanding is that the problem I described was endemic to low bar, but not such an issue with high bar or overhead squats, so it's probably related to something else. Can you get in there with a lacrosse ball?

So I read your post, pulled out my ball and started working -- HOOO BOY! I think my voice just changed several octaves. Man oh man, that felt soooo bad/good!

weese17

Bump...didn't hubs talk about this the other day?

Today, as a matter of fact. I haven't even read his post, though!

Cait_Sidhe

I was having this problem too. I started doing hip flexor specific stretches before squats and I am no longer experiencing the hip flexor pain. I just searched for hip flexor stretches on youtube and did the ones that seemed reasonable. Mostly, I do low lunges. I stretch out the lunge until I can feel it in my hip flexors and hold it for 30 seconds, then do the other leg. I also do another one where I lean forward slightly holding the bar with my left hand. I use my right hand to bring my foot to my butt and stretch that out for 30 seconds, then do the other side. Also, the pose in the OP's picture would work pretty well to stretch the hip flexors. Another thing that helped is warming up with some kind of cardio beforehand for 5 minutes. I'm guilty of skipping this step beforehand and it really does help me. Hope this made some kind of sense and that it helps.

clanmcvicar

I've been lifting for about a year, but only started squatting heavy multiple times a week (Stronglifts) back in January. So perhaps this is an overuse injury, but I'm looking for info/experience in case it's a matter of form/flexibility or something else entirely.

Anyway! I'm having sharp hip flexor pain during squats. The pain is significant, and it's there whether I do front, goblet, BB or even bodyweight squats, normal or sumo squat, parallel or ATG. I'm extremely flexible - hypermobile, in fact - so it's not a matter of my calves/ankles/hips lacking a full ROM. I have changed my stance several times over the course of the last few months, trying to find the position that will allow me maximum glute activation since I'm naturally more hamstring-dominant. I've been very conservative with the weight progression - currently lifting 60kgs for 5x5 in a wide sumo stance.

I was having some back pain that I thought was twisted vertebrae, but when I saw my PT about it two days ago, she said that my right glute was extremely tight and that it was causing a chain reaction of tightness up my spine. I'm wondering if this is somehow related to the hip flexor pain, since it's all in the same area and both problems started around the same time.

Any thoughts? Thanks!

Have you tried a Crossfit site for info? They are extremely helpful and have a lot of blurbs and info about these kind of things - or find a crossfit gym in your area and go and have a chat with them for some personalised service! They will show you the hip flexor stretches and things to help increase muscle stability in that area. My Crossfit gym contains a mini super power lifing pocket rocket by the name of Georgina - she is awesome with info, and does olympic powerlifing. You might find someone similar there. Just a thought!
Luck **

CoachDreesTraining

Is the pain very local and sharp, almost like a pinch, or needle poke?

To me, it sounds like you have femoroacetabular impingement (FAI), or a hip impingement.

This is a good test to diagnosis the problem. You'll feel a sharp pain at the 0:55 mark if you have a hip impingement.

http://www.youtube.com/watch?v=XA1VSK5NBCk

princesspita

Is the pain very local and sharp, almost like a pinch, or needle poke?

To me, it sounds like you have femoroacetabular impingement (FAI), or a hip impingement.

This is a good test to diagnosis the problem. You'll feel a sharp pain at the 0:55 mark if you have a hip impingement.

http://www.youtube.com/watch?v=XA1VSK5NBCk

Exactly my thought too when I read the initial post.

weese17

Is the pain very local and sharp, almost like a pinch, or needle poke?

To me, it sounds like you have femoroacetabular impingement (FAI), or a hip impingement.

This is a good test to diagnosis the problem. You'll feel a sharp pain at the 0:55 mark if you have a hip impingement.

http://www.youtube.com/watch?v=XA1VSK5NBCk

Oh my gosh - YES, that is the pain exactly. Off to google this.

weese17

Uh oh.

If it's a hip impingement, I appear to be screwed. I guess I'll call my doc.

CoachDreesTraining

Is the pain very local and sharp, almost like a pinch, or needle poke?

To me, it sounds like you have femoroacetabular impingement (FAI), or a hip impingement.

This is a good test to diagnosis the problem. You'll feel a sharp pain at the 0:55 mark if you have a hip impingement.

http://www.youtube.com/watch?v=XA1VSK5NBCk

Oh my gosh - YES, that is the pain exactly. Off to google this.

Oops...diagnose*


Foam rolling and some glute activation exercises should help!

jaweiss1

Oops...diagnose*


Foam rolling and some glute activation exercises should help!

Foam rolling and glute activation exercises are not going to do anything for FAI. Both cam and pincer FAI are pathomorphologies of bone shape.

jaweiss1

Uh oh.

If it's a hip impingement, I appear to be screwed. I guess I'll call my doc.

See if you can find a hip specialist who is familiar with FAI. Ultimately, radiographs are needed to confirm or rule out the diagnosis.

lizlee8

bump for great responses

professorRAT

I am having very similar issues. MRI revealed several disc bulges, etc. Nerve irritation in my spine (around T10-11) is causing chronic muscle spasms and pulling on my hip (also referring pain to my hip area). So yeah, it could well be a nerve impingement issue. Talk to your doctor again!

CoachDreesTraining

Oops...diagnose*


Foam rolling and some glute activation exercises should help!

Foam rolling and glute activation exercises are not going to do anything for FAI. Both cam and pincer FAI are pathomorphologies of bone shape.

I'm not suggesting that foam rolling and glute activation is going to reverse anything, but it will HELP stop the progression and relieve pain.

