Hip Flexor Tendinopathy

Hey Dr.Miles & Dr. Ray,

Thanks for reading over this, the work you guys do here is great. I’m not sure how it happened but it feels like I have some tendinopathy in my left hip flexor. Whenever I move my knee towards my torso I feel a shooting pain, probably a 4/10 if I had to rate it. The muscle belly also feels tender to touch. If I massage the area that hurts I feel a bit of pain. I’m currently running the 3 day GPP hypertrophy program and the pain started the weekend before week 3. Week 3’s Day 1 workout had me doing my comp squat and my e1RM dropped about 3% (383 → 371 lbs) but I was able to work through with minimal hip flexor pain. Fast forward to day 3 and the workout called for myo rep leg press. I couldn’t lower the weight down more than a quarter way down the sled without experiencing shooting pain in the hip flexor. I tried doing a high bar back squat instead with only 135 lbs on the bar and on rep 5 or 6 I had a really painful shooting pain so I re-racked the bar and just left. Now I’m on week 4 and I’m supposed to do my comp squat but I’m a bit apprehensive after what happened last workout. I have 2 questions really:

  1. How can I still train my legs with this issue? All of the other exercises, including deadlifts, don’t cause any pain at all. Only squatting movements seem to aggravate my hip flexor.

  2. What are some good practices to help the healing process? I want to get back to squatting ASAP because my e1RM was as high as 435 back in late October, and has dropped significantly since then. This setback isn’t encouraging.

Some extra background info that may help:

25 year old male, 5’10", 184 lbs, 36.25 inch waist, currently losing weight, 1850 goal calorie intake daily, currently running 3 day GPP Hypertrophy, Started seriously strength training in January with the following programs in this order: SSNLP, Texas Method, Bridge 1, Bridge 2, 3 Day GPP Hypertrophy.

Thanks and happy holidays!

Sorry to hear about the hip issue.

In regards to your questions:

  1. We need to manage load appropriately to ensure you can still train but with tolerable symptoms. A few ways to control loading while still feeling as though you are training - add in tempo work with a 3 second eccentric and 3 second concentric. See if this helps before making any other changes. What’s the set and rep scheme like currently?

  2. Healing will occur on its own, the primary directive in this instance is manage loading to the area while symptoms are regressing (which will happen with time).

I understand the desire to return to high intensity squatting ASAP, however the goal right now is training with tolerable symptoms to return to baseline and not improve beyond what has already been accomplished. Changing this premise will make a major difference in the long game. Keep us posted!

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I’m going through the exact same thing right now expect it’s my right hip flexor where I feel most of the discomfort and pain. It’s making it hard for me to continue with my training. I read I can do some simple stretches like lunges before each workout to reduce the pain I’m experiencing in my hip. I plan on doing a few of these hip flexor stretches before each workout and see if it helps ,

If anyone else has any other tips or advice on this i would love to hear it. Thanks.

The tips and advice are contained in Mike’s post above, in our tendinopathy podcast, and in our article on rehab here: https://www.barbellmedicine.com/blog…ining-what-do/ . In general, we do not recommend stretching for tendinopathy.