T Nation

Quad/Hip Pain


For the last year and a half I have had a nagging pain in my left hip whenever I train quads. Every type of IT band pain I research seems to deal with the outside of the knee.

The strange thing is that the band doesn't hurt during deadlifts, good mornings, kettlebell swings, etc.. (hip movements) It is only when I contract my quads. Even leg extensions make it hurt (in the hip).

I don't understand the relationship between quads and IT-band and I am quite certain that I do not have an outer quad tear as it has been over a year.

My chiropractor has done graston to get rid of some scarring and has given me an ever increasing list of rehab exercises that don't seem to change anything. I'm very frustrated because I haven't had a decent leg workout in a long time and quads are looking flat.

Any idea about what could be causing this? Thanks in advance...


1) What does your chiro think the cause is?

2) Have you seen any other specialists such as an ortho?

3) Going back to the last year and half (or even two years) describe the typical leg workouts that you performed.

4) "Left hip" is somewhat vague. If you can, be more precise regarding where the pain is.

5) On what part of the hip did the chiro perform the graston? Was there any relief - even temporary?

6) Has your chiro mentioned any other issues?


Yeh OP where exactly is the pain? pain in hip when training quads? sounds like Rec Fem to me.. but no idea without more info


Thanks for the response. I will answer accordingly....

1) My chiro thinks it's my glutes not firing on my left side that is causing the pain. Ever since doing kettlebell swings my glutes have gotten much bigger and stronger, so I can't imagine this being a problem.

2) He is the second ART certified chiro I have seen about this. The only reason I switched is because the last guy didn't do graston.

3) My leg workouts have been mostly front squats, as back squats hurt it more. I do heavy kettlebell swings for glutes and hams. I finish with one leg leg press or leg extension for my left side as that quad is always understimulated (from the pain).

4) It hurts along the IT-band. During training, it is more in the middle of the length of my thigh. Sometimes at night when it hurts, it's closer to the glute.

5) The graston did relieve it some, but then it quickly came back. The only real relief from the graston was that there was no longer any pain except during training or if I had to run.

6) I asked him if he thought it might be a quad tear. He said no because a tear would not last this long.

He asked me recently if it hurt during deadlifts. I told him no and he made a face like my answer wasn't normal. I still think it's strange that even the leg extensions would make it hurt. I can't find any IT-band pain that is associated with quads, only hip joint muscles. I guess I'm hoping to find someone who has had the same problem.

Thanks again.


It's really the outside of my leg. At the halfway point all the way back to the hip joint. I'm 95% sure it is the IT-band. But there is no pain at the knee, which seems to be the most common IT-band pain. It only hurts when I flex my quad.

Thanks for the response.


Firstly, just because a certain syndrome or ailment should have certain symptoms doesn't mean that it will work that way in your body. Sometimes things can take longer to progress from one person to the next. IT Band syndrome is definitely something that you feel more so in the knee as opposed to the hip joint, usually. I have struggled with hip pain for years. To the point where I have spent thousands of dollars, can barely train legs, and now am dealing with it affecting other areas of my leg/s. Yes legs, both legs. Mine is more in the hip joint itself. Any hip flexion hurts because whatever my issue is, it causes my TFL to work MUCH more than it should.

What has helped me just recently is a guy that I found that is a lifter and neuro-muscular therapist. He works the glutes, IT Band, and all insertion points from just under the knee to the hip joint/lower back. IT HURTS LIKE HELL. It is worse than ART. But is has been taking the pain away for longer and longer periods. The thing that I notice the most is after trigger point therapy I feel amazing. Zero pain. My problem is that there is also a bunch of scar tissue and arthritis in there so the pain eventually comes back.

The fact that your pain is in the middle of your outer thigh doesn't mean that the problem isn't in your insertion point at the knee or hip. Hell, it could still be the glute. You might think that your glutes are strong and lose but most are no where near what they should be. YOU have no way of knowing.

I know this is a stretch but try and find someone, not necessarily a chiro or ortho, that lifts and really gears there practice around kinesiology (spelling?). That or trying to get in touch with the strength coach of a nearby major college. Most chiro's and ortho's just aren't as knowledgeable as you would think when you throw in the abuse that we put on our bodies.

Hope some of this helps.


One possible explanation is irritation of the L4 nerve.

The vastus lateralis (VL), rectus femoris (RF), vastus medialis oblique (VMO) are innervated by L2, 3, 4.

