I need help discerning between FAI and soft tissue strain

Good morning Drs. Miles, Ray, and Amato!

As the title indicates I am currently dealing with some pain in my right hip which, compared to the first two to three weeks, is significantly better. Below is a full assessment of what I have noticed since onset, so my apologies in advance for the length.

On January 20, I had a slightly harder session due to adding ten pounds to my lunges in addition to a fourth set. That day only, I superset these with prone machine hamstring curls (possibly relevant due to fatigue). The squats I led the session felt fantastic compared to the week prior, possibly attributed to the fact that I widened my stance by about one inch and externally rotated my feet by a few degrees.

When I return on Thursday, January 23, everything through the morning and general warm up felt okay. However, it wasn’t until the specific warm up (lunge stretch, squats, elbow to instep, etc.) where my hips were full-on melting. As the warm up continued, they felt slightly (only just) better so I advanced to the warm up and working sets. I believed that this pain was a one-off deal and continued through all six sets of four, where only the last set felt remotely normal, contributing more toward my belief it was just a bad day, especially since nothing I did prior to this suggested I was symptomatic.

I thought it was interesting that the pain did not increase with depth nor external load. This pain was also noticeable when stepping down from a plyo box or going into a reverse lunge slowly, but only when my knee goes over my toes. Additionally, this pain seems to have reduced around the time I began stretching my adductors, but I am refusing to run with a post hoc assumption. Squats in any position/foot stance combination trigger the pain as well as both passive and active ROM. This includes actively flexing at the hip as deep as possible, rotating externally at the hip, and suspending the knee in that position. I also noticed that the pain was absent or drastically reduced when I used a softball-sized SMR ball on my anterior thigh just distal to where the pain was located. I know, I don’t believe in them either but I was just curious to see whether this pain was soft tissue, haha.

This pain disappeared almost entirely from my left hip but remains in the right hip to a 3-4/10 degree even though my pain-free ROM has returned to near full. Activities such as putting on socks or shoes in the morning irritate it about as much as squatting does. I have transitioned to high bar to reduce the hip flexion, though it irritates it about the same as low bar at this point in time. Lunging, however, does not trigger symptoms nor does sumo deadlifting (it was too mild to notice during the first week), so I have continued those in full since onset. Warming up seems to alleviate some of the pain prior to squatting, which leads me to believe further it is a transient problem. More interestingly, I can touch the floor straight-legged without pain whatsoever, though I am not educated enough to know if this would even be a concern for FAI.

Thank you so much in advance and if more information about myself or my activities is necessary please let me know so I can help with the process.

@IanES Hey, sorry to hear about the recent hip symptoms. Based on the information you’ve provided, whether we label this related to FAI or a strain - my approach would be the same. Check out this article for education about symptoms with training and load management, I think you’ll find it helpful: Pain in Training: What To Do?

If you are interested in learning more about FAI, check out our podcast here: https://player.fm/series/barbell-medicine-podcast/pain-and-rehab-episode-5-these-hips-dont-lieor-do-they

If you need individual assistance and guidance, then I recommend signing-up for a consult with us: Pain & Rehab Consultation

Good evening!

First, thank you for the links, I have been attempting to apply the article on finding an entry point, though patience has proven to be the hardest part. As for the podcast, I was hoping to find a video on FAI vs. strains via youtube but I was not aware there was a separate podcast channel. For that, I am grateful.

This process just got a lot smoother now that I know there aren’t two totally different courses of action to pick from. Thank you for your time and help Dr. Ray, hope all is well for you!

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