Lateral thigh pain in area under greater trochanter of femur from squatting

Pain & Rehab Forum [Moderated]
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Hello, good doctors of BBM. First, a bit of history: I’ve been doing a 5x5 LP restart after a 4 year hiatus since around January. Because i was so out of shape, i just started with empty bar weights hence the long time spent on LP since restart. I plan to switch to the Adv Novice template shortly and then onto the Bridge 1.0 and from there alternating blocks with a Str template and a hypertrophy template. Currently I’m at Squats 165x5x3, Bench 170x5x3, DL 245x5x1, OHP 125x5x3. Squats are low because back in Apr i took some deloads and did some other single leg stuff because of the aforementioned pain in the thread title.

The issue: I have a nagging pain i’ve been dealing with since about Apr 2 of this year. The pain feels about like a fist-sized area directly under the greater trochanter of the femur on my left leg. Possibly even a little tenderness on top of the GT. It mostly feels like the VL and IT band. I can feel it when i tense my quad, specifically the VL, and definitely feel the intensity jump up while squatting. Particularly going down and coming out of the hole until about half to 3/4 the way up. It seems to flare up and get worse with squats once i start getting up to around 150-160 lbs. It seems every time i get to around 150-160 lbs on my squats, this nagging pain comes back up to the point i can’t go up/down stairs, get up out of my chair, etc. without a lot of pain. I’ve tried high bar, low bar, and front squats. Front squats and high bar seem to piss it off the most. Pushing knees out to very wide (feeling almost excessive) seemed to help at first but i’m starting to have the pain even w/ that now.

Back in early april before i had discovered Barbell Medicine i tried all sorts of the usually recommended junk… Foam rolling, stretches, single leg activation exercises for the glute medius, TFL release, etc… None of that seemed to really help much (not surprised now that i’m up to speed with your content and thoughts on this kind of stuff). Now that i’ve found BBM and have actually gotten past some chronic low back issues thanks to you guys, i’m ready to tackle this new problem.

So i guess my questions are… What would you recommend as a way through this? Looking at somewhat similar topics in the forum and based on some of the YT videos, my first thought is to find some kind of variation that allows pain free lifting. Highbar and front squats seem to be out (they cause the most pain). Unfortunately i don’t have access to a leg press machine as i work out at my home gym, but i have resistance bands i could rig up for something similar. Would barbell lunges be something to try? I haven’t tried box squatting yet either. I have a bench, power rack, 2 barbells, and a variety of resistance bands.

Once i find a movement that allows pain free movement, what kind of load and volume should i be looking at? Should i avoid squatting all together until a few weeks of no pain? The idea of not squatting kills me, but if it will allow a long-term fix i’m willing to go that way if needed.

Thank you for your time!
-Greg

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Hey @gmorf33 - sorry to hear about the recent onset of lateral hip pain. Have you been using RPE to guide training? This would likely be my first recommendation to help with appropriate dosage of exercise while dealing with these symptoms. If you’ve tried regulating loading with RPE, you can also try increasing the volume, adding in a tempo, and regulating absolute intensity to help find appropriate dosage with tolerable symptoms. I wouldn’t approach this from the premise training has to be pain free but rather training with tolerable symptoms (not feeling debilitated during or after training).

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Thanks for the response! Yes, i’ve been using RPE for the last 3 weeks, but not for load management. I’ve been rating workouts while following the Novice LP. Most of my squat sets have been RPE 7-8. Since my post i have made a few changes, mostly in nutrition, thanks to some guidance from Jordan. Turns out i was vastly under eating protein. I’ve been tracking my macros and hitting 230-250g of protein daily and since then a lot of my pains have subsided. That’s also when the RPE of my squats started sliding down to the aforementioned 7-8. I’ve reduced volume slightly to 3x5. Next week i’ll be going 3x5 @ LP weight and then an additional 2 sets of 5 at a -10% load. With that additional volume i’ll probably increase my calories a tad (50-100) and see how it goes. I’ve been flying through the LP since my diet changes, up to 190 lbs on my last session. I do still feel that lingering pain a little bit, but so far it’s not flared up at all. I can do all of my daily activities and it doesn’t hurt or bother me in my squats, so i’m proceeding as i have been unless it starts to worsen.

