T Nation

Hip Labrum or Glute/Muscle (Lateral Rotator Group) Pain for Months


#1

I have this nagging pain in my right hipjoint. It mostly only flares up when I actively use the musculair involved. When I rotatate my right upperleg to the right and tighten the muscles inside the hip it flares up. My PT tried to find the issue and at one point it flared up thrice as painful when he rotated my leg. I do not feel it walking, one legged exercises, sitting etc. Only after squatting to depth with weight and Deadlifts from the floor it’s worse the day after. A high kick is something I cannot do because of the pain. It started to nag about 7/8 months ago. Rest didn’t help, focus on Squat technique seemed to help and it started to lessen. But eventually it came back for the worse, I think from a Sumo pull.
My PT is still oblivious though how to deal with it.
My best guess would be a strained obturator internus or another muscle of the Lateral rotator group, or perhaps a small labrum tear.

I seem to be able to Deadlift fine from a two-inch block with 90% of my Deadlift max. Squatting heavy from a box or even high squats seem to make it worse. Doing lighter work 60/70% doesn’t matter.
I decided to give myself a break from Squat and Dead’s for two months and focus on upperbody. It might be smart to do other lower body excercises, but I’m not sure. I really want to maintain my strenght.


The first exercise seems to target the muscle, the second however does not.

What would be a smart way to approach this?


#2

Firstly it may be worth seeing another PT if you feel your current one hasn’t been successful. It’s not like every PT is the same e.g. skillset, experience, area’s of expertise etc. Maybe a doctor if you haven’t got imaging done.

As long as you and your PT have ruled out other potential causes of your hip pain e.g. impingement, bursitis, osteoarthritis, labrum related, referred pain, etc. it probably is safe to say that it’s muscle related. As nice as peace of mind is the exact muscle or structure that is the source of your symptoms doesn’t matter because the management is the same (assuming muscle related injury).

Usually it goes something like manage symptoms/rest, restore range of motion/movement quality, early strengthening and lastly gradual return to activity. It has kinda gotta be done in order e.g. if symptoms have not resolved and tissues are not ready then moving forward will just aggravate symptoms.

I gotta ask did you really truly give it a rest lel? It just seems you’ve done a real good job at coming up with a list of stuff that aggravates you’re symptoms and compiling that kind of list is not really resting.

Low grade muscles strains usually resolve in a few weeks to months but if there’s been some mismanagement here than an injury can certainly turn into something chronic and be a bother long term.

If you have rested plenty long and followed the process properly as if this was a muscular injury and still had no success than this points us away from muscle injury and towards something that won’t truly heal with rest. It’s a clue at least.

IMO treat this like a chronic muscle/tendon injury.

Less is more approach would probably be better. Doing more e.g. hammering your hip with a exercise program while trying every exercise variation and loading parameter imaginable to find some way to work around your injury vs doing less e.g. moving/lifting without flaring up your hip and without testing the waters frequently.

If you’ve read all the above then you’d probably figure I’d say this is a bad idea lel. Not exactly tho

I can relate, I know your frustration and pretty much I can’t trust myself to rest properly from an injury (luckily all I’ve had recently were tiny niggles barely strains so I get away with it).

Carefully… very carefully you can do work that you are 110% certain won’t aggravate your hip. You said single leg work is ok so let’s go with that. Single leg press barely to knees/thighs at 90 degrees sounds low risk enough. It is non specific to squatting but approach it this way: Build your single leg press strength until you’ve fully loaded the machine (may be a bit of an exaggeration), program it in a nice accumulation block with plenty of volume and build huge as quads. By the time you’re back to squatting proper your legs will be bigger than ever before. Bigger muscle = stronger muscle.

Any pain or irritation and it’s a no go tho.


#3

Thanks!

I might have not giving it proper rest. At first I gave it a couple of weeks (3) and than started building up my Squat with 60% every week going up. I went crazy though with the Sumo when the pain was absent for a week or a few days. The first couple of months it wasn’t real pain more like a nag. I didn’t think much of it.
Now it’s like a tooth ache, every day I can’t resist the urge to tighten the area and feel for the pain. That might also not be a good idea…
I’ve decided 3 weeks ago to not Squat and Deadlift untill march (if there is no pain) but monday I couldn’t help myself to try Deadlifting from blocks, It didn’t hurt though but I can’t rule out that it was a ‘smart’ thing to do. I had a great training though. Upperbody alone is just not doing it for me.
It’s just a weird pain, a few weeks ago, I turned in my sleep and it flared up a lot. in the morning I could feel it aggrevated and it slowly went to previous levels the next day. At one point I even had trouble playing with my kids, that’s less of a problem now so somthing is changing for the better. But it’s very slow, maybe I just have to accept that.

