T Nation

Right Hip Pain


#1

During the last month I've had a sharp pain in my right hip flexor continuing to the lower back about where the illiocastalis inserts. It feels as if there's some small hard knob, that I can move around, which is not noticeble on the left side of the lower back. I've had tight hip flexors over a longer period and have been dooing box squats to work on hamstring and glute recruitment. I supspect the extra depth of the box squats to be an additional strain creating the pain.

When I first noticed the sharp hip pain I went to a physio, who claimed it was due to the tight hip flexors, he recommended static streching of the hip flexors 4-5 times a day, which has helped reduce the tightness somewhat. However the sharp pain in the right hip/lower back area has not changed. It is mainly noticeble when doing squats, leg press and lunges also, I find, that keeping my hips right below my torso when doing leg work results in the least amount of pain. Any clues as to what this could be and how to solve it would be greatly appreciated, thanks.


Squat Depth
#2

I have something similar.I get it the most when I walk but not when I run?!.
Read Chads articel from today about the core-muscles.It helped me.

I think the problem come from your back.
A bulging disc does not always hurt but mess your stabilizers up and your hips crank up.

Read Bret Contreras articels about the glutes as well.

See a fysiotherapist with MDI and OMI kompetens.

I am not a proffesional but have had something similar.


#3

Thanks for the reply, I’ll check those articles


#4

What stretch have you been doing for your hip flexors?

Do you have any pain stretching them?

Does your pain increase as you increase how much you flex your hip?

Can you give an example of what you mean by keeping your hips right under your torso during leg work? Like say during squatting? Just want to make sure I’m visualizing this correctly.

Does this bother you during the day at all in everyday life? When specifically? E.g. lifting your leg up to get out of the car, sitting for a prolonged time, etc.


#5

is the small hard knob a muscle knot?

i’m wondering about the keeping hips right under you thing, too.

could it have to do with the way your femur wants to rotate in the socket when you raise your legs?

the usual recommendation is heels just outside shoulder width, toes turned out 30 degrees…
but some people have femur / hip construction that dictates different.


#6

I’ve applied various stretches, the lunging type where there the rear leg is either on the ground or on a bench aswell as a standing strecth resembling the warrior 1 yoga pose, in which I rotate the hip outward, whilst not changing the foot-leg allignment, I feel this in the the inner part of the hip flexor (towards the crouch).

the only pain stretching item I have is a foam roller, is this what you mean?

defeneatly, the farer down I squat the sharper the feeling, it is tolerable until a bit below parallel.

During box squats, I have focused on sitting as far back as possible as to engage the glutes and hamstrings to the fullest, I feel this results in the hips going farer back than the torso, which elevates the hip pain; hope you get the picture…

There’s a bit of stiffness some times after hours sitting down, but not anything unberable. I’ve always had a hard time squatting down deep, without either lifting my heels or placing my feet at leat 10 cms more than shoulder width apart, I’ve noticed this outside the gym aswell.


#7

i used to have hip pain that bothered me the most when i was squatting.
i tried to fix it by stretching my hip flexors with lunges and yoga poses…
eventually learned that the best stretch for squats is to squat.

does that hurt?
(substitute a dumbbell or a small plate if you need to)

(be gentle for the love of god!!!)

it fixed me right up.

took a few months, though.


#8

BReddy, I do have some pain stretching them, but that feels pretty typical for a tight muscle; as if the stretching movement rips apart shortened muscle fibers, stretching the hip flexors on the right side though tends to create a mild pain on the side of the hip.

alexus, I wouldn’t say so,it is more to the outside, where there isn’t really any muscles inserting as far as I know. See the attached picture for reference


#9

The psoas (hip flexors) insert into the lumbar spine.

Did you try the goblet squat stretch or are you surmising? I was surprised… My hip flexors were tight and I thought the answer was quad stretching and lunging and stuff like that. Surprised me a great deal that the goblet squat stretch actually helped stretch out my hip flexors.

