4 Ways to Prevent Hip Pain When Squatting or Weight Lifting
Why do my hip flexors hurt after squatting?
Can lifting weights cause hip pain?
Many of my clients who are frequent gym-goers, CrossFit enthusiasts, or weight lifters come to me with these questions. Hip pain when squatting is more common than you might think, and it isn’t something you just have to live with.
Squatting is such a functional and effective exercise, no matter your fitness level. So, having hip pain after exercising or lifting weights not only impacts your gym progress, but your day-to-day quality of life as well.
There are a variety of reasons why hip pain from weight lifting occurs, but once you can determine the cause, it becomes much easier to treat and even eliminate.
Understanding how your hip functions
Before I jump straight into the reasons why your hips hurt, it helps to understand how your hips move when you exercise. Our hips have a powerful connection to our entire body. They are the center of our kinetic chain that is being used while you squat, connecting the upper body to the lower.
The hip is a large ball-and-socket joint that is reinforced with four ligaments and supported by multiple muscles. Two of these muscles are the iliacus and psoas muscles, which connect your spine and pelvic bone to your thigh bone. Together, they are known as your iliopsoas muscles, and they play a very important role when it comes to both flexibility and stability.
One important thing to keep in mind: although medical professionals generalize the way the hip joint is structured, not everyone will have hips that fit the “textbook” anatomical definition.
We all have different bone structures. The length of the femur (the leg bone), the angle of the head of the femur (where the ball comes off the bone), and the depth and angle of the socket (that the ball fits into), are all examples of bone structure that can vary widely from person to person.
All of these factors, in addition to the structure of the pelvic bone, correlate to the hip’s ability to rotate, flex, and stabilize. These determine if your leg rotates out when you squat or if your toes can point straight forward. This also impacts how stable or unstable your hip may be during activity. A deep hip socket, for example, is more stable than a shallow one.
There are also less-visible factors at play, such as how much collagen or elastin your body naturally has. This ratio of collagen to elastin affects the strength and stretch of the ligaments, joint capsules, tendons, and fascia in the body.
Those with more elastin are likely to be more flexible and have a larger range of motion when doing exercises like squatting. But too much elastin can make the hip unstable when it’s being asked to do challenging tasks. This instability will cause your hip flexors to become tighter in response, as the muscles will take over the work of holding you together if your connective tissue isn’t stable.
Those with less collagen have more joint support while exercising. On the downside, you may not have the mobility to get into the deepest version of that squat.
It’s all about balancing stability and mobility in the body. Your body is happiest when you are in balance, a concept that stretches into all aspects of life.
Common causes of hip pain when squatting
Squatting is an explosive and powerful exercise that puts an enormous amount of pressure and stress on our hip joints and iliopsoas muscles, yet is highly effective in strength building and athletic performance.
Although the main muscles that work to move your body during a squat are your glutes, quads, calves, and back muscles, the iliopsoas is behind the scenes, holding it all together. These two muscles stabilize the hip, pelvis and lumbar spine.
When tremendous and repetitive stress is placed on this area of the body, the iliopsoas contracts with intensity to hold your back from going out, keep your hips in the socket, and keep your tailbone connected to your pelvic bones. It’s a big job!
It’s no surprise that several different hip problems can arise from heavy lifting.
If and when you decide to seek treatment for hip pain from weight lifting, you will need to go over the symptoms you are experiencing with your doctor. Instead of including an exhaustive list of hip pain scenarios, I have listed the three most common reasons people experience hip pain when squatting.
Hip pain while squatting due to muscle strain
You are likely familiar with some form of muscle strain or pull. When a muscle is used beyond its capability, microtears or even major tears can occur. And it’s the most likely culprit of hip pain when squatting or exercising.
Pulled muscles are uncomfortable and can take a long time to heal. When it comes to your hips, a strain or pull can occur in those big mover muscles (the glute, back, or quad), but can also occur in either the iliacus or psoas muscle - and can be especially painful.
The iliacus and psoas major muscles (also known as your iliopsoas) work together to stabilize your core while you squat. And the rectus femoris (a part of your quadriceps muscle) is closely associated with the iliopsoas in location and helps you to stand up. Because the rectus femoris part of the quad crosses the hip joint as well, this part of the quad is especially sensitive to injury with challenging squats. It attaches to the front point of your knee cap and travels all the way up to the pelvic bone.
