How to Fix Hip Pain During Squats: Addressing the Common Causes when Squatting

Are you experiencing a pinching, sharp, or aching sensation around your hips during your squats?

Many people struggle with this issue and there are different reasons you may experience this. Common causes may stem from issues with form or technique, mobility, bone abnormalities, and muscle imbalances. Let’s dive into these common causes in more depth and go over some tests and exercises you can use to help correct these issues to improve your squat strength without pain.

Addressing Issues in Ankle Mobility

Restricted ankle mobility (specifically, restricted ankle dorsiflexion) may cause an excessive forward lean in your torso and force your hips back into a greater degree of flexion. This places more stress on the hips and this repeated stress over time is one factor that may cause pain while squatting.

Furthermore, you may experience greater restriction in one ankle compared to the other, which may also cause a hip shift during the squat towards the less restricted side. This places more load and stress on the less restricted side, thus potentially causing hip pain over time.

The reason this compensation occurs is because the body naturally tries to find the path of least resistance. This means that when you’re restricted, your body tries to find a way to gain the rest of that mobility elsewhere in your body to complete the movement (ie. your hips and lower back). 

Testing Your Ankle mobility

One test that you can use to test your ankle mobility is the 5 inch wall test.

Start by kneeling in front of a wall and placing your foot 5 inches away from the wall. Next, try to drive your knee toward the wall without letting your heel come off the ground.

You can use your fist with your thumb extended (think of giving a “thumbs up”) to measure the distance of the top of your big toe to the wall as an alternative to using a measuring stick.

If your knee isn’t able to touch the wall, then this is a sign that you need to work on improving your ankle mobility. 

The Cause of Poor Ankle Mobility

Restricted ankle mobility may be a soft tissue problem, joint limitation, or both. You can differentiate which problem you have by feeling where the restriction is coming from during the squat.

If the issue is soft tissue, then you will feel tightness in the calf muscle as you squat. If the issue is a joint limitation, then you will feel a pinch (aka bony block) in front of the ankle as you squat.

If the issue is stemming from a soft tissue restriction, start by foam rolling your calves by holding any spots that feel tender for 30 seconds. If you need to apply more pressure, you can cross your opposite leg over your shin and press down. Next, stretch your calves for 2-3 minutes each. My favorite calf stretch is to stand on the edge of a box and let my heels hang down.

If the issue is stemming from a joint limitation, use banded joint mobilization. You can set this up by placing a band around the front of your ankle (on the talus bone) and walking it forward until you feel a good amount of resistance from the band, then kneel down and drive your knee forward without letting your heel come off the ground.

When you reach your end range as you drive your knee forward, hold for 5 seconds then reset. Repeat this for 15 - 20 reps. 

Utilizing Weightlifting shoes for better squat depth without pain

One tool to help you squat with restricted ankle mobility is to wear weightlifting shoes that have a 1 inch heel. The raised heel allows your knees to travel more forward for greater squat depth and helps keep your torso more upright. However, this doesn’t mean you should ignore your poor ankle mobility while using weightlifting shoes, you should still work on it because squatting isn’t just an exercise, it’s a fundamental movement for everyday life.

Addressing Issues with the hips

A significant lack of external/ internal rotation of the hips can disrupt proper biomechanics of the squat and may potentially cause injury or pain down the road.

testing hip internal rotation

An indicator of lack of internal rotation during your squats is if your foot swivels outward during the descent. Because the body chooses the path of least resistance, your foot will turn out to complete the movement in order to make up for the lack of internal rotation coming from the hips. This will cause less hip torque and may also cause your knees to cave in. 

To test hip internal rotation, start by laying on your stomach. From there, bend your knees and let your foot drop outward away from your body, while keeping your hips squared with the ground.

A “normal” range for passive hip internal rotation is 30-45 degrees. You can set up a camera to estimate the angles of your range of motion. 

If this is the issue, one way you can work on gaining greater hip internal rotation is through a supine hip internal rotation stretch. To do this, you’ll lie on your back with your knees bent and let your knees drop inward toward each other. You can try both legs or one at a time. If you need a greater stretch, you can also cross your foot over your knee and press down. 

Testing Hip External Rotation

Lack of hip external rotation may also cause your knees to cave in during the squat. If the muscles responsible for externally rotating the hips are tight, then it will be difficult to push your knees outwards during the squat. Instead, your knees may cave inward.

Limited external rotation can also inhibit your ability to get deeper in a squat because your femur will jam up against your hip joint if you fail to rotate.

In addition to a limited squat depth, lack of external rotation can also cause less power generated in the squat, as you won’t be able to recruit the lateral muscles in your legs as efficiently. 

You can test your hip external rotation by lying on your stomach and bending one knee so the heel is lifted in the air. From there, drop your heel inward towards the opposite leg. Similar to the hip internal rotation test, you can set up a video to measure the difference in external rotation between each hip.

A “normal” range for passive hip external rotation is 40-60 degrees.

You can work on your hip external rotation by doing stretches such as the “figure 4 stretch” and pigeon pose. Performing hip controlled articular rotations (CARs) can also help with your hip mobility; make sure you’re working slowly through your end ranges. 

Testing for Hip Impingements

Femoroacetabular impingement (FAI), known as a hip impingement, is a condition where the hip joint is abnormally shaped.

The head of the femur jams up against the acetabulum (hip socket) and causes harsh friction that can damage the cartilage in the hip joint. This friction may cause stiffness and pain during squats and may eventually lead to arthritis. It’s important to note that there are many people out there with FAI that don't experience any pain (Frank et al. 2015).

Sometimes you may be able to tell if you have an impingement if you’re feeling a pinching or blocking sensation in your hip when sitting with your legs crossed, lunging, walking, and squatting.

A test you can use for hip impingement is the FADIR (flexion, adduction, internal rotation) test. You can perform this test yourself or have someone help you do it. To start, lie on your back, bend one knee then lift it up toward your chest until you reach 90 degrees hip flexion. Next, you will use your hand to press your knee inward towards your opposite leg then rotate your shin outward while keeping your knee bent. If this test causes pain in your hip, then that’s a strong indicator of a hip impingement.

If a hip impingement is the issue, you can utilize the following exercises and cues below to help mitigate symptoms.

Banded hip mobilization

The band helps create some space in your hip joint so you’re able to move through your full range of motion without blockage. Perform 12 - 20 reps each of pushing into hip internal and external rotation without lifting your foot from the ground. Make sure you have the band as high as you can near the hip joint and it’s pulling on your leg laterally. 

Front squat variations

Utilizing a front squat variation can help mitigate pain because it forces you into a more upright position, thus less hip flexion occurs during this movement compared to a back squat.

cue to “push the knees out”

You want to make sure that you’re pushing your knees out when squatting (but not excessively) in order to keep the knees in line with the toes. Using this cue can help change the position of your hip which may help reduce the pinching sensation. This also helps with greater recruitment of the outer hip muscles and helps create more power in the squat. 

Core stability and posterior pelvic tilt strength

Core stability exercises that focus on anti-extension of the spine and controlling pelvic tilt can help eliminate FAI flare ups caused by anterior pelvic tilt. Strengthening your glutes and hamstrings can also help with pelvic control because these are some of the muscles that help pull the pelvis into posterior tilt.

Two movements that you could try are deadbugs or planks with alternating leg raises.

Deadbugs:

Planks with Alternating Leg Raises:

These are general tips that may help people manage hip pain when squatting. Always consult with a healthcare professional to screen your pain and come up with a plan for your individual needs.