So, today we want to focus specifically on hip pain when squatting. Our goal is to help you eliminate hip pain during back squats completely, so you can reap the benefits of this incredibly effective exercise. 100% PAIN-FREE.
Hip pinching and anterior hip pain when squatting is one of the most commonly discussed and complained about afflictions in the gym. And to make matters worse, it’s so often incompetently managed. Some people work through the pain, others attempt ineffective or misdiagnosed remedies…and possibly even worse, many people just ditch squats altogether.
If you are experiencing hip pain during squats, the first thing you need to do is get a better understanding of the hips and squat mechanics from the ground up. Then you need to assess the situation to see what exactly is causing your hip pain. And finally, you need to take action, whether that is correcting your form, doing mobility drills, self-myofascial release, or going to the doctor.
In this post, we are going to cover the following:
Let’s first review the anatomy of the hip, as to make sure we are all on the same page when discussing the causes and fixes further below…
The hip is a large ball-and-socket joint. It is reinforced by four ligaments and a multitude of muscles. Moreover, the hips have a powerful connection to the rest of our body, from our knees to our lower back to our shoulders, they are the center of our kinetic chain foundation.
As to not overcomplicate things, we will only be discussing the key structures that play a role in hip pain when squatting…
The pelvis consists of three bones. Together they form the hip socket.
The hip socket is called the acetabulum. The head of the femur fits snugly into the hip socket, and it is sheathed by connective tissue and layers upon layers of strong muscles.
Now, let’s look at the ligaments and muscles…
There are three important and strong ligaments that make up what is called our joint capsule. The joint capsule is a watertight sac that encompasses the entire ball-and-socket joint of our hip. These three ligaments connect the head of the femur to the acetabulum (hip socket). These ligaments are the root of stability for the hip, they are called extracapsular ligaments - iliofemoral, ischiofemoral, and pubofemoral ligaments.
We also have one ligament, which is called our intracapsular ligament. It attached to the femur head and the acetabulum. This ligament is only stretched if our hip is dislocated. That said, we won’t be talking any further about our intracapsular ligament here as it is not vital for today’s discussion.
There are various muscles located on the posterior, anterior and lateral area of the hip. Let’s look at this in the least complicated way…
Iliopsoas (AKA “hip flexor” or sometimes simply referred to as the Psoas)
This is a muscle that connects the lumbar spine to the femur (thigh bone). Its job is to flex the hip. If this muscles is too tight, it can cause excessive anterior tilt of the pelvis and abnormal alignment of the hip joint.
We have three gluteal muscles that connect and extend from the back of the ilium (hip bone) to the femur (thigh bone). Combined, they extend and abduct the hip. If these muscles are weak, it can cause poor knee control when squatting or lunging. This leads to poor mechanics and may end up causing hip impingement. Ouch.
Deep Hip External Rotators
This is a group of many small muscles that connect the sacrum (tailbone) to the femur. Their job is to externally rotate the femur. If these muscles are week, the knees are apt to cave in (valgus aka “knocked-kneed”) during squats.
It absolutely can! Hip pain when squatting is one of the most common issues. That and knee pain. Hip pain during squats can be felt in the front of the hip (anterior hip pain), side of the hip (lateral hip pain) and back of the hip (posterior hip pain). Anterior and lateral hip pain being the most typical. Moreover, pain may be a pinching feeling or a sharp pain. It’s important to understand these various types of hip pain when squatting, as it will help you pinpoint what is causing your hip pain.
Unfortunately, there is no one cause that we can point to. So, we are going to go over some of the most common causes of hip pain. We will also explain the type of hip pain you will feel for each specific cause and where the pain is typically located within the hip.
Let’s go over the causes, then we will show you a video that will address self-help techniques all of the points below.
Remember the three ligaments that make up the joint capsule from the anatomy section above? Well, for a small majority of people, the lower and posterior side of the joint capsule can become tight and tense when the hip is placed into certain positions. If this happens, the point where the femur head rotates can relocate anteriorly. This change in biomechanics causes a pinch in the front of the hip.
We have noticed that many people come to the conclusion that this must be the cause of their hip pain after doing research. However, in our experience, this is not one of the more common causes for hip pain. In fact, the large majority of people don’t have this issue.
If by chance you do have restrictions and limitations in your joint capsule mobility, you can do the mobilization exercises provided in this article. And if that doesn’t help, you will need to seek out a qualified physical therapist or rehab professional, like Dr. Michael Risher, to help resolve the problem.
Before seeking out a specialist, look to the rest of the remedies in this post. You very well might able to fix your hip pain issue on your own, with some simple exercises, stretches, and alterations of your form.
If the muscles around our joints become tight or firm, the mobility of our hips will be limited. This is most often the cause of hip pain when squatting. It is also an easy fix, if you are willing to put some time into work on your mobility.
The muscles around our hip joint that can become tight or firm, thus limiting hip mobility, are the Gluteus Maximus, Adductors, Hip External/Internal Rotators, Rectus Femoris/Vastus Lateralis, Iliacus, Psoas, and Tensor Fasciae Latae (TFL).
