Hip (flexor) pain is characterized by a sharp or pinging sensation in the front of the hips, particularly when reaching the bottom position of the squat.
Many people assume that a “tight” hip flexor is the reason for their pain. But this ‘self-diagnosis’ is often made without proper assessment.
While tightness in the hip flexor may be the culprit, it’s important to identify the root cause before ‘guessing’.
In this blog post, I will explore why hip pain can occur during squatting and provide you with tests to help confirm whether a tight hip flexor is to blame or other issues.
Furthermore, I will give you the most effective tips and solutions to eliminate hip pain and help you squat again confidently.
1. Tight Hip Flexors
Testing For Tight Hip Flexors: The Thomas Test
- Sit on the edge of the box, and pull your leg (non-testing leg) towards your chest while maintaining a neutral spine.
- Lie on your back on a box or a massage table.
- Observe if your straight leg lifts off the box or if you feel a stretch on the hip.
- If you feel a stretch in the hip (groin area) and your extended leg lifts off the table, as shown in the picture, the test is considered POSITIVE.
- If your extended leg stays relaxed and in contact with the box (or slightly off), the test is NEGATIVE.
To ensure accurate reading, please pay close attention to the tips and common mistakes in this picture!
Imagine a two-sided spanner key with one side attached to your knee and the other to your hip joint. When you excessively pull your knees up, your pelvis needs to tilt posteriorly to accommodate the range of motion you are trying to achieve by forcing your knees up.
This compensatory action can result in a false Thomas Test reading where your extended leg lifts, which does not necessarily indicate tight hip flexors but rather an attempt to reach the position at any cost.
Therefore, maintain a neutral spine and pull your knees up until you can relax without compensation.
How To Fix Tight Hip Flexors
If your test result is positive, you have tight hip flexors, which can be a potential cause of your pain during squats. In this case, I recommend performing stretching and mobilization techniques like:
- (McGill) Psoas Lunge With a Bark
- Banded Hip Extension Mobilization
- Side Lying (Rectus Femoris) Quad Stretch
- Soft Tissue Release With a Foam Roller/Lacrosse Ball
- Sports Massage
It’s worth mentioning that tightness in the hip flexors can also result from your body’s protective mechanism to compensate for any weakness in your posterior muscles or hip stabilizers, such as the glutes or gluteus medius.
So, if you do not experience lasting results by completing these suggested exercises and releasing your hip flexors, check out the Glute Weakness section.
Also, if your Thomas Test result is NEGATIVE, continue reading to find out other reasons for your hip pain!
2. Wrong Squatting Technique
Why think of the worst when you only need a few simple coaching cues to squat with good form, pain-free?
The most commonly seen issues while squatting.
Stance: It is very common (especially in females) to start with a too-narrow stance, which does not suit their anatomy and creates hip pain. It can also increase the risks of knee valgus (knees caving in).
Failure to Generate Torque: The hip is unable to rotate externally.
Foot Position: Lack of activation through the feet due to pronation or supination, which can also result from the wrong stance.
Torso Angle: The fold-forward movement requires the hip flexors to work extra hard to prevent falling and maintain an upright posture.
These technique faults can lead to pinging pain in the hips, but you can avoid it with a few simple coaching cues!
How to improve your squat technique
Your Stance:
Finding the perfect squat technique is a trial-and-error process, so don’t be discouraged if you don’t get it right the first time.
The key is finding a comfortable stance to achieve more depth without rounding your back or experiencing hip pain. This will also enable a more upright torso position.
However, ankle or hip mobility limitations can sometimes be the root of the problem. If changing your squat technique doesn’t help, it’s worth looking into these areas.
It’s also essential to consider anatomy.
- Individuals with a deep ball and socket can maintain a more straight toe position with a narrower stance,
- while those with a shallow ball and socket might benefit from a slightly wider stance with toes pointed outwards.
Creating Torque:
In the first picture, you can see that I am externally rotating my hip to align my knees with my 2nd to 4th toes.
You may have heard the coaching cue, “Push your knees out,” but this can be confusing.
If you push your knees too far out, your foot may start leaning outwards (supinating), which reduces the power generated through your feet.
Instead, rotate your knees slightly out and drive them towards the 2nd to 4th toes while squatting and keeping your feet flat.
PRO TIP: To activate your glutes and create torque, a helpful tip is to place a loop resistance band around your knees and aim to keep a constant resistance on it.
Your Foot Position:
Your feet should remain flat with the toes spread out, so you can gain as much feedback from the ground as possible. This foot position is called: The Tripod Foot.
Your toe positioning can vary depending on your current mobility level and anatomy. Some individuals may find that a straight-toe position is less effective for their squat and can cause hip pain.
So, experiment with different toe positions to find what works best for you!
Your Torso Angle:
For some individuals, such as those with long femurs, a forward-leaning squatting position may be more advantageous due to their anatomy.
However, in other cases, this position may result from weak glute muscles, tight hip flexors, weak back extensors, or a lack of ankle mobility, causing lower back or hip pain.
What To Do:
- Adjust your stance and toe positioning.
