10 Minute Tip 21: Hip Pain in Barbell Training | Understanding how torso and hip position affect symptoms
THE HIP IS ONE OF THE MOST COMMON AREAS IN THE BODY THAT PEOPLE EXPERIENCE PAIN WITH BARBELL TRAINING AND THE POSITION OF YOUR BACK AND LEGS CAN EITHER ENHANCE OR REDUCE YOUR SYMPTOMS.
THE THREE MOST IMPORTANT POSITIONS OF THE BODY TO CONSIDER IF YOU HAVE HIP PAIN WHILE SQUATTING INCLUDE THE:
Back Angle
Hip Angle
Toe Angle
In this episode of the PRS Podcast, physical therapists and PRS Clinical Coaches, Drs. Rori Alter, John Petrizzo, and Alyssa Haveson discuss the influence of the back, hip and toe angle on hip pain.
The solution to hip pain while squatting is never a one-size-fits-all answer as the cause for hip pain can vary greatly from person to person.
SO IT’S IMPORTANT TO UNDERSTAND THAT THE PROCESS OF REDUCING HIP PAIN WHILE SQUATTING IS TRIAL AND ERROR AND A COMBINATION OF MANAGING:
Body position
Technical execution
Training fatigue
Recovery
If all else fails, it’s best to book a consultation with a rehab specialist who is knowledgeable in barbell training and sports/orthopedic injuries to help you identify and address the root cause of your hip pain.
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Dr. Rori Alter, PT, PRSCC, SSC: [00:00:00] Welcome back to the Progressive Rehab & Strength podcast. I'm your host Dr. Rori Alter here with my lovely co-host, Dr. Alyssa Haveson and Dr. John Petrizzo, if I could say our last name correctly. Well, don't use the last name. But he does, and so does my kid. But anyway, we are here again with another ten minute tip Tuesday, and we're going to be talking about the effect of the back angle and hip angle on hip pain in the squat and the deadlift. So typically we see the back angle or the hip be more affected by the squat. But there is some element of hip pain in the deadlift as well. So John, why don't you talk to us about how the back and hip angle affect the typical types of pains in the hip that we see with barbell training, which are commonly associated with arthritis and Femoroacetabular impingement syndrome.
Dr. John Petrizzo, PT, CSCS, SSC: [00:00:54] Sure. So these two things are related. And when you're talking about back angle, you're talking about essentially the angle that gets created between the torso and the floor. And when we're talking about hip angle, you're talking about the angle that's created between the torso and the femur. Just so everybody knows what Rori is referencing. And because the torso is involved in both of those torso positions is going to have an effect on the hip joint. So when we're talking about exercises that may be irritating for people or positions that may be irritating for people with femoroacetabular impingement or maybe osteoarthritis generally, things that we move into a more closed hip angle are going to cause more discomfort. So a more horizontal back angle will lead to a more closed hip angle. So if we were talking about, let's say the squat. A low bar back squat is going to utilize a more horizontal back angle and therefore is going to have a more closed hip angle, right? So if you're somebody that maybe has femoral femoroacetabular impingement, you may find that bottom position to be uncomfortable because of how acute the angle becomes at the hip. So a lot of people, you know, that I've worked with who have had that sort of hip pain typically respond better to a more open hip angle. Something like a front squat, you know, would be the opposite end of the spectrum where the torso is very upright and therefore the hip angle is more open and the bottom position. And that doesn't mean that they can't progress back to low bar squatting, but it just means that you have to kind of desensitize yourself to that position over time. And usually I'll run them through front squats for a while and then maybe high bar squats and then progress back to low bar squats and see how they tolerate it. So so just to answer your question, the two are always going to be interrelated.
Dr. Rori Alter, PT, PRSCC, SSC: [00:02:57] Do you well know the answer for me? But have you found that everyone with this type of impingement or with impingement syndrome or with hip pain feels better with a more open hip angle and more upright back angle or.
Dr. John Petrizzo, PT, CSCS, SSC: [00:03:12] No, not necessarily, you know, pain like you guys have talked about on the podcast before is multifactorial. Not all impingements are the same, right? So there's a lot more that goes that goes into it. So you can't just use that as a blanket type of statement, you know? Um. So I would say you just have to evaluate the person you're working with and what their symptoms are like and see what they respond better to. Yeah.
Dr. Rori Alter, PT, PRSCC, SSC: [00:03:43] How does I mean, this is kind of more related to the hip position, not necessarily the hip angle, but how does stance affect the hip and what can someone do when they have hip pain and it's not back position related? Like they can't find a better like a comfortable back angle. What can they do with their stance to help their hip?
Dr. John Petrizzo, PT, CSCS, SSC: [00:04:10] So again, that's going to vary a little bit from person to person. You know, what one person might be comfortable with. And so we've talked about like angle of torsion, right? And anteversion and retroversion and, you know, these sorts of things that that are going to impact, like what stance is going to have is going to be more comfortable for someone, Right. But certainly, like if you use a. Wider or more toes out sort of stance that's going to facilitate more external rotation and abduction in your squat, right? So in the hip joint, if you use a more narrow toes forward stance, that's going to facilitate probably a little bit more internal rotation and a deduction, you know, movement in the squat at the hip joint. So it really depends on where the person is most comfortable. But um, and you just have to experiment a little bit to see what works best for, for the particular person that you're that you're working with. Yeah.