The gluteus maximus and the adductors restrict hip flexion if they are too tight. These muscles are the most common culprits. Less likely but still a possible cause of limited hip mobility are the external and internal rotators.
As for the Rectus Femoris, Vastus Lateralis, Iliacus, and Tensor Fascia Latae, although these muscles should be slacked during hip flexion, due to their attachment points, if there is an increase in tightness or firmness, they can place the hip and pelvis into an anterior tilt position when standing. This causes a decrease in the amount of room needed for hip flexion, as there is less space between the acetabulum and head of the femur.
Now, we just wanted to explain things as concise and clear as possible, but thankfully, you don’t need to do a bunch of tests to figure out which muscles are tight or firm.
HIP MOBILITY TEST
We have one test that will do the trick for figuring out what muscles are the cause of the limited hip mobility that is causing your pain.
Thomas Test (aka Iliacus Test or Iliopsoas Test):
This test can be done even if you are not a clinician or coach. It is one of the most reliable tests you can do, and you can do it anywhere.
Let’s breakdown the findings more.
At step 4, we can notice a few things that can tell us which muscles are tight. By the way, the leg we are testing is the one that is extended.
At step 5, we can see if we need more internal or external rotation mobility. The most common cause of this is mobility issue is prolonged sitting. It creates weakness in the external and internal rotators.
If any of these indicators come back positive, we have two fixes to help improve the mobility of our hip musculature.
HIP MOBILITY FIXES:
Dynamic Hip Mobility Stretches
Dynamic hip stretches are effective for improving and normalizing hip mobility. The stretches/mobilization exercises seen in the videos below will be very useful before you do squats or as self-maintenance in the evening or on rest days. We will be doing these stretches to create normalcy in the range of motion, so we don’t want to overstretch and create a range of motion that is beyond what we need.
Begin by addressing the Iliacus, Psoas, and TFL with the following foam rolling drill:
From here, test to see if there are any improvements.
Test and re-test always.
In the video, the last technique is a self-myofscial release technique of the Psoas/Hip Flexors. So watch the video below until the end!
When considering mobility as an issue for hip pain when squatting, we must also look beyond the hips.
Poor ankle mobility leads to knee and hip compensation during squats. So, if you have poor ankle mobility, you will have bad squat form, which can cause hip pain during squats.
Therefore, another assessment you should do if you are having hip pain when squatting is an ankle mobility test.
In this article, we go over everything you need to know about ankle mobility, including tests and assessments and a couple of exercises to improve ankle mobility. It’s a must-read for those who are attempting to perfect their squat form and cure hip pain when squatting.
When it comes to a squat, the first part of the movement consists of the leg bone moving on the socket, and then towards the bottom of the squat we tilt our pelvis back and up, at which point our socket moves on the leg bone, so we can go deeper into the squat. This is all good.
The issue is, many times people prematurely tilt the pelvis, and this combined with our leg bone moving on the socket, creates a point where we reach our ball and sockets limit of movement too early, thus causing pain when we go deeper into the squat.
Work on your hip and ankle mobility, that way you can do the first portion of the squat with a more neutral spine and avoid a premature posterior pelvic tilt.
Brace your core
The muscles in the front really need to stabilize you to pull you forward as the weight is constantly pulling you back.
Now, we can get into this weird spot where we have the wrong muscles pulling on our hips and body to keep us forward so we don’t fall back, and that is typically where the hip pain arises from.
So, besides getting your form down, when you are squatting one of the main things to consider is bracing your core.
This is the first thing you want to do, as this will help alleviate pain off of your psoas and other surrounding structures. This is usually the number one reason for people having anterior hip pain when squatting.
So, on top of all the mobilization exercises that Dr Michael Risher is going to show you in the video below, make sure you work on your core bracing, using your abs and your diaphragm to brace and pull yourself forward so that you body doesn’t rely on your psoas muscles and hip flexors to do so.
Now, you’ll probably have noticed that not everyone squats the same. Although this can be due to good or bad squat practices, it can also be due to the fact that the femur and hip socket is shaped differently from person to person. Some people have what is considered “normal” anatomy, while others have variations. The hip socket may point forward for one person, while it points slightly laterally for another. Moreover, there are individual differences in the femur. Some people have femurs that are twisted forward, while others backward.
Studies show up to 40% of people might have slight abnormalities. There are tests for this, such as the “Craig’s Test”. You can also do an X-ray. Both may not be necessary, but it is good to understand that we all have differences, that way you can adjust your form if needed.
When it comes to squat form, there isn’t a one size fits all, and for some people, you simply can’t “outstretch the pain”.
Bony Limitation Fixes
The only way to truly fix a bony limitation is surgery. However, for most people, this won’t be necessary. As long as you are living a comfortable life and you are able to squat (with a slightly altered form) you are fine.
So, the best thing you can do if a bony limitation is the cause of your hip pain when squatting is alter your form.
Alter your form:
In many cases, altering your form can make all the difference in alleviating hip pain.