The femur isn't traveling properly which causes the pinching sensation during internal rotation and flexion. Stabilizing the hip should give the head of the femur some more room to travel, at the bottom of the squat.

While I'm sure some people have a disposition for FAI, I believe 90% of it is a result of poor hip position.

weese17

Thanks for the great replies, everyone.

I have an appt. in 2 weeks w/ an orthopedic / sports med doctor who specializes in hips, and his site specifically mentions FAI. Gotta love living in a major metro area sometimes - so many specialists nearby! I'll cross my fingers.

jaweiss1

The femur isn't traveling properly which causes the pinching sensation during internal rotation and flexion. Stabilizing the hip should give the head of the femur some more room to travel, at the bottom of the squat.

FAI is due to contact between the femoral neck and the acetabular rim, and the pain is caused by crushing or pinching of the acetabular labrum. You cannot make more room for hip flexion by stabilizing the hip. FAI symptoms in deep hip flexion (bottom of the squat) are due to this impingement. People with FAI should avoid deep squatting and other activities that elicit pain, as the pain is due to labral deformation. Repeated deep squatting will result in labral tears and eventually cartilage delamination around the periphery of the acetabulum.

CoachDreesTraining

The femur isn't traveling properly which causes the pinching sensation during internal rotation and flexion. Stabilizing the hip should give the head of the femur some more room to travel, at the bottom of the squat.

FAI is due to contact between the femoral neck and the acetabular rim, and the pain is caused by crushing or pinching of the acetabular labrum. You cannot make more room for hip flexion by stabilizing the hip. FAI symptoms in deep hip flexion (bottom of the squat) are due to this impingement. People with FAI should avoid deep squatting and other activities that elicit pain, as the pain is due to labral deformation. Repeated deep squatting will result in labral tears and eventually cartilage delamination around the periphery of the acetabulum.

You should of spent more time searching Google before posting this...

http://posturalrestoration.com/media/pdfs/Hip_Impingement_2.pdf
http://www.ericcressey.com/hip-pain-in-athletes-the-origin-of-femoroacetabular-impingement
http://www.pureperformancetraining.com/blog/FAI

jaweiss1

You should of spent more time searching Google before posting this...

http://posturalrestoration.com/media/pdfs/Hip_Impingement_2.pdf
http://www.ericcressey.com/hip-pain-in-athletes-the-origin-of-femoroacetabular-impingement
http://www.pureperformancetraining.com/blog/FAI

To be clear, coach, my knowledge does not come from google. I have a PhD in bioengineering, and my research is focused on musculoskeletal biomchanics. Part of my research targets the study of the biomechanics of hip pathology. I also happen to have FAI.

http://mrl.sci.utah.edu/

Best of luck trying to correct skeletal deformities with foam rolling and glute activation exercises.

CoachDreesTraining

You should of spent more time searching Google before posting this...

http://posturalrestoration.com/media/pdfs/Hip_Impingement_2.pdf
http://www.ericcressey.com/hip-pain-in-athletes-the-origin-of-femoroacetabular-impingement
http://www.pureperformancetraining.com/blog/FAI

To be clear, coach, my knowledge does not come from google. I have a PhD in bioengineering, and my research is focused on musculoskeletal biomchanics. Part of my research targets the study of the biomechanics of hip pathology. I also happen to have FAI.

http://mrl.sci.utah.edu/

Best of luck trying to correct skeletal deformities with foam rolling and glute activation exercises.

Thank you. Good luck with your research.

fishlover888

My 2 cents for the FAI discussion (getting my Doctor of Physical Therapy in August) -

Agree with you jaweiss that you can't correct skeletal deformities without surgery. However having treated a lot of patients with FAI, snapping hip, and hip flexor tendonitis (all of which the OP could have, hard to tell without physical exam), there are definitely ways to decrease pain and improve function. Myofascial release such as foam roller and glut activation could help, tho I would recommend a more individualized program based on specific impairments (strength, myofascial restrictions, tendonitis, etc). Surgery, for true correction of skeletal deformities, is usually the very last option in my book based on the long and highly restricted recovery.

Also OP just clinical experience/personal experience wise I have noticed a link between pelvic alignment problems and aggravation of FAI. It's possible that your glute tightness is causing an alignment problem, sacral or iliac, which is aggravating present FAI symptoms. It's also possible if you have an FAI or an alignment problem, that is causing the tight glute Kind of a chicken or egg thing there.

Anyway OP glad you are seeing a specialist, hopefully it all works out for you and you can get back to squatting soon! Just FYI if it is FAI and you end up considering surgical options, it is a very long recover time so make sure you talk to your physician about all of that. Some of my patients still come in surprised that they have to be on crutches for months. Update us after your appointment!

weese17

Hi all:

I thought I'd post a follow-up.

I saw the orthopedic surgeon today about my hip pain, and it turns out that I have hip impingement (FAI) and labral tears in BOTH hips. Essentially, I have bony growths in both hip sockets that are keeping the head of my femur from operating normally, and this has led to a gradual wearing-down of the cartilage in the socket as well as the tears in the cartilage. Today's appointment was just the very first step in diagnosis (via x-ray) - next step is an arthorgram with injection to get more information on the exact state of the situation in my hips. Ultimately, though, the only way to fix these problems is via surgery. I will have to get the tears repaired and the bone filed down.

If anybody has experience with this sort of surgery, I'd love to hear about it. Thanks!

keeponkickin

I have FAI and labral tears in both hips. I had a regular MRI and then a MRA. I'm having surgery on the left hip in a couple of weeks. Doc said a long rehab of about 4 to 6 months on each side.