You Are Going to Have Hip Pain, Unless…
When you are physically active, train and/or play sports, you unfortunately have a greater chance to experience pain.
And no, pain is not “just a part of it,” or at least it should not be!
One of the goals of training is to reduce the risk of pain and potential injury, not exacerbate it.
But if you are training in suboptimal positions, and/or placing too much stress on a specific joint or tissue, you are setting yourself up to experience an overuse injury.
One of the most common areas to experience an overuse injury is at the hips. More specifically, the anterior hip (front of the hip), which becomes compromised and is often the site of pain.
Many times it feels like the front of the hip is just “wicked tight” and that it simply needs to be stretched out. But no matter how much stretching you do, the front of the hip never seems to be able to “loosen up.”
And further, it is common to experience a pain or pinch in the front of the hip (and many times into the groin region) when performing squats, lunges, step ups or any other movement that requires good a deal of hip flexion (when the hip is folding and the upper leg is moving toward the chest).
So really, what the hell is going on?
It would be nice to sit here and tell you exactly what the cause is, but as with almost every situation, it really depends.
But there are a couple big players that may be causing you to experience a decrease in performance, hip discomfort, or worse, set you up for an unwanted injury…so ya, even if you are not in pain yet this is a must read!
Hip Pain Reason 1) Sorry, you were born that way!
When we look at the hip joint, you can see that it is a ball (head of the femur) and socket (acetabulum). And when we observe the hip move into flexion, you can see how the neck/head of the femur moves up in the socket.
Well for some of us, the socket is rotated more to the front (anteversion) or the back (retroversion). In either case, when we descend into hip flexion with our feet pointed straight ahead as most of us are coached, we run out of room in the socket and the neck/head of the femur bumps into the top of the socket.
This bone to bone contact impinges (or pinches) the structures between them causing them to degrade. Over time the structures can fray or tear and result in injury and chronic pain.
But in the short term, we are likely to feel a pinch or “tightness” in the front of the hip.
So does that mean that if we are born with hips that are not completely “normal” or not “aligned normally” that we can not train or play sports?
No, of course not!
But it does mean that we must be aware of our position when doing exercises or movements that require deep ranges of motion into hip flexion.
The best way to know whether or not you need to implement a modified position or depth is too have a professional assess your hips. This is something we do at TOP Fitness and I do with my online clients when we hear of pain or discomfort at the front of the hip.
But what happens when you don’t have access to a pro?
Well this is a “Duh” statement, but the biggest thing you can do is to move according to how it feels at the hip…if it hurts don’t do it that way!
If you squat with your toes straight ahead and it pinches in the front of the hip, try squatting with your toes pointed out slightly (retroversion), or you may have orient your foot more towards the midline of your body (anteversion) for example. One way will feel worse than the other.
Whichever direction feels better and you can achieve a greater depth without the pain, then that is your new stance. Obviously if it feels worse, don’t squat that way (or lunge, or step up, etc.).
And for some of us, we may have to squat to a slightly shallower depth…we just might not be built to squat to a low position.
Just because you can’t hit an ass to grass squat, doesn’t mean you are weak and worthless.
Better to reduce the range of motion a little than crutch yourself around after going under the knife (and surgery is no fun, I promise).
Hip Pain Reason 2) You are starting in a bad position!
Thinking about the hip, you can imagine that if the hip socket was tipped forward (anteriorly tilted) that the neck/head of the femur would not have much room to move before it came into contact with the socket.
Yet this tipped forward position is exactly where many of us live, play and train from.
Our “normal” position is one that is tipped forward, shutting down the hip socket before we even begin to move.
So when we do squat, lunge, step up, sprint, etc. it is much easier for us to run the neck/head of the femur into the brim of the socket, and impinge the structures between them.
So the goal is to achieve a neutral position at the hip before we do anything else.
For those of us that walk around with the anterior tilt, this means that we must rotate our hip backwards slightly (posterior tilt).
This is achieved by the contraction of the deep abdominal muscles (obliques for example), and is a huge reason why you will always hear us coaching up the core before anything else.
You can think about it as if you were to pull your zipper up towards the ceiling.
If we do not set our hip in a good position, and keep it there via our core, we will end up more easily impinging at the front of the hip.
The key here is setting the hip in a neutral alignment. We have to be careful not to over correct and end up looking like your 80 year old Grandpa Steve (no offense to any true Grandpa Steve out there).
An easy way to help you understand where you should be is to turn sideways to a mirror and rotate your hip forward and backward until your hips (waistband) are level and your low back has a slight curve to it. This position is what you need to try and achieve throughout the day, as well as with training before and during every movement.
Hip Pain Reason 3) Your ass isn’t working.
Lastly, a very common reason for the anterior portion of your hip to be bothering you is the fact that your ass isn’t doing the work that it should…you have a lazy ass!
OK, so maybe not a lazy ass, but an ass that doesn’t turn on at the right time and with enough force to do its job.
During hip extension (straightening of the hip…think standing up from the bottom of the squat) you have muscles that are working to produce the hip extension. These muscles include the glutes (your ass), hamstrings and adductor magnus as the prime movers.
While all three need to work to produce optimal function and force, many times we rely on one or two over the other. And commonly, we use our hamstrings and adductor more than our glutes.
The issue is that the glutes are not only a huge force producer which will allow you to squat more weight, run faster, jump higher, etc., but they are also a stabilizer for the head of the femur in the hip socket.
The action of the glutes actually provides a “suctioning” force on the head of the femur which keeps it centered in the socket…a good position and very good thing when it comes to moving!
When we are not firing our glutes at the right time and with enough force, our hamstrings are likely to take over.
And while the hamstrings can do a pretty good job of producing force, they also create a pull on the femur that results in the head of the femur gliding forward out of the hip socket (anterior glide).
You can imagine this is not a good thing as the front of the hip has structures such as the anterior hip capsule that should not be pressed on, or worse, through.
This produces the tight/pressure feeling in the front of the hip that many of us think is do to a tight hip flexor, when in fact, it is actually our femur pressing forward out of the joint.
Overtime this can result in degradation of the anterior hip capsule and chronic pain.
Your goal needs to be to focus on using your glutes, or in everyday terms, your ass, to help you get up from the bottom of the squat, deadlift, lunge, step up, etc.
If you can create and strengthen the pattern by which you utilize your glutes like you should during training, this is more likely to cary over to sprints, jumping, etc. and will help you not only stay away from hip pain and other injuries, but will also help you perform at a higher level.
Some simple exercises to help with this are glute bridge variations, and this is why you will find many of these variations within TOP Fitness programs as well as my online clients’ programs.
The glutes are not only nice to look at, but they are a huge factor in preventing unwanted hip pain and injury…so get your ass to work!
Hip Pain…No Thanks
There is no question that training is essential for health, fitness goals and performance.
But in the same token, when training is performed without consideration for structural limitations (if there are any), performed from a bad starting position or performed using faulty movement patterns (wrong muscles as the wrong time), training can easily lead to more issues than positive outcomes.
The above concepts should be understood, and the tips should be implemented in order to continue to progress your fitness and performance without running into hip pain and injury.
Pain sucks, believe me! Train hard, but first and foremost, train smart!
Pass this info along and reach out for any questions.
To you health and performance,