Got Pinching Hips?
This is a common complaint from our athletes, they feel a pinching sensation and pain when squatting, deadlifting, going up stairs, running, doing ab exercises, etc.
So, what’s going on here?
It could be a hip impingement. The hip is a ball and socket joint, in which the head of the femur is the ball that sits in the acetabulum of the pelvis. Impingement occurs when the head of the femur pinches against the acetabulum, which can lead to some labral damage and pain. That being said, multiple studies have found 40-69% of asymptomatic individuals have damage to the labrum of the hip on MRI. Meaning, there’s no need to freak out, you have an opportunity to address the pain without surgery.
Can I keep strengthening while addressing the pain?
Yes, absolutely. In fact, we believe it’s important to continue to exercise, but we may need to make some alterations just to decrease the pain initially during the rehab process. After the symptoms have decreased, we will want to gradually re-introduce the movements that previously caused discomfort.
Hip Hinge: The first thing you want to do is make sure you’ve got a good hip hinge. If you find you initiate the squat or deadlift going into an anterior pelvic tilt. This pelvic tilt will actually bring the head of the femur closer to the top of the acetabulum, giving you less room before pinching occurs.
Squats: If the back squat is bothering you, you might consider changing to the front squat. The front squat requires a greater upright torso, which decreases the amount of hip flexion. The decrease in hip flexion may be sufficient enough to decrease or eliminate the discomfort. You can also try a box squat or altering the tempo.
Additionally, spend some time playing with your squat set up by altering foot width and turn out. A wider stance with a slight toe turn out may be more comfortable for your bony anatomy. Remember there is no one single perfect squat.
Deadlifts: Altering the type of deadlift can help decrease the discomfort in the early phases of rehab. Changing from a conventional deadlift to a sumo deadlift places the torso more upright. You can also try the trap bar/hex bar deadlift, which also allows for less hip flexion.
What do I do about my tight hip flexors?
Time to strengthen the hip!
Many, people who complain about their hips pinching note that they have incredibly tight hip flexors, they do the couch stretch or foam roll, over and over again, but nothing ever gets better. It’s probably time to stop stretching and rolling and start strengthening those bad boys. We’ve often found that a muscle the feels tight is, in fact, weak, and screaming out to be strengthened. Here are some exercises you can incorporate to increase your hip flexor strength.
Seated straight leg raise:
Supine eccentric hip flexion:
Standing end range hip flexion lift off:
Anything else I could add in?
Another position of discomfort for people is often hip internal rotation. Gradually adding in internal rotation movements and mobility. When we say gradually, we mean it, don’t try to aggressively push your hip into internal rotation, this may aggravate the symptoms more. It may be helpful to start with closed chain internal rotation, where you’re moving your trunk instead of your hip, this is often more tolerable.
The rotational deadlift and the single leg internal rotation deadlift are great options for this.
Studies on Hip Labral Pathology in Asymptomatic Individuals