Once the goblet squat stretch feels comfortable (and the hips are open) then one can intensify the stretch by working on maintaining lumbar curve. First, you want to check that you can actually hold a lumbar curve:

Then you want to work the goblet squat stretch while maintaining your lumbar curve.

Then hey presto pain free full range of motion squatting mobility…

Of course you might find something prevents you along the path. All I know is that it worked for me (but it took me several months for everything to feel comfortable and pain free).

edit —

with stretching… if you aim to rip the fibers then things can get a bit complicated. one way of stretching is to stretch until you feel tension (no pain!) and then simply hold that position. the fibers should relax after being held for 15-30 or so seconds. then you can move the position a little more and feel a stretch again and kind of repeat the process. if you actually tear them then they get adhesions and stuff as they start to heal… and messing around with rolling / self releasing the lumbar spine is fraught. in my experience, anyway.


#10

I’ve done the goblet three times today already; feels great. Weird though, by intuition I would have thought that this would actually contribute in making the psoas even tighter, but the opposite seems to happen. This might very well be the solution I’ve been looking for, even better, it doesnøt aggrevate the hip pain in any way, maybe because of the low poundage used. Thanks alot, I’ll let you know how things turn out.


#11

[quote]manowarrior wrote:
I’ve done the goblet three times today already; feels great. Weird though, by intuition I would have thought that this would actually contribute in making the psoas even tighter, but the opposite seems to happen. This might very well be the solution I’ve been looking for, even better, it doesnøt aggrevate the hip pain in any way, maybe because of the low poundage used. Thanks alot, I’ll let you know how things turn out. [/quote]

Stop stretching your hip flexors. Often times pain with hip flexion is caused by a weak psoas, not a tight one. The psoas helps the hip joint stay nice and snug in the the socket and when it is weak the femur tends to move around in the socket when it shouldn’t. Stretching the hip flexors helps encourage this right now.

The likely reason the goblet squat is helping is because when you are in that deep of a squat you are actively recruiting the psoas and not much else in the hip flexor category. That is, you are actually strengthening and activating them = good idea.

Two things to do (in this order), take a tennis ball/lacrosse ball/baseball/golf ball, throw it under the glute of the side of the hip that is bothering you, and roll SIDE TO SIDE just like you would foam rolling (see picture).

Next, perform a wall psoas hold (I’ll attach another picture in another post). Unlike the picture I’ll show you though, make sure your entire back (lower especially) is FLAT against a wall. Make sure the knee is above 90 the whole time. If this is harder on the affected hip, this is likely a major cause why your hip is bothering you. Try to go for 30 seconds at least. If that’s easy, use your hand to push down as resistance.

Try the goblet squat after doing the above. It will likely feel even better.

Other things: try to limit sitting as much as possible, stop stretching your hip flexors for a while, stop performing box squats and such until your pain has subsided. If you keep doing things like squatting while it’s painful you are only encouraging inflammation which is going to make getting rid of your pain hard.

Let me know how this goes, hope it’s helpful!


#12

[quote]BReddy wrote:

[quote]manowarrior wrote:
I’ve done the goblet three times today already; feels great. Weird though, by intuition I would have thought that this would actually contribute in making the psoas even tighter, but the opposite seems to happen. This might very well be the solution I’ve been looking for, even better, it doesnÃ?¸t aggrevate the hip pain in any way, maybe because of the low poundage used. Thanks alot, I’ll let you know how things turn out. [/quote]

Stop stretching your hip flexors. Often times pain with hip flexion is caused by a weak psoas, not a tight one. The psoas helps the hip joint stay nice and snug in the the socket and when it is weak the femur tends to move around in the socket when it shouldn’t. Stretching the hip flexors helps encourage this right now.

The likely reason the goblet squat is helping is because when you are in that deep of a squat you are actively recruiting the psoas and not much else in the hip flexor category. That is, you are actually strengthening and activating them = good idea.