- Switch to a different squatting technique, like a front squat, to keep your torso upright.
- Elevating your heels during squats may also help improve your torso angle and technique and ease hip pain (opening the hips and ankles). If this helps, that might be a sign of limited ankle mobility. Therefore, I recommend completing ankle mobility exercises.
- Engage your lats by pulling the bar through your back and pushing your head back instead of forward. This will help you ‘keep your chest up.’
3. Weak Hip Flexors
We have spoken about tight hip flexors, but what if your hip flexors are weak?
You’ve tried massages, soft-tissue release, and stretching, but the pain remained!
The psoas muscle is responsible for hip flexion, lateral rotation, adduction, hiking (lifting) one hip up, and bending the spine to one side. Interestingly, it’s considered a hip flexor muscle because it attaches the lumbar vertebrae to the lesser trochanter (near the femur). It can also be considered a core muscle.
Since the psoas stabilizes the trunk and helps maintain our center of gravity over our feet while squatting, weakness in this muscle can lead to hip pain and make it difficult to squat efficiently.
Testing For Weak Psoas Muscle:
- Step up on a box (knee height) with the leg/side you want to test.
- Lift your leg off the box without leaning back and overextending the spine, also avoid rounding the back.
If you cannot lift it off, you have weak psoas muscle.
How To Strengthen Weak Hip Flexors
One way to strengthen the psoas is to perform exercises that involve hip flexions (lifting the knee up hip height or higher), such as hip flexor marches or straight leg raises.
When completing the hip flexor marching exercise (with a resistance band, body weight, or ankle weight), you can initiate your squatting position by starting with a wider stance and bringing your knee slightly outwards (abduction).
Make sure to give extra attention to your weaker side! This can help activate and strengthen the necessary movement for a pain-free squat.
4. Weak Glutes
The tightness and pain you feel on the hip flexors sometimes can result from weak glutes or instability of these post-chain muscles like the glute max and medius. These are hip stabilizers and have an essential role while squatting.
Therefore, strengthening these muscles can give you long-lasting relief from your hip pain.
Testing For Glute Max Strength:
- Perform a single-leg bridge and hold the top position for 10 seconds.
- Avoid overextending your back, brace your core, and squeeze your glutes on top.
- Feel which muscle fires dominantly: the Hamstrings (back of the thigh), Lower back muscles, or the Glutes.
- Perform the test on both the Right and Left leg.
- The test is positive if you do not feel your Glutes firing or other forces are working dominantly.
Testing For Glute Med Strength:
- Lie on your side with your bottom leg slightly bent for stability and the top leg extended.
- Perform a sidekick with the top leg without rotating the hip forward or backward, as this may compensate and make the sidekick easier.
- Ask someone to apply resistance to your kick.
- Try to overcome the resistance for at least 3-5 seconds while keeping your leg up.
- The test is positive if you cannot resist, and your leg drops toward the ground.
How To Improve Weak Glutes
In case of a positive test, complete exercises like:
- side plank clamshell,
- banded squat (the loop band around your knees),
- sidekicks,
- lateral mini-band walk,
- standing banded sidekicks,
- single or double leg glute bridges,
- thrusters,
- single leg work for stability like single leg deadlift or single leg sit down and get-ups.
FURTHER READING: Top 10 Single-Leg Exercises for Strength, Mass & Athleticism
5. Hip Rotation Restriction (Limited Joint Mobility)
When the femur (thigh bone) is not moving correctly in the hip joint (ball and socket), your hip pain is caused by joint restriction.
To confirm this, perform the hip internal and external rotation (FABER) test!
To assess for side-to-side differences, perform the FABER test (external rotation test) and check if one side is higher than the other. If there is a difference, it may indicate the need for joint mobilization. The same applies to the internal rotation test.
How To Fix Hip Rotation Restriction
Try banded joint mobilization exercises for internal and/or external rotation in such cases. This can significantly improve your squatting and get rid of your hip pain!
PLEASE NOTE: IT IS POSSIBLE TO HAVE MORE THAN ONE TYPE OF LIMITATION!
TO CONFIRM THE REASON FOR YOUR PAIN, COMPLETE THE ABOVE TESTS. IF ANY POSITIVE, DO THE MENTIONED EXERCISES FOR A FULL FIX.
6. Hip Strain
You can easily differentiate hip impingement from hip strain. If you have a strained hip, placing your hip into a stretched position (even completing the Thomas Test) would be painful.
Also, when the hip flexor muscles are contracting, like lifting your knee to hip height, doing leg raises, applying resistance to a flexed hip position (knee up), or coming up from a squat WOULD BE PAINFUL. This would not be the case with hip impingement.
How To Fix Hip Strain
If the mentioned movements hurt, you are likely to be dealing with hip strain.
If you can NOT tolerate squatting, avoid it until it heals. Instead, you can complete isometric contraction exercises like a wall sit and glute bridges that work the same muscle groups as squats.
Also, try to keep weight off it as much as possible and limit walking!
IMPORTANT: Your hip pain may result from something more serious. So, if the suggestions and exercises above did not help, seek professional advice from your doctor to close out any severe damage!
