Hip Flexor Tendinopathy

Pain Science & Rehab Discussion
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Hi guys,

To provide some context: I’ve been resistance training on and off for 2 or 3 years now. My first real program was the Starting Strength Novice LP, which I attempted 3 different times (with relatively poor results) before starting the Barbell Medicine Beginner Template 3 weeks ago. I’ve had to restart this once, after week 1 day 2, upon experiencing sudden pain in my left shoulder, which went away as I did a few light sets of overhead presses that weekend and my shoulder appears to be fine now. Having missed a day of training, I decided to repeat the first 3 workouts this week.

Now about the injury in question, I went on a walk before Wednesday’s session to complete my daily 5k steps (this was the first time I’d walked this many uninterrupted steps in years, aside from resistance training I’ve been completely sedentary). As I was nearing the end of the walk, the area around my left hip started to feel like it was inflamed (I’m aware that there’s very likely no inflammation, but this is the best way to describe the pain). The pain was tolerable to the point where I decided to proceed with my resistance training for the day. However the pain got worse as the session progressed, and I was unable to complete the second set of squats. After an hour or so of rest the pain was much worse, and it hurt to raise my left leg even slightly, say to walk up a flight of stairs. The next day it was just as bad but I managed to lie in bed and do some straight leg raises for 2 sets of 4, which I repeated on Friday, deciding not to do any other physical activity. The next day it felt much better and I was able to complete 5k steps, the pain was still there but it was much more manageable. I did the same again today. I’m hoping to start resistance training again soon.

I read the relevant section in this article: Training With Hip Pain Part II and found that I was unable to get into the start position for the reverse Nordic without feeling a very tight stretch in my quads, enough that I can’t maintain that position for more than a couple of seconds. I have to imagine that this is not normal, but as far as I can remember, this has always been the case when I’ve been resistance training.

Additionally, my right hip is also complaining, and has been for a couple of months, but not to the extent that the left currently is. Clearly there’s a technique issue that’s causing this, as it’s been a reoccurring problem every since I started squatting a couple of years back, but I’ll make a separate topic in the training forum for that.

So in summary: my hip flexors show signs of tendinopathy, with the left having been in acute pain recently, and there’s a tightness in my quads that prevents me from staying in the Nordic curl start position for more than a few seconds without severe discomfort. I want to make sure I’m not missing something about dealing with the tendinopathy and also I’d like to know what’s going on with my quads, since it’s less obvious what the problem is there.

Finally, and this is probably more pertinent to a form check, but I’ll include it here for completeness: when my knees are pointing straight forwards, my toes are pointing out by about 10 degrees. A quick google search says this is called “duck-footed”. I’m not sure if this relates to any of the pain I’m experiencing, so I thought I’d mention it.

Thanks for your time

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Now about the injury in question, I went on a walk before Wednesday’s session to complete my daily 5k steps (this was the first time I’d walked this many uninterrupted steps in years, aside from resistance training I’ve been completely sedentary).

I think it’s great that you’re making an effort to increase your physical activity. Just to make sure I understand - the day your pain started to flare up was the first day you started walking 5,000 steps? 5,000 steps isn’t all that much in the grand scheme of things, but depending on how sedentary you were prior to this, it could be possible that the increase in walking in addition to recently starting resistance training might’ve been a significant enough increase in activity that your body wasn’t quite ready to handle it all. Also, if you were previously sitting for most of the day and not moving around much, it’s not all that surprising to me that your hips and quads are tight. I would advise you to continue to get your steps in, adjust your training loads and/or ROM to tolerable levels, and let your pain resolve itself over time.

Your technique may or may not be contributing to your hip pain. I would lean toward not (unless you’re trying to force a squat technique that your hip anatomy disagrees with) but it’s impossible to even make a guess without seeing a video.

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Thanks for the reply. Similar problems have occurred in the past every time I’ve started resistance training and the weights got heavy and I was a little surprised at it happening with much lighter weights this time around; I think you’re right that the added walking contributed to it. With past instances of pains/injuries I always stopped training completely in response which I suppose meant that I never actually fixed the problem. It seems obvious looking at it now, but I wasn’t as knowledgeable on pain and injury management as I am now. Anyways I’ve made sure to get my steps in everyday so far, and the pain has subsided a moderate amount. I’m going to resume resistance training at the start of next week and see how that goes, but my confidence level with regards to squatting is quite low; I’ve just never been able to do it without pain. I’ll get round to posting a form check soon, but I’m not expecting any miracles.