When you’re experiencing a hip flexor strain, you might feel pain in the front of your hip, leading from the outside of your hip down into your groin area. You may even feel mid-to-low back pain where the psoas attaches. Muscles that are strained hurt when used or stretched. They also tend to hold tension to protect themselves. Injured and tight muscles become weak because the brain is trying to tell you to stop moving so much so it can heal! If you ask an injured muscle to work hard, it’s not going to be happy about it.
Unlike delayed onset muscle soreness that lasts a few days, muscle strains last weeks or months.
More specific symptoms of a hip flexor strain include:
- Muscle spasms in your hip or thigh
- Pain that comes on suddenly
- Increased pain when stretching hip muscles
- Increased pain when actively lifting your thigh towards your chest or raising your knee
- Pain or tenderness when touching the front of your hip
- Swelling on the hip area
- Pain when walking, especially up the stairs
Other muscles that are strained will feel similar sensations just in different locations.
Something to note about the hip flexors is that strain creates tension because an injured muscle wants to protect itself by encouraging you not to move. A strained muscle also becomes weaker for this same reason.
When the hip flexor complex is tight or holding tension due to injury, or even from having to work too hard for other reasons, that tension is pulling on the bones of the hip, spine, and pelvis. This also changes the length of the other muscles that attach to these bones. These other muscles like the hamstring, glute, and quad become weaker as a result. Shortened or lengthened muscles lose some of their strength, resulting in increased susceptibility for strains themselves. Furthermore, tension in the hip flexors will change the mechanics of the entire leg, spine, and tailbone, making you more susceptible to further injury somewhere else.
Very few people realize that working out with tight muscles makes you more susceptible to strains in this way.
Hip impingement when squatting
One type of bony issue that causes impingement is known as femoroacetabular impingement (FAI). This common issue causes you to feel pain and stiffness in your groin and hip flexor area. With movement, you may even feel a catch or clicking feeling on your inner hip. You may also feel discomfort when sitting for extended periods.
FAI occurs when the bones of your hip joint have a suboptimal fit, causing your bones to pinch or rub too close to surrounding tissues. These rubbing or pinching movements create unnecessary friction between the various bones and tissues, causing deterioration and pain.
To break it down further, the hip is designed so that the femoral head, which is the ball of the hip joint, sits on the femoral neck. You can envision this as you would a scoop of ice cream sitting in an ice cream cone.
So, when the hip joint - either the femoral head and the socket - does not fit together as they were designed, they will rub against each other, creating friction. This prolonged rubbing in the hip socket (such as in avid gym-goers) is one of the causes of hip pain when squatting. This bone structure can also pinch muscles and tendons nearby.
One thing worth mentioning: this pain often has very little to do with how much weight you are lifting. The weight may speed up your symptoms or increase your discomfort, but easing off on your gym visits or weights won’t fix the problem.
Often, I find that even though the bones have set the stage for pinching, when the iliopsoas muscles have been unnaturally pulling on your hip joints, it causes even more pinching to occur. A tight hip flexor twists the core and further impinges the hip joint in flexion. Deep flexion, where your knee goes up towards your chest as in a deep squat, is the motion that is limited when you have an anterior pelvic rotation due to a tight hip flexor. It’s also the motion that is irritated with an impingement issue.
Once they’re able to release the iliopsoas muscles - particularly the iliacus - my clients have noticed their symptoms either go away or are remarkably improved, allowing that joint to have more space to move before it is pinched!
Hip bursitis causing hip pain when squatting
Lateral hip pain when squatting can be caused by bursitis.
Bursa are small, fluid-filled sacs that sit in various places around your hips. They are positioned between the bone and the soft tissue of the joint to cushion those structures when you move. When your bursa gets inflamed, it causes bursitis.
There are two bursa sacs located around your hip joints, and they can become inflamed for several reasons:
- Improper posture when sitting, standing, or squatting
- Laying on the side of your hips for extended periods
- A hip injury of some kind
- Overuse of hips from running, jumping, squatting, etc.
