Lateral Quad/Hip Pain

Hey Pain & Rehab crew,

I’ve been dealing with some nagging pain in my lateral left thigh for close to 3 months now and it’s starting to get pretty mentally draining. It doesn’t feel like a strained muscle, closer to tendinopathy type pain. The painful area begins a few inches below the greater trochanter of the femur and goes about halfway down my vastus lateralis (pretty much the upper half of the IT band). The area just below the greater trochanter hurts if I press it somewhat hard, but it doesn’t hurt to palpate below that - that area only hurts when I squat and to a lesser extent, sumo deadlift. Basically anytime I need to use my quad, but certainly more so on squats. Outside of the gym, I feel some pain climbing stairs.

I’m quite familiar with the modern approach to treating aches and pains in the gym. The trouble with this injury is that it’s hard to find a relatively painless entry point because the pain occurs throughout the entire ROM of the squat, even on bodyweight squats. The pain does intensify, though, at the bottom of the squat and as the weight starts to get heavier, both in relative and absolute intensity. I’ve pinpointed this to be somewhere around the 75% range of my squat 1RM and pretty much anything above an RPE 6-7. So, I’ve modified my squat and sumo deadlift training accordingly: I haven’t squatted or sumo deadlifted anything heavier than a 6@6 for about 8 weeks. I’ve also been keeping my weekly volume of squats and sumo a bit lower than normal, as I seem to pay for higher volumes with more “hangover” pain/sensitivity in the quad the following day. Additionally, as far as squats are concerned, squatting slightly above parallel and slowing down the eccentric seems to help a little, so I’ve been doing all my squats with a 3-0-0 tempo and an inch or two north of comp depth.

The pain doesn’t seem to be getting any worse, but it isn’t getting better. Still, the approach above allows me to train with tolerable pain levels (2-3/10). Pain symptoms actually tend to improve the further into a workout I get. My most painful sets are usually my warmups, but by the time I’m up to working weight, the painful area is less sensitive. I’m wondering if I should just continue doing what I’m doing since the pain isn’t getting worse overall, or if the fact that I basically have the same amount of pain after 2+ months means what I’m doing is stymying the healing process.

I acknowledge this may be a somewhat odd case, so let me know if this is worthy of a consult. Thanks in advance!

Nate

If you haven’t already, I would experiment with even higher rep targets (like sets of 12-15, similarly RPE capped) to pull back further on absolute loading. I would also consider incorporating unilateral and/or machine-based movements, such as a single-leg leg press, single-leg leg extension, and seeing whether movements like a reverse sled drag provide any stimulus to the affected area.

Beyond this, for further individualized guidance I would say that a consult would be very reasonable if you haven’t noted improvement after 3 months.

Thanks for the response, Austin. I have experimented with both higher reps and unilateral work (still doing unilateral work on my secondary “squat” day, currently doing SSB split squats). I admittedly may have prematurely abandoned the 10+ rep bilateral squat sets. I’ll go back to sets in the 10+ rep range on squats and give reverse sled drags a go as an accessory movement for a few weeks. If I’m still not seeing improvement, I’ll set up a consult.