In part 1 we discussed what femoral acetabular impingement (FAI) is and how squatting can be causing pinching and pain in your groin and hip. In part 2 we'll start troubleshooting the squat to figure out why you're getting the pain.
Now, remember the tests I spoke about that can rule in FAI or labral pathology? Here's another special test for femoral acetabular impingement and hip pathology.
Do you notice how this test for hip labral pathology is eerily similar to the bottom position of a squat when things go wrong?
- source: www.nunnsperformancetraining.com
No offense to this incredibly powerful gentleman here but he's got a good deal of hip internal rotation going on in the bottom position of his squat. Notice how his knees are not over his toes? He's placing himself into the same provocative and painful position that physical therapists test for in the above video. This position of extreme hip flexion and internal rotation can be causing hip and groin pain.
Contrast that with the hips of this Chinese weightlifter in the bottom position of the squat.
- source: www.crossfit55.com
He's got a lot more external rotation going on in his hips at the bottom of the squat. Notice how his knees are forced out and and his knees are aligned with his toes. If we can achieve this position in our squats then we can hopefully alleviate some of the pain we get.
Take a look at the first picture again. Do you ever find yourself in this position when squatting? If yes (and I believe this is the case in a lot of individuals) then we've got some work to do to fix this issue. If you're getting internal rotation of the femur at the bottom of the squat (it doesn't have to be a lot) then you're placing yourself in a provocative position and risking hip injury.
So why might your hips fall into internal rotation in the bottom of a squat. It could literally be coming from any part of the body that isn't operating properly during a squat. We'll break down the overhead squat because if you can hammer a perfect overhead squat then you can really hammer any other type of squat.
Perfect Overhead Squat
- Feet Flat - Not excessively turned out
- Knees over toes
- Hips back with the hip crease below the top of the knee
- Flat neutral spine
- Upright torso
- Externally rotated shoulder
- Arms locked out
- Bar over your center of mass
- source: t-nation.com
Now, given that our body is a system of joints, if you've got a limitation in any one of these areas it's going to affect what goes on with your hips. Everything up and down the chain needs to be addressed including the hips themselves, so let's get started.
1) The Feet - Your feet are the only thing that comes into contact with the floor and will therefore help to set the rest of your joints in the proper place for squatting.
Learn how to use the "short foot"
Now apply it to your squat:
You can practice this foot position during deadlifts and lunges also.
2) The Ankles - A lack of ankle mobility can cause internal rotation of the hips at the bottom position of the squat and end up causing impingement.
My favorite ankle mobility drill
Some additional mobility drills from Kelly Starret
3) The Knees - The knees are a slave to the joints directly above and below them. The important thing to keep in mind is that the knees need to stay in line with the toes during a squat.
- source: wg-fit.com
If your knees are aligned with the toes during a squat it's also a sign that your feet and hips are in an optimal position. The cue "knees out" creates external rotation at the hip and that's what we want. External rotation of the hips is going to decrease impingement in the bottom of a squat.
4) The Hips - As discussed previously, excessive internal rotation of the femur in the bottom position of the squat is the mechanism of injury in femoral acetabular impingement. If you have your toes pointed out slightly and your knees are aligned over your toes, then your hips are going to follow suite and externally rotate into a healthy position.
The hips need a balance of mobility and stability to achieve this position.
- Here's a link to some of my favorite hip mobility exercises.
- This video below demonstrates my favorite hip stability exercises.
5) The Lower Back (Lumbar Spine) - It's vitally important to learn how to keep the spine in a neutral position and move from the hips during the squat. Individuals with femoral acetabular impingement tend to have decreased range of motion in their hips and can end up compensating to get deeper into a squat by rounding the lower back. This can lead to what has been termed "butt tucking" or "butt wink" during the squat. Now you've got hip and lower back pain. So on top of getting your hips more mobile, learn how to use the hip hinge and move from the hips while keeping a neutral spine.
6) The Upper Back (Thoracic Spine) and Shoulders - Limited flexibility in the upper back and shoulders can decrease your ability to get your arms overhead into an overhead squat. If you lack flexibility here, your body will try to gain flexibility from another joint and if that joint ends up being your hip, you'll end up with groin and hip pain.
My 6 favorite thoracic spine mobility drills
I think this is where we'll call it for today. Next time we'll go over some stretching techniques for especially pinchy hips as well as the concept of joint centration and which exercises to use to help clean up your hip problems.
I love overhead squats,
Dan Pope
P.S. If you enjoyed this article then head over to www.fitnesspainfree.com and sign up for the newsletter to receive the FREE guide - 10 Idiot Proof Principles to Crossfit Performance and Injury Prevention as well as to keep up to date with new information as it comes out via weekly emails.
References:
Macrum, E., Bell, D., Boling, M., Lewek, M., & Padua, D. (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sports Rehabilitation, 21(2), 144-150. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22622377
Reiman MP, Weisbach PC, Glynn PE. The hips influences on low back pain: a distal link to a proximal problem. J Sport Rehabil. 2009;18(1):24-‐32.
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