Hey Pain & Rehab Team,
I’m a 32 year-old male, 6’1" 215 lbs. and have been training for about 7-8 years. I haven’t tested maxes in a long time because of my hip, but my e1RMs for SBD hover around 485/335/585 when I’ve been able to train normally. I squat low bar with a somewhat wide stance and pull sumo (moderate stance, tibias on the rings). Apologies for the long post incoming, but I’ve sort of been through the wringer with this left hip for a while now.
I’ve been dealing with a painful and dysfunctional left hip for about 16 months and am unsure what to do. Prior to these most recent 16 months, I also dealt with some left glute pain that resulted in bad radiculopathy from about December 2021 - April 2022. From around March 2023 to February 2024 I dealt with symptoms of greater trochanteric pain syndrome (GTPS) that caused pain in my lateral left hip and down my lateral thigh (IT band area) during primarily squat but also hinge patterns. I consulted with Quentin Willey early on in the process and developed some strategies that helped me rehab the area and train around the pain during that time. Symptoms were 80-90% resolved within a few months, but lingered for a while longer.
I was pretty much pain free from February 2024 - late April 2024 and trained fairly normally until I experienced a pain flare up in my left SI joint that made back squatting and sumo deadlifts impossible. That flare up resolved very quickly (about a week) but there was some minor stabbing pain in my left glute that I’d feel in the first half of the sumo deadlift (floor to knees). I trained fairly normally regardless. Two Fridays ago (about 7 weeks after the initial flare up) I had another SI flare up, yet more intense this time. The pain is both a constant dull ache that radiates to the lateral and anterior part of the hip, as well as an acute jolt that I feel primarily in my SI and upper glute that also shoots down my leg (rarely below my knee). I can maybe do a quarter squat but the ROM after that is too painful to achieve. I can’t abduct my hip enough to get in a sumo stance, but can pull baby weights off high blocks in a conventional stance. Weirdly, I can do Bulgarian split squats pretty much pain free as long as I keep my torso fairly upright.
I should note that I have reduced the amount of volume, intensity, and specificity in my squat and deadlift training in response to these injuries and haven’t really made an attempt to get back to what I was doing a couple years ago. I went from squatting and deadlifting 2x/week (comp lift + a close variation) to 1x/week and replaced the variations with accessory movements like Bulgarian split squats, walking lunges, back extensions, single leg RDLs, leg curls, etc. For example, I used to do about 8-9 working sets of deadlift + 3-4 sets of hinge accessories, whereas I’ve been doing 4-5 working sets of deadlift + 4-5 sets of hinge accessories. I rarely go above RPE 7 on both compound and accessory work for lower body.
In daily life, my hip and SI feels like it locks up whenever I sit for too long or with my hip joint below my knee, and I have to move very gingerly during transitional movements (standing up out of a chair, changing direction while walking, etc.). I can’t do things like put on pants while standing up because I can’t bend my torso forward with my left knee raised. Relaxing my leg while standing and attempting to swing my leg forward and backward is very painful on the SI and hip joint. I can mostly walk okay, but have a slight limp. In short, the pain is fairly debilitating and is significantly affecting my daily life.
All of these injuries have been non-specific in that I can’t trace the onset of pain back to any particular action or occurrence. I am well versed in evidence based rehab and pain science as far as a layman goes, but given that these issues have been ongoing for so long - with brief periods of normalcy only for it to flare up again and get worse - I’m unsure how to handle them going forward. I have never had imaging done and am generally reluctant to do so given the prevalence of abnormal findings in pain-free people, but I am wondering if I should get scans done on my SI joint and hip labrum given the chronic nature of this dysfunction and pain. I’m just mostly at my wit’s end.
Any help or advice would be greatly appreciated. Thank you for your time.
Nate