My Hip Hurts! Training with a Hip Labral Tear, Part 1

So your hip hurts? I’m sorry to hear that - mine does, too! The good news is there are always safe workarounds in the case of injury or lingering issues (that should be accounted for as they always add up to real injuries down the road).

If you’d like to learn about the “why” behind some hip trouble, check out: "My Hip Hurts!" Training Around Femoroacetabular Impingement

Today, we’re just going to start talking more specifically about solutions for hip impingement - often felt as a pinching or dull ache - and often resulting in hip labral damage (there is a wide variety here).

It’s a pretty good rule of thumb that squatting is either not recommended or recommended to be heavily modified for athletes who are having hip labrum issues. This is because of the high degree of hip flexion during the squat - or where the knees come closer to the chest - can cause some major problems in the hip. The usual recommendations to modify the squat are to adjust depth or move more towards unilateral exercises (like split squat and lunge variations). 

Hip IR/ER: the body needs a balance of both and should be both strong and mobile throughout both rotations.

Some strength coaches have famously denounced the bilateral squat pattern because they feel the risk vs reward does not make sense and will remove the movement all together. 

I’m not there, yet! But I will say, that for the athletes I work with, they almost all have the same risk factors in common: poor ankle ROM, long femurs, and short torsos (relative to leg length). This is a recipe for hip trouble over the long term. 

In these cases, I like making unilateral lower body exercises the main lift (be it as a precaution or a necessity) because it ensures we are getting a full range of motion in training the legs. Then we don’t have to rely so heavily on squatting to full-depth to get proper training effect.

The classic box squat. Easy on the knees, great way to load the hips. Might this be too much of a “good thing” over many years with little variety?

But, adjusting squat depth and favoring lower body unilateral work is certainly not a new approach. 

Here’s what is: combining postural breathing exercises while encouraging the natural internal rotation of the hip. I’ve been diving in deep on using postural breathing exercises coupled with hip adduction. These positional breathing drills, which are realigning the diaphragm and the pelvis simultaneously, while also involving the adductors and even the hamstrings. The adductors themselves do not get a lot of work while squatting, and could cause an imbalance or injury if not addressed (side note: a split squat DOES heavily involve the adductors).

Pounding the adductors, hamstrings, with a simultaneous “tail tuck” and “rib tuck” through exercises relieves the hip a bit in how we then start to train the surrounding musculature. This can be quite refreshing for the athlete over time. More on these specifics next week in part 2.

But why keep chasing the squat? Why bother trying to make adjustments? Why NOT just join the group that bans this movement pattern from lifts? 1. Variety is key (I’ll touch on that later); 2. A bilateral squat is VERY functional: defensive position, anyone? Bilateral jumping is also pretty darn commonplace 3. It allows you to use more weight and thus tax the core a lot more.

Not what I’m talking about! This is bad squat IR and shows weakness and lack of control. An injury waiting to happen.

Okay, I’ve convinced myself. Let’s keep plugging away:

Most coaches when coaching the squat do not allow for natural internal rotation of the hip, true, most coaches will coach athletes to drive the knees out really hard and maybe even use a wide stance as well. 

The opposite of this, and perhaps the more natural way to squat, that I’ve been experimenting with lately is this idea of not driving into so much external rotation when squatting, and allowing a little bit of natural internal rotation. 

With this knee travel, the knee must remain inside the toe box and we should see this slight motion in the deeper portion of the squat or as part of a natural motion in the split squat. Again, and I can’t emphasize this enough, the knee motion is very slight, always under control, and stays within the toe box.

If you are struggling with hip pinching or catching, I recommend getting the hip looked at by a qualified medical professional who can help you understand what’s going on inside. If things are looking manageable, that’s awesome! You can train.

Please come back next week for part 2 of this post and I will share exercises ideas, specific training days, along with safe loading parameters. Getting the correct work-arounds will help you not only feel better but also feel like you are making progress once again.

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