Two things to do (in this order), take a tennis ball/lacrosse ball/baseball/golf ball, throw it under the glute of the side of the hip that is bothering you, and roll SIDE TO SIDE just like you would foam rolling (see picture).

Next, perform a wall psoas hold (I’ll attach another picture in another post). Unlike the picture I’ll show you though, make sure your entire back (lower especially) is FLAT against a wall. Make sure the knee is above 90 the whole time. If this is harder on the affected hip, this is likely a major cause why your hip is bothering you. Try to go for 30 seconds at least. If that’s easy, use your hand to push down as resistance.

Try the goblet squat after doing the above. It will likely feel even better.

Other things: try to limit sitting as much as possible, stop stretching your hip flexors for a while, stop performing box squats and such until your pain has subsided. If you keep doing things like squatting while it’s painful you are only encouraging inflammation which is going to make getting rid of your pain hard.

Let me know how this goes, hope it’s helpful!
[/quote]


#13

thanks for that. i thought stretching my hip flexors (with the quad stretch in particular) was creating anterior femoral glide syndrome. now i know - it was!!! my hips have never felt better since i’ve stopped with trying to stretch them, hit up my hips with a plastic softball (as you said!) and worked hard on the goblet squat stretch and maintaining lumbar curve. got a fairly good ATG front squat now - but my hip flexors are definately the weak link in the chain. thanks for making some sense of that for me.


#14

[quote]BReddy wrote:

[quote]manowarrior wrote:
I’ve done the goblet three times today already; feels great. Weird though, by intuition I would have thought that this would actually contribute in making the psoas even tighter, but the opposite seems to happen. This might very well be the solution I’ve been looking for, even better, it doesnÃ?¸t aggrevate the hip pain in any way, maybe because of the low poundage used. Thanks alot, I’ll let you know how things turn out. [/quote]

Stop stretching your hip flexors. Often times pain with hip flexion is caused by a weak psoas, not a tight one. The psoas helps the hip joint stay nice and snug in the the socket and when it is weak the femur tends to move around in the socket when it shouldn’t. Stretching the hip flexors helps encourage this right now.

The likely reason the goblet squat is helping is because when you are in that deep of a squat you are actively recruiting the psoas and not much else in the hip flexor category. That is, you are actually strengthening and activating them = good idea.

Two things to do (in this order), take a tennis ball/lacrosse ball/baseball/golf ball, throw it under the glute of the side of the hip that is bothering you, and roll SIDE TO SIDE just like you would foam rolling (see picture).

Next, perform a wall psoas hold (I’ll attach another picture in another post). Unlike the picture I’ll show you though, make sure your entire back (lower especially) is FLAT against a wall. Make sure the knee is above 90 the whole time. If this is harder on the affected hip, this is likely a major cause why your hip is bothering you. Try to go for 30 seconds at least. If that’s easy, use your hand to push down as resistance.

Try the goblet squat after doing the above. It will likely feel even better.

Other things: try to limit sitting as much as possible, stop stretching your hip flexors for a while, stop performing box squats and such until your pain has subsided. If you keep doing things like squatting while it’s painful you are only encouraging inflammation which is going to make getting rid of your pain hard.

Let me know how this goes, hope it’s helpful!
[/quote]

This is exactly what I said to my physio, I told him that the strecthing, I had been doing up to the point where I sought him out, was aggrevating the pain rather than easing it. As mentioned earlier I have had a hard time going much deeper than parallel on the squat, maybe over the years this has led to a muscular inbalance because the psoas was never proporly trained. If this is the case, then I am defeneatly gonna train the hip flexors explicitly from this time on. Thanks alot, I will keep you updated on this!

One more question, while I have your guy’s expertise; on the goblet squat it feels as if my hips are reluctant to go down much deeper than my than parallel because of the tension in the inner thighs, is this somehow linked to weak hip flexors aswell?


#15

your adductors might be tight. just go as low as you can go and hold it. after 30 seconds or so it will start to feel comfortable then you can push it a little lower. go easy. if you try and force it you will just rip something / piss it off. it will come in time.