- Tightness in the hip flexor complex which in turn causes unnatural tension in the muscles that are nearby the bursa
Once a bursa is irritated, it will no longer be able to properly protect the tissues near the hip joint. There is a major bursa on the outside of the hip that helps cushion many muscle attachments on the greater trochanter, a part of the femur that sticks out on the outside of the hip. When this bursa is irritated, it is called trochanteric bursitis. The iliopsoas attachment also has a commonly irritated bursa that gets irritated in the inner groin.
Some other common symptoms of bursitis include:
- Redness surrounding the outer hip and upper thigh (for trochanteric bursitis)
- Noticeable swelling of the hip area
- Limited joint movement
- Pain in the hips while walking, sitting, or lying down, especially when lying on the outside of the hip
- Warmth in the hip area
Pain from hip bursitis may not always be consistent or noticeable. It can come and go in flare-ups after activities such as CrossFit, running, or weight lifting.
You may not even notice the hip pain when squatting or lifting, but once you are home and resting, pain may arise.
Four ways to prevent hip flexor pain when squatting
1. Focus on form
When performing a squat of any kind, but especially while weight lifting, your form is the best defense against any type of injury. If you are using poor form, you can accentuate your hip pain in CrossFit or other weight lifting activities.
So, take a step back from your weights next time you’re in the gym - or even do this little exercise at home. Break down each movement to ensure that you are not putting a strain on one part of your body over another.
To perform a basic bodyweight squat, follow these steps:
- Stand with feet hip-distance apart, toes turned slightly out. The position of your toes will vary depending on your bony anatomy. Allow yourself to have a natural stance for your hips
- Stabilize your stance by tightening your core and turning your chest upward
- While doing this, begin to shift your weight back into your heels and push your hips behind you as you squat down
- Continue to slowly lower yourself until your thighs are almost parallel to the floor
- During this movement, your feet should remain flat on the floor, and your knees should stay over your second toe
- Keep your chest lifted and gaze either forward or slightly up
There are other variations of a squat, such as a jump squat, sumo squat, and barbell squat, which all require slightly different positioning to be performed correctly. For loaded or barbell squats, for example, you could move below a parallel position with your thighs.
If you are not properly distributing the weight throughout your body, more pressure is put on your hips to compensate for changes in posture and positioning.
When squatting, most clients say they focus on their legs or keeping their knees in the proper position. While these are vital aspects to squat form, focusing on our hip positioning is equally important.
If it’s not possible for your thighs to become parallel to the floor when you squat, it is likely that you lack strength and mobility in your iliopsoas muscle or other areas of the body. Leaning too far forward as you squat will put added stress on your back and quadriceps while also shortening and tightening your iliopsoas.
If you are feeling wobbly or off-balance when you slow down, that may be an indicator that your iliopsoas muscles have been weakened from overuse or poor form. Remember, these muscles are supposed to help you stabilize.
When your hip flexor muscles have proper mobility and strength, they assist you to pull your squat deeper while still maintaining form in your back and keeping the center of gravity over your feet. Your best bet with form is to work with a skilled trainer or practitioner who can watch you move and help tweak your motion.
2. Flexibility and mobility
During your warm-up or cool down, consider adding in some hip mobility exercises along with stretches, especially if you have hip pain when squatting.
You don’t have to limit it to those times either. Any time during your workout, between sets, or even at home before bed is a good time for stretching. If you improve your flexibility, you will simultaneously be able to increase your mobility.
If you’re already experiencing some pain or tightness in your iliopsoas, it should be addressed before you turn to strengthening exercises.
Hip mobility is important when performing a squat because if any muscles (calf, thigh, glute) are too tight, or a joint is unable to move fully, you will not be able to get into a full squat position. Beyond your hips, your knees and ankles need to be able to flex adequately to get to that desired depth in positioning.
If you do not have enough flex or mobility in any of these three joint areas, you compromise a neutral spine.
For squatting specifically, the flexibility of your hip flexor muscles, like the iliopsoas, dramatically impacts your form and ability to properly perform a squat. If you have tight iliopsoas muscles, you will have a tendency to lean forward as you squat. Even a slight lean forward when squatting shifts your center of gravity, increasing activation of your quadriceps while decreasing in your glutes.
Lastly, keep in mind that you don’t have to go as deep into your squat as you currently are. It is much better to listen to the cues your body is giving you than to overwork your iliopsoas muscles.
