Hip Pain From Squats: Pinching in the Crease of the Hip

What causes the pinch at the bottom of a squat?

The hip is a ball-and-socket joint. In femoroacetabular impingement (FAI), extra bone on the ball (cam), the rim of the socket (pincer) or both makes the two surfaces contact early as the hip bends.

A deep squat combines a lot of hip flexion with some inward rotation, which is the exact position where those bones meet. AAOS OrthoInfo notes that turning, twisting and squatting may cause a sharp, stabbing pain in people with FAI, usually felt in the groin.

Over time, that repeated contact can damage the labrum, the ring of cartilage around the socket, and the joint cartilage itself. That is why a pinch that keeps coming back is worth paying attention to.

Could it be something other than impingement?

Yes. Not every squat pinch is FAI, and the location and feel of the pain help sort it out.

Pain on the outside of the hip during or after squats is common and usually involves the gluteal tendons rather than the joint. It tends to ache over the bony point of the hip, may be tender to touch and is often worse lying on that side. Single-leg work and heavy lunges tend to aggravate it more than double-leg squats.

• Hip flexor strain or tendon irritation: a pulling pain at the front of the hip, often after heavy volume
• Labral tear: deep groin pain with clicking, catching or a locking feeling
• Outer hip pain: usually the gluteal tendons, often worse after lunges and step-ups
• Hip dysplasia: a shallow socket that can cause groin pain with activity
• Low back problems: pain into the buttock or hip that changes with spine position

What squat changes help with hip pinching?

Hip shapes vary a lot from person to person, so there is no single correct squat. The goal is to find the stance that lets your hips bend without bony contact.

Try these changes one at a time with light weight and see which feels clean. Many lifters find a pain-free depth simply by experimenting for a session or two.

Warm up with bodyweight squats to a comfortable depth before loading the bar. The hip often moves more freely after a few easy sets, and the warm-up shows you where today's pain-free range ends.

• Widen your stance a little beyond shoulder width
• Turn your toes out so the knees track over them
• Squat to a box or bench set just above the depth that pinches
• Keep a neutral lower back instead of tucking the pelvis at the bottom
• Slow the descent so you control the bottom position
• Try a goblet squat, which many people find easier on the hip

Which gym lifts should I modify?

Any exercise that drives the knee toward the chest under load can provoke an impinging hip. Common culprits include deep back squats, front squats, leg press with a deep sled position, deep lunges and some machine hip flexion exercises.

Hip-friendly options include box squats to a comfortable height, trap-bar deadlifts, Romanian deadlifts with a moderate range, hip thrusts, glute bridges, step-ups to a lower box and sled pushes. Each still builds the legs while keeping the hip out of its pinch zone.

Cleveland Clinic notes that people with FAI can usually stay active, though they may need to change how they exercise or train. Modifying the lift is often enough to keep training while a hip problem is evaluated.

Keep a short training log while you experiment. Note the lift, depth, stance and how the hip felt that evening and the next morning, which makes patterns easy to spot.

Can physical therapy help squat pain?

OrthoInfo lists physical therapy among the first treatments for FAI. Specific exercises can improve hip motion and strengthen the muscles that support the joint, which can relieve stress on the labrum and cartilage.

A therapist will often work on core control, gluteal strength and pelvic position, then rebuild the squat pattern gradually. This is also a good time to review programming, since sudden jumps in weight, volume or frequency are common triggers.

OrthoInfo's hip conditioning program advises that you should not feel pain during an exercise, and to talk with your doctor or therapist if you do. That is a useful rule in the gym, too.

When is squat pain a reason to get checked?

A pinch that disappears when you change your stance is mostly a technique and anatomy issue. Some patterns suggest damage inside the joint and deserve an exam.

Seek urgent care if a lift caused a sudden pop with severe pain and you cannot bear weight.

• Pain that persists outside the gym, such as when sitting, driving or putting on shoes
• Clicking, catching or locking in the hip
• A pinch that keeps getting worse despite changes
• Pain that wakes you at night
• A new limp

What does a hip specialist look for?

Our team examines hip motion, especially flexion and inward rotation, and uses specific impingement tests. X-rays show the bone shapes behind FAI and dysplasia. An MRI or MR arthrogram is added when a labral tear is suspected.

Most lifters improve with exercise changes, therapy and time. When the joint is damaged and symptoms persist, hip arthroscopy to reshape the bone and repair the labrum is an option, and many people return to lifting afterward.

If you want a plan that keeps you training, our Saturday Hip Pain Clinic is a good place to start. Bring your training history and any imaging you have.

Questions patients ask