T Nation

Hip Pain in Right Hip


#1

Okay here's the deal, when I come out of the bottom of a squat it HURTS my right hip near my hip flexor. My wife says it is tendinitis, which I believe because she works in a pt clinic and is about to be in pt school(we hope), she got her undergrad in exercise science and sports medicine. This said, besides ice/advil is there anything I can do to fix it? Also, I have problems with my sacroiliac joint. Any advice on that? It keeps going "out" of place. The tendinitis bothers me more than anything, I've gone from squatting below parallel just under 500lbs to not squatting much of anything. Right now, I'm suffering from a hand injury that occurred on duty so I'm doing an hour of cardio every day trying to drop a little weight. As soon as my hand is healed I'll get back to lifting heavy. Wanting to do the velocity diet after I get these couple of issues worked out. I'm having to stretch a lot and gain some flexibility, too. By the way, this is my first post. You guys look to have a pretty solid forum.

EDITED TO ADD MY NUMBERS, just in case it might make any difference...

240lbs(I'm working on that)
595 deadlift
440 squat(below parallel, did 475 but didn't take it down quite far enough)
no clues on bench press... crossfit is against bench pressing for some stupid ass reason... hence why no longer doing crossfit..
235-240 on overhead press


#2

Have you had your hips evaluated? What did the scour tests show? Have you had any problems with anterior hip pain before?

What is your hip mobility like? Any other low back injuries besides the SI jt issues? What type of cardio have you been doing since your hand injury?


#3

No, I have not had my hips evaluated. Just my wife had me do a couple of things and when I told her what hurt and where, she said it was tendinitis. I've never had any hip pain before. My hip mobility is pretty horrible, I'm working on that now. I stretch well after I do the cardio. For cardio I've alternated between an eliptical, stair climber and upright bike. It seems to really loosen and help the pain in my hip.

My SI joint doesn't hurt unless I do heavy squats/deads and put a lot of pressure on my back. I'm thinking of going back to the therapist and seeing what she says about it. No other issues in lower back that I know of. When I get back in the gym I'm going to have a buddy of mine watch me during me ascent/descent on squats and make sure my pelvis is level.

Also, I seem to move my right or left(can't remember) foot when I squat. I forget if I turn it in or out, I'll have to pay attention to it next time I do squats. I wasn't having any problem going well below parallel(I was easily able to do squat cleans) before I developed the tendinitis. I may have strained it somehow to cause the injury to the tendon.


#4

yes, there is anterior pain. I'm not sure I answered that.


#5

Look up Piriformis Syndrome


#6

I'm not quite sure how she came to the conclusion of tendinitis without doing an actual evaluation. But regardless, there could be a host of issues going on. Since you stated you have horrible hip mobility, I'd venture to guess that you have some impingement occurring during the squats that is causing the bulk of your pain, along with some poor muscle activation causing improper biomechanics during the squats.

I really don't see the low back pain being SI joint dysfunction since you only get it after heavy squats/deadlifts. It is more than likely poor glute activity during those exercises (most likely due to the poor hip mobility and tight hip flexors) causing the lumbar erectors to take on that extra load and causing muscle strain and tension through the low back. Could the SI joint ligaments be taking some of that force as well? Sure. But I don't see it being an SIJD.

I would focus on tons of mobility drills and foam rolling to fix your mobility deficits in your hip. I would also recommend starting to work on some glute activation drills and really focus on making sure you are priming them properly before those big lifts. IMO, I would look into other forms of cardio as well as I don't see them helping your case. Ellipticals have been shows to cause a lot of rotation at the lumbar level, which can be an issue for somebody who already has low back pain, as well as the fact that while on an elliptical you are in a fixed plane of motion with can contribute to overuse issues at the hip flexors. Make sure you are using full ranges during the stair climber and upright bike as most people limit their ROM and end up worsening their mobility issues.


#7

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#8

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#9

BBB,
I think I should've reworded it as I don't see the low back pain being SOLELY SIJD related. I don't doubt that it is getting irritated from the DLs/squats, but IMO from the sound of his condition, it is likely due to surrounding muscular imbalance issues.

At the time when I wrote that, I was thinking of SIJD as a laxity to the SIJ ligaments, which from my experience has presented symptoms in people more often than just during DLs and squats. In his specific case, with it coming after only heavy squats/DLs, I'd look at it as the surrounding muscular weakness/imbalance causing the extra strain to be placed on the lumbar erectors and possibly the SIJ ligaments as well.