The adductor magnus, longus, and brevis are innervated by L2, 3, 4. It is debatable just how much they contribute in a bilateral squatting pattern. They play a larger role in unilateral work. Regardless, it's something to be aware of.

This may explain why direct quad work such as leg extensions and front squats bother you. The leg extensions obviously recruit the VL, VMO, RF. The squats recruit the VL, VMO, RF, and the adductor complex.

Now let's look into why hip extension movements are NOT troublesome.

You mention kb swings and deads. Semimembranosus/tendinosus, biceps femoris long/short heads are innervated by L5, S1, S2.

The glute max is innervated by L5, S1, S2.

This may be why those movements are not troublesome. Yes, the the quadriceps complex play in a role eccentrically decelerating the kb swing. They also play a role in knee extension of the deadlift. Furthermore, the adductor magnus can also assist in hip extension. However, the empirical evidence that kb swings and deads do NOT cause you trouble lead me to suspect that their involvement is NOT SIGNIFICANT enough to act as a trigger.

And the only unilateral movement you say you've been doing are leg press and leg extensions. Because the nature of these movements require little to no stabilization, the glute medius and minimus may not be working as much. This is relevant because the glue medius and minimus are innervated by L4, L5, S1.

As you can see, the common denominator is the L4.

The following MIGHT be what's taking place:

  • Activities in which the quads are the agonists cause an irriation of the L4
  • The pain radiates upward, along the L4, which could explain why you sometimes feel it at the hips, as this is where the glute medius/minimus are. And don't forget the med/minimus are innervated by L4 (as well as L5, S1)
  • Your selection and execution of hip extension work do not activate the muscles that are innervated by the L4 enough to cause a trigger. Don't misunderstand me here. There is some activation of the muscles innervated by the L4 but just not enough.

I suggest that you get tested for possible nerve compression or irritation. You'll need to see a specialist and pray that he actually gives a damn and doesn't just look at you as his next Mercedes payment.

Let me know what you think and how this pans out. As a strength/conditioning coach, I am very curious as to the outcome.

Chronic pain can often be a puzzle wrapped in paradox sprinkled with irony. I hope I'm not leading you down the wrong path. However, based on the information you provided, I believe that it cannot hurt to at least eliminate the possibility of an issue with the L4 nerve.


Wow! Thanks for all your help. I will look into it. I should probably start by mentioning this to my chiro.


Thank you very much!


Great post


I don't mean to be a party pooper, but L4 refers to the nerve root, which would mainly be affected by flexion/extension of the lumbar spine.


No worries regarding the party pooper comment. I despise group think and even I stated several times that my theory is just that - a theory.

You state the L4 is "mainly affected by flexion/extension of the lumbar spine."

"...mainly affected..." does not equal always affected.

Moreover, the L4 does innervate the muscles I described. And aggressive recruitment of those muscles (based on the OP's description of his workouts) have clearly and repeatedly triggered a negative response.

Don't forget the OP has proactively tried other modalities.

I believe it's time to start eliminating what the cause IS NOT so we can better decipher what the cause IS. When dealing with chronic pain, that's often what the game plan comes down to.

The test for nerve irritation I mentioned won't make the situation worse. And I've no reason to suspect the exam will be a financial burden to the OP. So let's get an accurate diagnosis and, if my theory is incorrect, we move on. With my suggestion, we at least move forward; because if we can add just one more item that is not the cause, we're better off than we were before.

This, in essence, is the difference between winning or losing an intellectual debate and actually helping someone who is at wit's end.


I re-read my posts on this thread there is a clarification I need to make. I referenced the L4. I should have specified that the muscular branches of the L4 could possibly be the something the OP may want to look into. I apologize for what can be misconstrued as a generalization.


I have been reading on L4 pain. Most of what I have read implies that there would be back pain as well. I don't have any back pain but do have it on the outer thigh. I also notice quad weakness on the left (affected) side. This was one of the symptoms of L4 issues. I'm starting to think this is my situation.

I'm curious if there is a way to fix this without surgery. Perhaps chiropractic treatments of just the lower spine. I suppose it could be an impinged nerve rather than a damaged one? I would think if I had a slipped disc there would be spot pain as well.

I'm certainly going to talk to my chiropractor about this. Thanks you guys, your input was very helpful.


If you read my post dated 7-4, I made a clarification. It's not just the L4 itself, it's ALSO THE NERVES THAT BRANCH OFF the L4 that, in my theory, should be examined.

I realize that I should have clarified in my post dated 7-3. I simply used "L4" as a short hand. And I can see why that can be misleading.

