There is more than one cause of anterior hip pain with squatting but a great deal of cases are the result of FAI – Femoral Acetabular Impingement.
What is this?
The presence of compression between the neck/head of the femur (ball) and the acetabulum (socket).
What does it feel like?
An uncomfortable “pinching” sensation.
The sensation in the front of the hip often leads people to think they’re tight through their hip flexors, as they try to stretch out the front of their hip. However, it’s often NOT a tightness that needs to be stretched. In some cases stretching can make it worse.
What does it look like?
Very often it manifests in a squat pattern that looks like this:
What causes it?
Bony adaptations in the hip can occur in people over time, either on the acetabulum (Pincer lesion) or on the ball of the joint (Cam lesion). These are most prevalent in athlete’s who have a history of kicking sports (84% in young male soccer players) – but are not always symptomatic (15% complained of symptoms).
The bony anatomical reasons mentioned above could be a contributing factor to hip mobility restriction, however this could also be due to the soft tissue surrounding the joint. Put simply, the ball rotates in the socket during the descent in a squat, and a lack of hip rotation can create difficulties achieving a deep squat. This may be able to be modified with stretching or soft tissue work – or it may be an anatomical variation we need to work around by changing squat width, depth etc.
Assuming the range of motion in the hip is adequate to achieve a deep squat, lack of stability and strength may be the driving factor for the pinch. A lack of hip stability which allows the knees to drop in during the squat can cause excessive hip internal rotation and adduction of the hip that leads to the pinchy sensation in the bottom position.
Like a lot of sports related injuries, training load is one of the main contributors to FAI and a relative reduction in training load might be imminent in your rehab as we’ll discuss later on.
How can you tell which of the above causes pertains to you and whether FAI is causing your hip symptoms?
To find out more about FAI and how to diagnose this condition, stay tuned for our next post. 🙂