hip pain squatting image

Hip Pain While Squatting

In Squat by Michael Mash

The barbell squat is one of the most pivotal exercises to build mass amounts of strength, muscle, and improve function in daily life. However, if done improperly, it can lead to both muscle aches and joint pain. Many lifters often experience deep anterior hip discomfort with squats, specifically at the bottom portion of the lift. This post will provide you with both the knowledge and tools on how to tackle this annoying pain!

Femoral Acetabular Impingement (FAI) is a condition where the hip bone or pelvis is abnormally shaped, causing bone-on-bone contact when you move your hip into flexion. A review by Frank et al. (2015) showed that up to 50% of athletes had FAI development on x-ray analysis. This congenital excess bony growth is a sure fire way to flare your hips up if you're not squatting correctly.

Traditional physical therapy has a simple solution for FAI: make sure to keep your squats shallow, or don't squat at all! I'm here to tell you there are a few quick fixes you can make to eliminate your anterior hip pain without giving up such a vital exercise .

Tip 1: Push the knees out to be in line with the toes
This seems to be the biggest mistake I see with squatting. Either people are not pushing their knees out far enough (creating a valgus stress) or they're pushing them out TOO much (creating a varus force)! Both circumstances create abnormal forces on the knee. Pushing the knees out to be in line with the foot not only engages more hip musculature to allow you to lift more weight, it changes the position of the hip so you no longer get bone-on-bone hip impingement.

knees out starting strength image

From Starting Strength, 3rd edition

Tip 2: Front squat during flare ups
Sometimes pushing the knees out during back squats is not enough to stop a flare-up associated with FAI. In that case, temporary substituting in front squats instead of back squats is a good alternative until your hip calms down. The decreased hip angle associated with front squats allows more room for the hip to "breathe" and for the inflammation to subside. Front squat until the anterior hip pain subsides and then slowly resume back squatting,making sure to push your knees out!

Tip 3: DON'T aggressively stretch your hip flexors
Just because something hurts, doesn't mean you should stretch it. This, however, seems to be a natural tendency because it does provide some temporary relief. Deep anterior hip pain associated with FAI is generally NOT caused by tight hip flexors. Aggressively stretching your hip flexors might just contribute to inflammation

Tip 4: DO work on anterior core stability and posterior tilt strength
Squats and deadlifts are GREAT stability exercises. They are considered anti-flexion spinal exercises because they teach you to stabilize your core by NOT allowing it to flex (or round) forward. The problem is, if you don't train the anti-extension aspect of the core as well by utilizing exercises such as dead bug progressions, hollow-body holds, and hip thrusts, you can begin to live in a position of anterior tilt. Excessive anterior tilt can exacerbate the bone-on-bone contact associated with FAI.

Ensuring the knees are in line with the toes is the BEST way to avoid anterior hip pain associated with FAI. Aggressively stretching the hip flexors may cause temporary relief, but in the long run this may actually exacerbate the issue. Also, incorporate front squats if you are flared up, and make sure to do you anterior core stability and hip thrusts to optimize pelvic alignment. Utilize these tips to avoid anterior hip pain while squatting!

Frank JM, Harris JD, Erickson BJ, et al. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy. 2015;31(6):1199-204.