I guess in the end, it is almost semantics as I feel we are discussing the same point, just from different view points. I do think that i worded myself poorly and should've said "I don't see the low back pain being solely SIJD related, coming from loose/hypermobile ligaments."


#10

Any websites I can go to in order to see what to do to fix this? Any exercises I can use to see if it helps? I've been using a pole in order to lower myself down slowly into the squat. It seems to significantly lessen the pain when my feet are 1.5 hipwidth apart and toes are pointed out approx 30 degrees(the way it should be...) Would this help or am I hindering things? I may need to find a way to post a video of me doing these. Not sure how I'd do it as I don't have a digital video camera, maybe take my laptop to the gym really late one night and use the webcam, other than that.....


#11

For what it's worth here are my lifting numbers. These happened before the anterior hip pain. They were also done in spite of my low back(hurting on the right side). Also, my hamstrings are insanely tight, more so my right than left(maybe that's something to do with the pain?). There is some kind of impingement when I bend over straight, causing it to hurt on the right side. It hasn't hurt since I quit weight training. I feel like I'm rambling. Could I give one of you guys a call? None the less, my numbers. Squat 440(below parallel) and 595 deadlift. No idea what my bench was because per my crossfit coach, bench press isn't a "functional" movement. No longer do I go to crossfit. Overhead press was 235 or 240. Bodyweight was 240.


#12

x2 and I am one of those people with a short trunk and long limbs. I messed up my SIJ bad enough to the point where I coudn't deadlift the same weight before the injury until 6 months later.

Getting shoes with no heel helped a lot. Using shoes with no heel and a hard sole while training helped me a lot.

Using a tennis ball on the hips helped and general foam rolling. Eric Cressey has a good video on foam rolling. You can google that.

Stretching helped me a lot too. Fixing some hip problems that lead to overpronation of my feet helped too.


#13

Thanks. I also am reading "squat like you mean it" by Tony Gentilcre and I've been researching on how to get my glutes/hams activated. Should I do the foam rolling laying prostrate on my stomach and roll it over the painful area in my hip? I'll look funny as shit doing that, haha oh well. Do you mean your feet were externally rotated? What can I do about that? I already use chucks to squat and do all my lifting in. They seem to help some.


#14

Correct, externally rotated feet.

http://articles.elitefts.com/articles/sports-training/a-strength-coach%E2%80%99s-guide-to-movement-assessment-part-1/

This vid is awsome of many levels :slight_smile:


#15

The second video is a great feeling stretch and other things.


#16

Ok, so I see what I can do to help out with the lower back pain. What about the anterior hip pain? Or, is it associated with the lack of mobility/flexibility and i just need to keep doing these stretches and the exercises outline in the "squat like you mean it" thread?


#17

Shirley Sahrmann, one of the most knowledgeable physical therapists around, has started to recommend never stretching the piriformis. Just something to think about.


#18

IMO you should try the supine internal rotation movements cressey and gentilcore have been doing lately if you think an external rotator is an issue. Stretching the piriformis itself, while you may feel it stretch is likely not a good idea in my opinion, Ive never had any success stretching that muscle.


#19

anterior hip pain, possibly strained psoas, play around with the iliacus/psoas insertion area and see if its tender, if so possible art may help.


#20

That is the key element right there. OP, can you pinpoint the area that hurts? Meaning, can you find the area or spot with your finger and if you apply pressure does it feel like a really deep bruise. Sure, mobility issues and tight piriformis can wreak havoc on your legs and hip flexors and that may be your issue, it may not.

I have, and continue to have issues, in both hips. It is right at the anterior joint directly on top of the done. TFL area. My mobility is pretty good, actually very good compared to a few years ago. One thing you can do to help give a better idea of the affected area is this. Sit in a chair with you but close to the edge of it. Lean forward like your going to stand up and as soon as you engage your glutes, quads and hips to get your but off the chair do you feel the pain in that hip. What I am getting at is it could be a muscle, or group of muscles (adductors) that for whatever reason has had to compensate for a weakness or imbalance somewhere else and the stress was just too much for it.

Go to a chiro that specializes in sports injuries, therapy, and is licensed to do ART. There are so many different possibilities beyond the cop out of arthritis (like my ortho told me and was wrong). The muscles in the legs take so much abuse especially when squatting and pressing heavy weights that they can become stuck or adhere to each other (not literally) and not move and glide over each other smoothly like they should, especially in the hip area. Good luck.