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How you can help your “pinchy” hip?

How you can help your “pinchy” hip?

So your squat is shallow and you get a pinching pain in the front of your hip when you reach your full depth. What can you do about this?

 

First you need to establish if the cause of these factors is actually the hip….. 

  1.  Assessment

What is your Passive Range of Motion?

Checking your hip rotation ROM (internal, external, flexion, extension) is a good starting point for testing what is blocking you reaching your full squat depth without symptoms.  However, it is best if someone with experience does this for you to ensure you are getting accurate results.

An ideal ROM would look something like this:

External rotation 0-60 degrees

Internal rotation as pictured 0-45 degrees

Hip extension 0-15 degrees

Hip flexion 0-125 degrees

 

Stability Assessment:

Next, check your stability in the hip with a single leg glute bridge and a single leg squat.

With these tests, we are looking for quality of movement, rather than symptoms. For example;

 

  1. Does one side feel easier than the other side (stability and fatigue)?
  2. Where do you feel the fatigue (gluteals, hamstrings, lower back)?
  3. Are you able to maintain good alignment, ie are your hips straight/level, is your torso position upright, how is your ankle/knee/hip alignment relative to each other?

 

Squat Technique:

Next we need to know how your squat looks under load since a bodyweight squat might not reveal any discomfort or compensation. In this picture we can see a common compensation where there is hip discomfort.  Mostly we see clients lean away from the side of the pain but occasionally the pattern of compensation is toward the side of the discomfort.  Either way we want to minimise these asymmetries in our movement.

 

Other causes:

Finally, we need to look at possible other causes for compensatory movement patterns, for example, ankle stiffness, knee pain or stiffness, low back injury, pelvic rotation, scoliosis and so forth.  Any of these factors may influence your position in a squat and cause symptoms of pinching in the anterior hip. Of course sometimes it is also related to our genetic hip structure (size of the acetabulum and femoral head alignment etc – refer to our previous post regarding the hip:    ).

 

So we’ve established the hip may be the primary cause of your symptoms.  What can we do about it?

 

Rehab:

Once we have established some of the imbalances of range of motion, stability or technique – what can we do about them?

 

Mobility:

Please be aware:

There is no magic stretch to fix hip impingement.

However, there are a few mobility techniques you might find useful in reducing your symptoms and improving your tolerance to a deeper squat.

 

Trigger or Foam Rolling the TFL:

Using either a foam roller or a trigger ball, spend 2-3 minutes on each side getting stuck into the TFL. Find a good spot and hang out there for 30 seconds or so before moving onto another spot.

      

Barbell Inner Thigh Rolling

Applying a pressure that feels tolerable to you, spend 2-3 minutes rolling out the inner thigh. Try and target tissues high up the thigh, near the groin.

 

 

 

 

 

 

 

 

 

 

Banded Hip Mobility:

Starting in a half kneeling position, place a heavy band high in the groin of the painful hip. Using the band as distraction, try and mobilise the hip joint by lunging forwards and turning the knee inwards for 2 minutes. Don’t push into any pinching sensation thinking it may improve the more you do it, it’s important to understand the difference between a good stretch pain and a bad pinch pain.

Something you may want to avoid – Hip Flexor Stretch:

 

This is often a great stretch to help relieve tightness at the front of the hip. Unfortunately, if you’re experiencing hip impingement, this stretch may force the ball forward in the socket, thus increasing your pinchy sensation. Pay attention to your symptoms if you insist on continuing with this stretch. A generalised stretch pain through the front of the thigh is desirable, a localised pinch the front of the hip is not. 

 

 

Training Stability:

If you’re trying to work on some of the imbalances of your squat, you must train a single leg squat. Gradually build up the height of the box or plates to continue challenging yourself.  The single leg glute bridge and monster walks will supplement the single leg squats by increasing the conditioning of the hip muscles. You’re training these drills for endurance, so try and work in the 15-20+ rep ranges until fatigued in the glutes.

 

Single Leg Squat                                                         Single Leg Glute Bridge                                        

 

 

Monster Walks

 

  

Anti-Rotation Training:

 

The Pallof Press is a surprisingly challenging drill to work on reducing rotation during a squat. Placing a band on the pole, press the the band straight ahead and don’t let it rotate you. Again, we are training this exercise for endurance, so try and continuously press for 45+ seconds until you feel the fatigue through your mid section.

 

 

 

Squat Technique and Building Strength:

 

As we mentioned before, the anatomy of you hip may not allow for a narrow squat (or maybe you just need to take a break from narrow squatting!) It’s important to respect that we all have anatomical variances that means we simply cannot all squat the same. You can test where it feels best for you in the 4 point kneel demonstration below.

Start in a 4 point kneel

Rock back on to your heels and test how that feels in your hip joint.

Inch by inch, keep widening your knees to find a width that feels most comfortable in the hip joint.

When you’ve decided on a width, roll back on to your heels and compare it to your normal squat. You may have ended up with the same squat width as you normally have – or you may have found a more comfortable squat position to train.

 

 

Bracing Mechanics

A good bracing technique is important to stabilize the spine.  Think of your mid-section like a can of stability, wrapping around you like a corset and protecting your spine during a lift.

 

Indications of a poor bracing technique can be seen in the top 2 images below.

  1. Excessive extension of the spine and ribs flaring creating intra abdominal pressure and poor spinal stability (see image below top left).
  2. Maintaining excessive extension through the squat, causing additional pressure through the front of the hip (see image below top right).

 

In order to correctly brace as seen in the bottom two images above, you must:

  1. Breathe in as much air as you can down into your belly (see image above bottom left).
  2. Keep your ribs down and brace like you’re about to be punched before engaging with the lift.
  3. Hold the brace throughout the entirety of the lift (see image above bottom right).

  

Training Modifications:

 

Depending on what symptom modifications you’ve been able to make with some of the mobility and stability work – you may be able to load in a reduced capacity.  This can be achieved by either squatting down to a box or by reloading your new squat width. You also  need to modify the load to ensure you can address some of the technical faults that need work, i.e. favouring one leg, rotation, bracing etc.

 

 

 

 

 

 

 

 

Returning to training: Poke the bear, just don’t poke the hell out of it!

 

If these modifications are helpful and you can train with reduced pain – fantastic. Remember that there may still be sensitive tissue to respect, and suddenly loading up a new technique can actually cause other problems if you don’t rebuild slowly. Whether or not your need to completely deload, or are able to train through some discomfort depends on the person.

 

If you’re suffering from a long term injury, then check out this post on how to approach your training in order to address the issue instead of just avoiding it. Some injuries may allow for some discomfort or pain while you rehab (or in some cases even require it.)

If you have an irritated hip joint and want to accelerate your hip impingement rehab – temporarily avoiding movements that cause pain, then slowly building them back up is the ideal approach.

 

Written by Daniel Morrison

Edited by April King

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