The Hip Pinch – how to fix
Ever been squatting and felt that annoying pinch at the front of your hip? Don’t worry you are not the only one! This is easily one of the most common complaints from CrossFitters/Weightlifters. The hip pinch that is being felt is known as Femoral Acetabular Impingement (FAI) and can occur due to a variety of restrictions when squatting.
What causes the hip pinch?
There are a few different causes of FAI however this article will focus on the most common cause; poor hip biomechanics. Biomechanically, during a squat the femoral head/neck should slide posteriorly in the hip joint therefore creating space at the front of the joint for a large range of hip flexion. When there is a dysfunction in hip biomechanics what can happen is that the head/neck of the femur can actually be pulled into the anterior part of the joint causing the head of the femur to come into contact with the hip socket causing pain and reduced mobility. This dysfunction can be caused by overactive tight hamstrings overpowering the underactive Glutes and this coupled with hip flexor muscles that are not doing their job is a recipe for a painful hip!
What are the symptoms?
- Pain deep in the hip when sitting for too long.
- Deep pain that’s hard to palpate on the anterior surface of the hip.
- Gradual onset.
- Pain with activity e.g. Squatting and Lunging.
Don’t leave it too long before you start treating it!
The hip pinch may now seem easy enough to treat – fix your hamstrings and glute issues and everything will be fine, right? Well this all depends on how long you leave it. If this issue is left too long then over time the constant contact between the femur and the acetabular (socket) can leave some lasting damage in the form of bone growth. There are two types of deformity that can lead on from the hip pinch. A CAM deformity can form on the femur, which is essentially small abnormal growth on the head of the femur or there is a PINCER lesion which is a growth on the rim of the acetabulum (socket), both abnormalities can lead to increased contact between the two surfaces.
How can we treat this?
Firstly there will need to be some activity modification and this is not just to do with your squatting. Movements performed in everyday life activities may have to change as well, sitting for one.
Firstly if you tend to sit all day at a desk with minimal breaks in an 8 hour period this is not going to help. Fixing your hips into flexion will only causing more inactivity in your glutes, so try to get up and move! Whilst you are sitting try to make a few changes. Sit with your legs apart rather than with your knees tucked in together and avoid sitting with crossed legs as this only compounds the impingement problem.
Secondly, if you do prefer to sleep on your side then please do but with a pillow wedged between your knees and ankles, again preventing excessive internal rotation at the hip. At the same time avoid sleeping in extreme hip flexion.
Lastly avoid any repetitive activities that cause constant repetitive hip flexion e.g. rowing or cycling.
First on the agenda is to strengthen those glutes and we will do that by following 3 simple exercises.
Stage 1 – 3 x 10 per exercise, 3 times a week.
After 2 weeks if the symptoms are improving and the stage 1 exercises are becoming far too easy then progress onto stage 2.
Stage 2 – 3 x 10, 3 times a week
After another 2 weeks if your symptoms are still improving and you have mastered the stage 2 exercises then move on again to the final stage.
Stage 3 – 3 x 10, 3 times a week.
- Glute/Ham raises with weight
- Sumo Squat with weight
- Single leg squat (gradually increasing depth from box)
- Single Leg RDL into Single Leg RDL with band
Whilst working through the progressions of these corrective exercises you will need to be incorporating stretching into your routine. These stretches should be performed in isolation or post exercise and should be held for 30 seconds performing all 4 stretches 3 times. This should be carried out 3 times a week.
- Overstretched Lunge
These exercises can be progressed from one stage to the next every 1-2 weeks depending on your speed of recovery. Once the issues of FAI have subsided then these exercises can be continued to maintain hip strength and to ensure your hip can move safely and efficiently. The first 3 exercises are also perfect to do on a squatting day prior to lifting as they will ensure your glutes are firing before you start!
Hopefully that will give you a brief understanding on the impingement issue that is so common throughout the weightlifting and CrossFit world.
If you do have any questions then don’t hesitate to email me at firstname.lastname@example.org
Rob Lang MSc, BSc.