I am looking for a good PT but it’s like an open market here in the Netherlands and good PT’s are a rarity especially dealing with the hip. They all seem to now how to deal with neck pain or a back strain but this…


#4

I’m Untrained/uneducated;

Your glutes are supposed to drive your leg. If your right Glute is slacking, you’ll use the “lateral rotator group” in a compensatory way. Instead of the powerful Glute driving your movements, the “lateral rotators” are trying. These muscles are supposed to support and stabilize your hip and thigh, not drive your thigh. As a result they are irritated, tight, maybe inflamed. When you use them by mistake (turning in sleep, hunkering down to play with kids) it hurts!

This is a Hip Impignment. If the joint isn’t moving exactly right, it can cause issues with your labrum. Like “rubbing” things together in the wrong way.

For me, the cure was to work my glutes! I used the high sumo deadlift ( from pins in the rack, a few inches below knees). Instead of getting fake hip tension, and damaging my hip by Excessively Rotating my knee “open” and my foot “out,” I kept my toes straight ahead and tried to push Out the side of my foot. Like a skiing stance, instead of twisting my feet out. If I kept pushing Out, I could feel the tension shift from the “hip rotators” to the glutes.

After some practice, I can “feel” my glutes and can Deadlift and sorta squat using Glute drive and not crunching up the front of my hip. But if I go too heavy and can “feel” my backside drop out, the tension move to my front hip and inside of my leg, and it feels like my groin could tear off.

You could try some Compression Pants(like Rheband) or Supportive Briefs (like powerlifting equipment) for tightness to support your Glute and hip.

I’ve been wearing a pair of “Inzer Power Pants” to prevent any hip issues.


#5

You might be on to something there. Yesterday I hammered my posterior chain with hyper extensions, GHR and reverse hypers. I also did one legged leg presses. The pain is still there but it’s kinda numbed down and my glutes are sore from the work.

I also think my issues started with the use of the cue to push the floor apart and or gripping the floor with my feet. And to be honest my gym lacked a hyperextension so my posterior chain work was mostly RDL’s, GM’s. Sorely lacking in the glute divison, but since I have fairly big glutes I never gave it a second thought.

Thanks.


#6

Man, don’t get me started! I’ve had trouble with my right foot and my right hip. It’s “flat” so if I’m not careful the arch collapses, and my knee “falls” and “rotates” in, which really re-enforces the messed up hip action.

But if I excesively Grip the Floor with my toes, my foot rolls over and my hip over compensates by twisting too far open which kills my groin.

It actually took awhile to learn how to keep my right foot squarely on the floor during the Sumo Rack work.

Now, if I were shoes that I haven’t worn in a year ( my winter boots) they don’t even fit right because my foot position and hip were so crooked.


#7

If you’re down with Louie, and looking for some ideas about how to train around this check out;

The Westside Barbell Podcast
Episode 5 - The Deadlift for sprinting
Episode 14 - The Posture Strength Curve

They talk a lot about using the Sumo Deadlift, partial deadlifts, Iso metric work and training like an athlete not a power lifter. They gave me lots of ideas about how to lift without getting hurt.

Here’s another power lifter talking about training firemen. Again, ideas about how to train to stop injuries instead of training like you’re injured.


#8

Thanks guys. @FlatsFarmer, I to have less of an arch on my right foot. Most past aches have come from the right side. When I bring my knee to my chest my right hips pops, my left does not. I’ve always figured this would lead to issues but none of the PT’s I’ve shown it to ‘believed’ me. I too tried to correct it by arching my feet, griiping the floor etc. But it only made things worse…

And offcourse I’m open to Louis’s views or Wennings. I just wish I had the ‘mobility’ for the way Clarence Kennedy trains.


#9

You may not be able to train exactly like him, but if you keep an open mind and positive attitude you can develop a productive program based around pulling from blocks and catching lifts in the power style instead of the full squat style.

Once you figure out how to get stronger in the limited ROM, things will get more stable. Then you can start pushing the ROM of the stable range, or mobility.


#10

Thanks Flats.