There are other nerves that branch off the L4, such as the femoral, that might be worth examining.

And I very much doubt most chiros have the training for the type of testing I'm referring to.

It's a neurologist you should see.

Again - and I emphasize this - mine is just a theory.

To recap that theory, when you use your quad complex (VMO, VL, VI, RF) as agonist (the primary), you get a negative reaction. Perhaps there is/are some type of irritation or impingement along the nerves that branch off the L4.

This may explain why squats, leg presses, leg extension cause a negative reaction (the quad complex are all primary actors in these exercises). These muscles are innervated by nerves that branch off the L4.

You also mention that movements such as kb swings and deads do NOT cause negative reactions. In these movements, the quad complex are not the primary movers. And the hamstring complex are NOT innervated by nerves that branch off the L4. So, even if the quad complex is being activated, perhaps that level of activation is not enough to cause a trigger.

The only unilateral work you mention doing are leg extensions and leg press. Since little to no stabilization is required on these machine-based exercises, I doubt your glute medius and minimus are activated to a sufficient degree. The glute med/min are innervated by branches of the L4.

The glute max is innervated by INFerior gluteal nerve, a branche of L5, S1, S2. The kb swings and deads you do recruit the glute max.

But it's questionable if YOUR EXERCISE SELECTION AND EXECUTION recruit the glute MEDIUS/MINIMUS to a significant degree. In other words, that hypertrophy you've noticed could primarily be at the glute max. The glute med/min are innervated by the SUPerior gluteal nerve, a branch of the L4, L5, S1.

So, again, my theory that you may want to discuss and test for with a qualified neurologist is the following:

1) Your quad-dominant exercises may be creating an issue with the nerves that branch off the L4.

2) This radiates to the nerves that innervate the glute med/min, which also are innervated by branches of L4. Perhaps the femoral to the superior gluteal...???

This could explain that pain in your hip whenever you do quad-dominant activity. Another muscle that is innervated by the branch of the L4 is the tensor fasciae latae. If you look this up, you will see that it's location is also where people refer to as the hip region.

3) The hip extension movements you perform may NOT recruit the quad complex and glute med/min to the degree that they irritate the nerves that branch off the L4. This could explain why kb swings and deads do not cause a negative reaction.

This is why I suggested getting tested for issues with nerves that branch off the L4.

As you can gather, there is a complex network of nerves involved. Furthermore, this theory is certainly not air tight.

However, the one paradigm I do feel comfortable is that you are most likely at a point where you need to start eliminating what the cause is not - AS LONG as it does not make your situation worse.

This is why a neurologist is a better option as they should be able to utilize more sophisticated testing modalities compared to most chiros.


Hey guys, I wanted to give an update. I mentioned the possible L4 nerve problem to my chiropractor and although he said it was technically a possibility, it was very unlikely due to having no back issues. He did say it was worth looking into once all other avenues were explored.

When I first started seeing him, he did tell me to limit my depth on squats to about 80 degrees of knee bend from now on (or at least until pain subsided). I have to admit, I didn't heed his advice on this until after our last appointment. I decided to do some bench squats which stop me right above parallel. I have now had two excellent squat workouts with zero pain in my left quad.

I have often thought that shallow squats don't really stretch the quads but they were pleasantly sore afterwards.

Thanks again you guys for all of your input.


I'm glad it's working out for you.

What I find interesting is that you mentioned leg extensions also cause the pain. When you do the leg extensions, is the angle between the femur and tib/fib greater than the 80 degrees as suggested by your chiro? You can experiment with this your next leg day. Keep the bottom position to 80 degrees of knee bend and see if the pain is there or not.

And remember - I specifically mentioned not only the L4 but also the nerves that branch off the L4 such as the femoral nerve as well as the gluteal. That's why not having any lower back issues may not be correlated. Any nerve-specific issues are better addressed by a neurologist. So it doesn't surprise me that a chiro would be dismissive.

Finally - going to about 80 degrees strikes me as a temporary solution. I'm not advocating ATG squats because that clearly is not for everyone. However, if you cannot break parallel moving forward, there are other issues that need resolution.


Good points. Maybe it is too early to get excited, but it does seem like I have found a way to get stronger on something without causing me pain. I'm pretty sure the leg extensions are giving me more knee bend than my current squat technique.

A big challenge now is getting the left quad to fire correctly because I have a habit of anticipating pain on that side and therefore compensate in some other way.

I would eventually like to squat lower but I am hoping over time I can ease into a lower depth without the old problem coming back.