There is nothing like a good squat cycle.  After 3 to 6 grueling weeks under the bar, there is very little out there quite as rewarding as adding 5-20 pounds to a long standing 1RM.  These gains however, do not come without a price:

1)  Your new glute girth may ruin all of your dress pants at unpredictable and inconvenient times.

2)  Your newly acquired posterior hip muscle strength may result in Anterior Hip Pain.

I’ve been working with strength athletes for many years. I am all too familiar with the sound of the athlete in my waiting room who is habitually and subconsciously thumping on their anterior hip with their own fist.  This article will lay the groundwork for an effective preventative protocol as an alternative to that self percussive ritual now referred to as Old Country Sign.

Anterior hip pain is a common presentation for trainees undergoing a progressively loaded squat cycle. This pain is often blamed on a tight hip flexor and psoas.  That is after all, the approximate location of the discomfort and the athlete does in fact present with a tight and painful psoas.   The resulting advice is to stretch and rest the psoas but unfortunately, stretching and resting that tissue while continuing the progressive loading rarely results in symptomatic relief in any kind of timely manner. The reason that these stretches do not bring lasting relief is because they do not address the cause of the pain.  The pain is likely the result of relatively weak hip flexors and rectus abdominis.  Stretching and resting weak, inhibited tissues does not help them.  The result of this relative anterior weakness is altered and aberrant motion in the hip socket and subsequent impingement.  Allow me to explain.

The solution to this condition is balancing the forces which stabilize the hip and regaining optimal motion of that joint.  This optimal motion is referred to as Joint Centration.  A centrated joint is one which is supported proximally to distally, with balanced muscle forces across all angles of the joint. The result is that during the hip flexion of a squat, the head of the femur “spins” from the center of the acetabular joint without friction or impingement. (Picture a baseball spinning within the confines of an ice cream cone)  The alternative is when the femoral head develops a tendency to “roll” instead of “spin” causing anterior motion within the hip joint. (Picture that baseball rolling up on and crushing the edges of that cone) This “rolling” results in the mechanical impingement and inflammation of the hip flexors and the presentation described by most symptomatic back squatters. The long-term chronic effect of this mechanical impingement is a self-perpetuating cycle where bony lesions form at the point of impingement as illustrated in the following video.

Clearly, the best course of action is to be proactive and to avoid the loss of joint centration that leads to this presentation. Your next question is “So what do I do?”  Easy now. You’ll be better armed to manage your healthy hips over the course of your lifetime after I explain the mechanisms behind the exercises rather than if I were to turn you loose with a few new stretches.

Centration of the hip involves many tissues supporting a tremendous range of motion, but for this discussion on the squat, it will suffice to simplify into flexors and extensors of the lumbar spine and hip.

Posterior hip extensors:
Proximally attached- Glutes
Distally attached- Hams
Lumbar and Thoracic Spinal Extensors-  Erector Spinae

Think about the muscles used during both the eccentric and concentric phases of the squat.  These hip and spine extensor muscles are aggressively and preferentially strengthened during a squat cycle.  To maintain pain-free hip motion, this shift toward extensor strength must be matched by trunk and hip flexor stability.

The posterior extensors of the glutes – and to a lesser extent, the smaller, deeper superior and inferior gemelli,  are the tissues that require extra mobilizing and stretching to prevent their contraction from pushing and displacing the femoral head anteriorly into the front of the socket and the surrounding soft tissues.  Don’t worry about stretching the hamstrings and the erector spinae as much for this presentation.  Research (McGill Low Back Disorders 2nd Edition, 2007) has thoroughly demonstrated that lower back flexibility is more of a liability than an asset, so keep your mobility work for this condition focused on the glutes.  Click Here for one of my favorite wall streches for the posterior hip/ glute/ piriformis/ gemelli.

Anterior Hip Flexors–
Proximally attached- Iliacus, Psoas
Distally attached- Quads, Rectus Femorus
Rectus Abdominus (particularly the lower portion)

Even with proper hamstring recruitment, the rectus femerus and other quadrucep muscles will be disproportionately strengthened in a squat cycle relative to the more important Short or Proximally insterted Psoas and illiacus.  That means to avoid allowing your newly, powerful quads from turning your smoothly spinning bearing handle of a hip socket into a teeter totter, invest time into mobilizing the rectus femoris and strengthening and stabilizing the psoas and lower rectus abdominus.

 

OK.  Finally.  Let’s answer the question:  “So what do I do to avoid anterior hip pain with squat cycles?”

1) Acute Phase- You are in a squat cycle and it is already symptomatic.  

Once the symptoms have set in, you are best off icing, resting, getting soft tissue work, and stretching.  Just do whatever you can to survive your squat cycle. The symptoms will not likely subside until the cycle is over and the inflammation runs its course.  In extreme cases of discomfort or in chronically recurring cases, you will have to discontinue the squat cycle.  Take that time to knock down the inflammation, retrain the anterior hip as described below, and then return to squatting with improved results.

2)  Sub Acute-  Proactive Phase- Stabilize and  Balance Your Hips.

• Stretch- Gluteus Maximus, Rectus Femoris, Piriformis, and Gemellus
• Strengthen- Rectus Abdominus and iliopsoas.  Strive to make gains in the static contractions as described below.

Pick several of these movements of appropriate challenge and train them year round.  Your coach tells you to do extra pushups outside of your regular training right?  Well here is one more reason to follow through on that advice.  Ramp up the frequency of this skill work before squat cycles and attempt match the gains you make in your squat with equal gains in your static flexion endurance capacity.

Complimentary Hip Flexor and Rectus Abdominis movements:

basic-

• Plank and Pushup (Static)
• Inch Worm  (Static)
• Mountain Climber (Dynamic)
• Heels to Heavens (Dynamic)
• Hollow Rocks and Hollow Robs (Static)
• Dead Bugs (Dynamic)

moderate-

• Toes To Bar (Dynamic)
• Knees to Elbows (Dynamic)
• Flutter Kicks (Dynamic)
• Ring Pushups (Static)
• Ring Pikes (Static)
• Ab Roll Outs/ AKA Ab Wheel/ AKA Evil Wheel (Dynamic)

advanced-

• Strict Renegade Rows  (Static)
• Barrel Rolls  (Static)
• Stir the Pot  (Static)
• GHD Situp  (Partial ROM)
• Front Lever (Static)
• L-Sit (Pull-Up, Ring Dip variations)  (Static)

Pick a static movement of appropriate challenge and work to improve your max duration capacity to an equal proportion as your squat improvement.  Integrate 2-3 dynamic movements into workouts, joint prep, or cool down per week.

The Big Picture:
When you undergo a cycle to increase the strength of your squat 1RM 10%, you must improve your plank by a comparable amount.

*Correcting hip centration is sometimes more complex than simply balancing the anterior side with the posterior side.   If the above advice fails to yield results, make an appointment and have your firing patterns assessed to dial in your specific homework.