#16

[quote]manowarrior wrote:

[quote]BReddy wrote:

[quote]manowarrior wrote:
I’ve done the goblet three times today already; feels great. Weird though, by intuition I would have thought that this would actually contribute in making the psoas even tighter, but the opposite seems to happen. This might very well be the solution I’ve been looking for, even better, it doesnÃ??Ã?¸t aggrevate the hip pain in any way, maybe because of the low poundage used. Thanks alot, I’ll let you know how things turn out. [/quote]

Stop stretching your hip flexors. Often times pain with hip flexion is caused by a weak psoas, not a tight one. The psoas helps the hip joint stay nice and snug in the the socket and when it is weak the femur tends to move around in the socket when it shouldn’t. Stretching the hip flexors helps encourage this right now.

The likely reason the goblet squat is helping is because when you are in that deep of a squat you are actively recruiting the psoas and not much else in the hip flexor category. That is, you are actually strengthening and activating them = good idea.

Two things to do (in this order), take a tennis ball/lacrosse ball/baseball/golf ball, throw it under the glute of the side of the hip that is bothering you, and roll SIDE TO SIDE just like you would foam rolling (see picture).

Next, perform a wall psoas hold (I’ll attach another picture in another post). Unlike the picture I’ll show you though, make sure your entire back (lower especially) is FLAT against a wall. Make sure the knee is above 90 the whole time. If this is harder on the affected hip, this is likely a major cause why your hip is bothering you. Try to go for 30 seconds at least. If that’s easy, use your hand to push down as resistance.

Try the goblet squat after doing the above. It will likely feel even better.

Other things: try to limit sitting as much as possible, stop stretching your hip flexors for a while, stop performing box squats and such until your pain has subsided. If you keep doing things like squatting while it’s painful you are only encouraging inflammation which is going to make getting rid of your pain hard.

Let me know how this goes, hope it’s helpful!
[/quote]

This is exactly what I said to my physio, I told him that the strecthing, I had been doing up to the point where I sought him out, was aggrevating the pain rather than easing it. As mentioned earlier I have had a hard time going much deeper than parallel on the squat, maybe over the years this has led to a muscular inbalance because the psoas was never proporly trained. If this is the case, then I am defeneatly gonna train the hip flexors explicitly from this time on. Thanks alot, I will keep you updated on this!

One more question, while I have your guy’s expertise; on the goblet squat it feels as if my hips are reluctant to go down much deeper than my than parallel because of the tension in the inner thighs, is this somehow linked to weak hip flexors aswell?
[/quote]

The adductors are also hip flexors. So, if the psoas (a hip flexor) isn’t working properly they could be trying to pick up the slack as well. This could cause them to become overactive/tight/stiff.

As with the traditional thought of hip flexors, don’t bother stretching them either though. This might even give you pain too. The tight/stiff hip flexors/adductors are a symptom of the psoas not working properly. You don’t give a cancer patient caffeine because of their fatigue (symptom), you try to get rid of the tumor (cause / psoas).

Remember though, make sure you are only training that hip above 90 degrees of flexion. Get rid of anything that trains that leg where it isn’t flexing all the way. For example, using the elliptical would be a horrible idea.

And take your time progressing. Often times just trying to hold the hip above 90 is a serious amount of work for most people.

Also, if you’re barefoot, sitting in a full squat for 30 seconds or more can be a ton of work for most people as well. They’ll often nearly fall backward. Remember that if you’re holding a weight in front of you you’re actually making the movement easier and taking some of the work the psoas should be doing out of the movement. This is my long way of saying working to where you can just sit in a toddler esque squat, barefoot with no weight, is often the way to go.

Hope this helps; keep us updated.


#17

Oh, and instead of a weight you can just hold on to something like a pole to help you from falling back. I have people grab whenever they’re about to fall and then let go as long as they can, then grab again, etc. This way they’re working as much as they can without falling back.