T Nation

Hip Flexor Pain

Hello, long time lurker, first time poster.

I’m a 19 year old college student with a little over a year of serious training experience, and am currently on my college’s powerlifting team. During January and February, I was attempting the Smolov Squat Program.

After a couple of weeks, I noticed my hip flexors, especially the left one, were beginning to become very sore and stiff from training, but I just assumed that the symptoms were simply due to underrecovery, and the fact that recently I’ve had to make the switch from a very narrow stance Olympic squat where at the bottom of the rep my ass would rest on my calves, to a wide stance Powerlifting squat where I have to stabilize myself in the parallel position and change direction.

(Also I have mostly done box squats for the past six months, so I was embarassingly deconditioned to actual squatting.) Out of my desire to properly complete the program, I kept pushing myself until I reached a day where I couldn’t make it through my warm-up sets because the pain in my left hip was just too much.

I’ve done virtually no squatting for a month. I find that deadlifts, sled pushes, and other movements involving hip extension are not painful. I’m beginning to think that it was the eccentric and isometric phases of the lift that really did me in, especially considering I was using a much wider stance than usual, and had to stabilize more.

My hip has been making slight improvement, and I have been taking NSAID (2 ibuprofens) and around 10 fish oil caps (30% concentrated) daily. I foam roll my hip for a few minutes around 4 times a week. I also try some static stretching as well (although I understand that with certain hip conditions this is a bad idea).

Squats with even just the bar or 135 pounds are still painful, especially with a closer stance. With a wider stance, the pain is less severe.

Does anyone have any advice? Thanks.

I had a nasty psoas major strain from squatting over the summer and really the only thing that helped was ART and rest.

Thanks for the advice. Would you advise only staying away from painful activities (i.e. squatting and other movements that have an eccentric phase that puts me in weighted hip flexion), or would it be best to stop all hip-dominant movements completely? I don’t want to have to give up deadlifting, but if it means faster recovery, then it would be pretty foolish not to.

Also, how long did your recovery take? I’m starting to think that my injury is more severe than I first thought, since even a month later with no squatting, I have substantial pain.

Hoping this won’t get buried.

At what point does the pain occur? If it’s the bottom of the squat, it could be anterior femoral glide. This basically means that your glutes aren’t firing and your hamstrings are taking over, allowing your femurs to slide forward and irritate the hips. Once they’re irritated, even narrow squats can become painful.

I would take a week off from squatting. Do a lot of glute activation work and stretch your hamstrings if they’re tight. Foam rolling or ART could only help. Be aggressive with the treatment! Then start doing goblet squats. Focus on spreading the floor as you descend and sit back so your shins stay close to vertical. Drive with your hips and keep your weight on your heels.

Your hips may still be tender at this point, but if you’re activating your glutes you should be able to goblet squat without pain.

Oh, and I wouldn’t mess around with any hip flexor stretches for the time being. Could further irritate things.

I am wondering what you are doing for mobility and warm-up. Sounds like everything is pretty tight with little hip mobility. If you aren’t doing that pre-session, I would start and even do it on your off days. I have super tight hips and I can’t go a day without some sort of mobility to keep things open.

Where is the pain on your leg EXACTLY??? Does it run down your leg? On what side of your leg??? What stretches have u done??? How often???

In other words: Elaborate
The hip flexors are several muscles, http://upload.wikimedia.org/wikipedia/commons/thumb/e/e2/Anterior_Hip_Muscles_2.PNG/180px-Anterior_Hip_Muscles_2.PNG

I have dealt with hip flexor pain. Although my knowledge is limited to what I experienced I can’t help you if you don’t explain to me wtf is going on.

p.s using pictures with marks on them is a good idea too.

It’s never a good idea to diagnose someone over internet, but I’m 80-90% sure that what Wfifer said is spot on.

[quote]wfifer wrote:
At what point does the pain occur? If it’s the bottom of the squat, it could be anterior femoral glide. This basically means that your glutes aren’t firing and your hamstrings are taking over, allowing your femurs to slide forward and irritate the hips. Once they’re irritated, even narrow squats can become painful.
[/quote]

This is what I’d be banking on.

I’ve suffered from it before, as a result of Sheiko.

For me, the thing that fixed it was laying off squats for a couple of weeks and stretching the shit out of my piriformis.

Just resting and hoping it will go away will do nothing. You HAVE to take remedial steps.

[quote]wfifer wrote:

Oh, and I wouldn’t mess around with any hip flexor stretches for the time being. Could further irritate things. [/quote]

I’m really glad that all my preaching on here (and on Atoboldon.com a long time ago) hasn’t gone for naught.

[quote]Hanley wrote:
wfifer wrote:
At what point does the pain occur? If it’s the bottom of the squat, it could be anterior femoral glide. This basically means that your glutes aren’t firing and your hamstrings are taking over, allowing your femurs to slide forward and irritate the hips. Once they’re irritated, even narrow squats can become painful.

This is what I’d be banking on.

I’ve suffered from it before, as a result of Sheiko.

For me, the thing that fixed it was laying off squats for a couple of weeks and stretching the shit out of my piriformis.

Just resting and hoping it will go away will do nothing. You HAVE to take remedial steps.[/quote]

Like the hip flexors, don’t stretch the Piriformis either. If you do anyway, at least be very gentle on it. Stretching the shit out of it would be a very bad idea.

I really don’t see why the Piriformis would be one of the first things to address with this type of injury. Technique first, then glute/hams, then maybe things like Piriformis.

I agree, when I’m dealing with this it’s actually painful to stretch the piriformis and glutes. In fact it’s the same anterior hip pain I get when squatting. If I get on all fours and lean into the hip (i.e. TFL stretch) and then back I can stretch without pain. Why is that?

I usually just roll around on a tennis ball. Seems to take care of piriformis-related issues.

Spent a long time away from computers, so I haven’t been checking up on this. Thank you everyone for your responses, they’ve been very helpful.

To wfifer, the pain is at the bottom of the movement. I often sit in the full squat position throughout the course of the day, and it doesn’t bother me anymore. But weighted hip flexion is considerably painful.

The pain is entirely isolated to the hip flexor region (it seems like it’s right around the hip attachment, in the middle (as opposed to towards the inside or outside of my leg). It’s hard to be specific because I’m aware that the hip flexor musculature is very intricate and confusing.

I do know, however, that hip internal rotation in a position of hip flexion is especially painful. I’m not sure what to make of that, but does anyone know if this might indicate what exactly is wrong?

I’ve been doing a huge amount of self myofascial release on a PVC pipe, on the hamstrings, quads, TFL, groin region, and glutes on a softball. My hamstrings have been a little tight lately, but normally I stretch out my hamstrings regularly, mostly using a lying stretch where I try to get the most hip flexion I can while maintaining a straight knee.

Most of my mobility work is fairly repetitive (I do the same movements too often just out of lack of imagination), and I frequently do tube walking, ankle eversion, the “lunging” hip flexor stretch (which I will stop doing, since I read an Eric Cressey article advising against stretching the hip flexors with femoral anterior glide syndrome), the hamstrings srtech described above, and a couple of quadriceps stretches both standing and lying.

I’ve actually taken about two weeks off from training, since I just competed in a powerlifting meet and was already suffering from complete physical exhaustion.

I sort of had my back against the wall, because I wasn’t sure what steps to take to address the injury, and I knew continuing what I was doing would just make it even worse. Aside from the meet, I’ve done very little squatting in the past month.

After a couple of weeks of rationalizing that doing nothing is the right thing to do, I feel like I’m not much closer to recovery. This indicates that I should probably be more active about this. Thanks to everyone for all of the advice.