If it does start to worsen when i add in the extra two backoff sets next week, do you recommend reducing load of those backoff sets further than 10%, or rather adding a tempo to them (which i’m assuming means will auto-regulate the load down because tempo is harder than normal speed)?

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I have initial diagnosis of Trochanteric bursitis in both hips, so very useful discussion. Low bar to depth is out for me so I will experiment with alternatives. I wonder of recovery for bursitis, should I expect something similar for tendonitis??, I’m going to use some subjective feedback using body weight squat to measure pain. Going to knockoff intensity, and incorporate tempo, pause, isometric exercises. I’m ditching the strength program (for squats at least) until recovered, then will build back up. Long term I must do session/weekly RPE including GPP stuff too, as this may of added to stress on hips esp. with cycling.

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I’m curious - who arrived at this diagnosis and what was the basis of the diagnosis?

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Just wanted to follow up on these questions and also give a quick update. My pain has flared up again a couple of times but it’s not consistent. It seems to be best when i focus on my glutes and “hip drive” out of the hole, with a slower decent. I"m trying to avoid a lot of the micromanagement and hyper awareness of my movement, but this does seem to help.

I did stumble upon the recommended strongerbyscience Greg Nuckles article Austin linked in another thread. That helped me understand quite a bit more about how tendons work and why you would do things like tempo squats, etc. I found this article about TB and lateral hip pain which seemed to match up pretty good to what i’ve read from BBM and the SBS article above: Fixing Lateral Hip Pain – Squat University

Do you think that is a good approach to manage this pain? Anything in that article you would disagree with?

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Hey @gmorf33 - in situations such as this, often symptoms are a part of the process but shouldn’t be severely increasing during or after training.

My usual approach, dependent on severity of symptoms, involves upping repetitions per set (typically 8s, 10s, 12s, or 15s) and lowering external intensity by dropping internal intensity (RPE) and adding in tempo work. There’s not a perfect program for working through these issues, rather finding where you are at with tolerable loading and moving through the process over the subsequent weeks. A major premise shift that’ll likely need to occur while working through this issue is NOT chasing after any particular weight or load. See: https://www.barbellmedicine.com/reco…e-the-process/
I prefer a “low and slow” approach, which is why reps are increased and weight decreased so we can get some small wins under our belts with tolerable loading. Admittedly, I’m not a fan of LP, most especially when working through symptomatic issues because the premise is just keep adding weight week after week.

We’d also be happy to consult with you if you need further guidance: Contact Us | Barbell Medicine

Squat U article - a lot of irrelevant information focused on anatomy and biomechanics. The exercises recommended aren’t necessary either. I don’t see this article adding anything to how I would manage situations such as yours.

1 Like
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Hey guys, sorry for reviving an old thread.

Would you say this is reasonable for general chronic aches/pains from training?

I get pretty bad hip pain radiating down to my knees from squatting. I’m about to commence phase 2 of the beginner program (as per Jordan’s recommendation) and the squat frequency is a fair bit higher than what I’ve been doing before.

I am aware of the approach to aches etc in terms of reducing load, finding variations. So, would it be reasonable for me to swap out squats for eg. tempo squats with reduced loading as long as the pain is not unbearable and hope for it to go away?

I’m itching to get started on the template but don’t want to aggravate any pains.

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Sure, I think in general this is an easy heuristic to go by but like most things, there are likely exceptions.

I think what you’ve outlined for exercise changes is reasonable (without knowing the context of your situation in more detail).

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Fair enough, thank you.

Of course, the devil is in the details. But as long as I can train productively long term, I should be okay, especially since my hips are asymptomatic in day to day life anyway.