You can still get a great workout without moving your legs past parallel to the ground. As you go past parallel, your hips go into more and more flexion, shortening your hip flexors quite a bit. Short muscles become weaker and those hip flexors have a hard time stabilizing your hip, tailbone, and spine, making those areas more prone to injury the deeper you go. Throw in overcoming mobility issues in other parts of the body, like your ankles for example, and you’re setting up a precarious situation.
Box squats are a great way to strengthen without asking your body to go too deep into hip flexion. It’s the best of both worlds.
3. Strengthen and stabilize your muscles
It is generally accepted that squats are an effective form of exercise since they utilize multiple muscles simultaneously. Just in a standard bodyweight squat, you’re using your:
- Abdominal muscles
- Foot muscles
With so many muscle groups engaged during a single bodyweight squat, you could see why strength and stability are important in preventing pain. When the other muscle groups surrounding your hip and hip flexor are strong, they add much-needed support and stability during the exercise.
Take the psoas muscles in your hip flexors as an example. If you have weak psoas major muscles, your entire hip could experience instability, which could cause overuse of other muscles, like your back.
If those same muscles are too weak, even in one area, it puts additional strain on your hips. Any added strain could cause you to lose a proper form or even injure your hip.
This is why it is also important to diversify your workout routine. You can target more muscle groups and transfer the strain across more areas of your body when doing cross-training. And this may prevent hip and back pain while squatting.
Finding a way to strengthen all of these muscle groups, including your hips, will give you a more stable base and improve your ability to perform a squat. Some targeted exercises that can improve hip strength and stability include:
- Hip flexion
- Side-lying leg lifts like a clamshell
- Hip extensions
Many other exercises target your hip muscles and, for a short time, you may want to work with a physical therapist to have the most effective outcome.
4. Make time for rest and recovery
One of the easiest ways to injure your hips is overuse. This is true beyond squats, weight lifting, and CrossFit, too.
If you’re a runner or a cyclist, hip pain can be a real issue if you do not schedule some good old fashioned rest and recovery into the mix. This goes beyond just taking a rest day or adding some extra time between reps, though.
When you are working on improving your form and overall strength, getting enough sleep is a vital part of the recovery process. Muscles like your iliopsoas use this time to fully relax, take a break from the demands of the day, and repair themselves after a difficult workout.
How to relieve and reduce hip pain
Now that we’ve listed some ways to avoid hip pain when squatting, let’s discuss what you can do if you are already experiencing it.
First, it is important to identify and diagnose the cause of your pain. For this step, you will want to work closely with a trusted medical professional. When you figure out the cause of your symptoms, you don’t need to rely on anti-inflammatories and endless rest days.
For a more targeted approach to hip pain when squatting, I use release techniques and tools like the Hip Hook to create a full release of the iliacus and psoas muscle. Just 5 minutes a day on the Hip Hook should be a standard practice for all weight training regimens. As you now know, tension in this muscle can easily occur with weight lifting and CrossFit, and tension in these muscles can be responsible for pain related to this activity.
Unlike standard foam rollers or balls, the Hip Hook targets the root of your hip pain by providing prolonged (30-90 seconds), precise, angular pressure on the iliacus and psoas muscles. These muscles are hard to access without a specific tool or a skilled practitioner. Use this tool to ease your hip pain and tension so you can get back to the workouts you love.
And once you’ve achieved that release, it’s important to find ways to strengthen your muscles, increase mobility, and dial in your form as you go forward. This will help you prevent hip pain when squatting, weight lifting, and exercising in the future.
FAQs on hip pain when squatting
Can I squat with hip impingement?
Even though the bones have set the stage for pinching, when the iliopsoas muscles have been unnaturally pulling on your hip joints, it causes even more pinching to occur. A tight hip flexor twists the core and further impinges the hip joint in flexion, such as a squat. Releasing the iliopsoas muscle will not structurally change the impingement, but symptoms and movement can be improved.
Why does my hip hurt while squatting?
There are a variety of reasons you may have hip pain while squatting, from bursitis to arthritis to impingement, and many of them can be improved by releasing and stabilizing the hip flexor muscles.
How can I warm-up for squats?
Releasing your hip flexor muscles is a great practice before working out. It’s too easy to think of muscle-release as a post-workout routine, but releasing them with prolonged pressure beforehand will help your body to realign and use those muscles more effectively.