Find you right stance
Many people have slight differences in their hip structure, which is why a lot of people have various differences in their squats too. You will see most powerlifters have different stances when they squat. Some are slightly wider with their toes pointing slightly outward, while others have their feet shoulder-width-or-less apart and feet squared forward.
These strong powerlifters have found the right squat for them. That way they can lift heavy and without pain.
So, if you are having hip pain when squatting, try to reassess your squat form. Try a wider or narrower stance, try pointing your toes slightly out or more squared forward - FIND YOUR STANCE. Do this through bodyweight only squats…
All in all, it will feel more natural when you are squatting, so it shouldn’t be difficult to figure out…Moreover, there is a great chance this will completely stop your hip pain when squatting.
Although mobility and improper form is the most common cause of hip pain when squatting, a hip impingement may very well be the cause.
So, it is good to asses for a hip impingement.
How does a hip impingement occur?
Hip impingement can be a “deformity” aka abnormal hip structure (simply the way you were born). They can also occur from an injury or from repetitive bumping or pinching of the femur on the rim of the acetabulum. This leads to a build up of cartilage around the acetabulum. This can be caused by years of poor form and technique when squatting, from sports, or many other various activities that put pressure on the hips.
Symptoms of hip impingement:
Often time, people born with abnormalities of the hip joint won’t feel any pain in the hip, except when squatting or doing other movements that puts their hip in certain positions.
For those who have become structurally abnormal through injury or repetitive bumping or pinching of the rim of the acetabulum, they may also not feel pain until years after the hip impingement first starts. When they do feel pain, whether that is quickly or overtime, the symptoms are:
Hip impingements may very well not fixable without surgery but there are some mobilization exercises that you can attempt by yourself or with a chiropractor or physical therapist before doing the surgery route. They might resolve the issue. But it will require consistent maintenance for a good amount of time. The mobilization exercises in the video below are good for attempting to cure pain when squatting if you have hip impingement, as they are going to work to give your femur and acetabulum some space to move and not pinch/grind when rotating during a squat.
Although back squats are arguably the best squat you can do, sometimes back squats just aren’t for everyone. There are many variations of the squat that use different mechanics, thus changing the stress on the musculature and joints in a different manner.
For example, with goblet squats and front squats, your torso will be in a more upright position (neutral spine). Therefore, it will likely be easier on your hip joint and you won’t feel hip pain with these variations of the squat.
As for back squats, even where you position the bar on your back can make all the difference. High-bar back squats can be done with a more neutral spine as the barbell won’t be pulling your back as much, putting less pressure on your hips and low back.
If you do a low bar back squat, definitely try squatting with a high bar back squat (go light at first) and squat down with a neutral spine.
Overall, if you can’t seem to fix the issue with hip pain when squatting, you can still do squats! Doing variations of squats will allow you to target your lower body and get a great workout in without the worry of hip pain.
Related: Front Squats vs Back Squats
Goblet squats are the easiest on your hips, then front squats.
Other variations of the squat to try - Animal & Ancient Inspired Squat & Steel Mace Squats.
These are good self-management techniques for hip mobility, both at the joint capsule and muscle/tissue level. They also may be effective for those with hip impingements, however, if you don’t see improvements and your hip impingement is serious, go see a doctor.
The mobilizations in this video are going to loosen up the joint. They are going to help distract the joint (pull the joint from the socket ever so gently), which is going to reset the muscles and joint, and help you stretch just a little bit so that your body is more aware of where the joint is in space and so the body doesn’t have as much tension on these muscles that shouldn’t have tension.
These exercises are designed to help cure hip pain when squatting.
When to do these mobilization exercises?
As a warm up or general maintenance. If using it as a warm up, don’t overdo it, as you don’t want to create too much laxity in your hip joint. The key is to do enough so that you can mobilize your joint just a little bit.
Do this on both sides for 1 to 2 sets.
This mobilization exercise is similar but it is the exact opposite set up.
How to do:
Do this on both sides for 1 to 2 sets.
For this one, keep in mind, you don’t want to loosen up your psoas too much, but you do want to create a little bit of a stretch there. That’s going to help activate it slightly while also alleviating the pain you have in the front of your hip when squatting.
For this exercise, Dr. Michael Risher is using a 7LB SET FOR SET Steel Mace.
Maces are great for grip strength, core strength, shoulder strength and more. However, not many people realize they can be used as a mobility tool with the right understanding of how to use the mace.
Now, specifically for your hip flexors, this is going to be sort of like what a chiropractor or physical therapist does when releasing a client's psoas muscle.
**With Dr. Michael Risher’s exercise here, you are getting a chiropractic exercise that you can do on your own!**
TIP: Try going at an angle towards the outside of your hip. This tends to be where most people feel the most tender and where they have their hip pain. So, doing a little bit of mobilization and self-massage with your mace in that area can be very helpful.
Note: This is not something that you should do too much. If your pain is serious, you should definitely see a chiropractor or physical therapist. But, this is good if you are looking for a bit of self-mobilization to help control your hip pain and help loosen up your hip flexor.
If you have serious hip pain or it doesn’t get better with the above mobilization and techniques, OR it seems to be getting worse, please do go see a doctor, physical therapist, or chiropractor.
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