I have been struggling with a hip injury for over 2 years and was hoping to be able to get some guidance on what should be the next step in my recovery.
To give a little context, 2 years ago I found out that I had a partial tear in the front of my labrum in my right hip, which was caused by having CAM type FAI (Had an MRI which showed that this was the case). After long periods of not training at all or not training my lower body for various reasons that don’t have to do with the gym, I started going to physiotherpay as was adviced by the orthopedist I went to (He said at that point, around a year and half ago, that he didn’t recommend surgery as I was 18 at the time). I have been doing banded exercises and getting ultrasound treatment for the area (I go to my physiotherapist once a month) ever since. Intially I could not squat at all without pain, and I slowly progressed from the leg press to doing squats with a full ROM with only the bar.
Right now I am running the beginner template and instead of doing squats 3 times per week, I have one session in which I do pin-squats for a limited ROM where I can increase the load without as much pain (Slightly above parallel, but not close enough to parallel that I am satisfied with the depth I can get to comfortably), and I reached 70 kg for sets of 6 that I can do with limited pain, though I still can feel slight pain in my right hip after I finish my sets. The second session I try to hit depth using only the bar for sets of 8, though I feel pain in my right hip in the bottom portion of the movement, even when using only the bar as weight or even when doing the exercise weight-less. In the third session I do bulgarian split-squats and leg extensions to compensate for some added work that I don’t get in the second session.
My question is, what is the next step that I can take in order to be able to squat pain-free to a sufficient depth?
Before my injury I was squatting low-bar, though I am currently trying to squat high-bar as from what I read online it puts less stress on the hips because of the more upright back angle.
Any help would be much appreciated and thanks in advance!
Sorry to hear about this tough situation. Fortunately we have an article on this specific topic, with some general recommendations:
In addition to the above, it is likely that incorporating more variety (of both bilateral and unilateral exercises) in your rehab training, while managing overall intensity, will be beneficial in your journey.
If you’d like to get more individualized guidance, a consult with our rehab team would be a great idea here, as they have lots of experience working with folks in this situation.
I have previously read the article written by Derek and have tried to incorporate the main points from it in the modifications I made to the beginner template which I am currently running (About to start phase 2 in the template).
I will take your advice and add more variety in my rehab training, though I still do have a couple of question about how to progress with my recovery:
Is there a specific squat technique that in theory should result in the least amouny of pain? Right now i am doing high-bar squats, with my legs fairly narrow (Slightly less than shoulder width) and my feet pointed out in a 45 degree angle, while staying relatively upright due to it being a high-bar squat rather than a low bar squat. Would a wider stance with my toes pointed in less of on outward angle for example result in less pain in theory, or any other changes in technique as such?
Are there specific exercises which I could use in order to improve the bottom portion of the movenent? As this is where I feel the majority of the pain, and whenever I try to a good depth I feel pain, even when not using any weight. I have been doing banded exercises for almost a year which were given to me by the physiotherapist that I went to, though I don’t seem to see much improvement.
As for getting a consult with the rehab team, it is certainly something that I will look into in the future if my situation does not improve, though do to me being enlisted in the army it is not something that I can currently consider.
I would not worry about what “should” work “in theory”, but rather simply do the actual experimentation to see what you can tolerate.
I would be using a wide variety of movements that allow me to “access” the problematic range of motion in different ways. This could include things like any type of squat (back/front/goblet), split squats (with / without rear leg elevated), deep lateral lunges, single-leg leg presses, posterior medial taps, etc.
I’m not sure how that precludes a consult from being an option (outside of financial considerations), but we will be here if you need us.
I will be organizing my lower-body training in the beginner template as follows taking into consideration all your recommendations:
Day 1:
Pin squat (Shortened ROM and emphasis on weight - In order to have at least one squat variation where I can use higher intensity)
RDL
Day 2:
Front squat
Day 3:
Conventional Deadlift
Goblet Squat
Single-leg leg press (The reason there are 3 lower body exercises on this day and only the 1 on Day 2, is because it fits better on this day due to time management and this workout being on the weekend)
I will also be experimenting with different techniques to find what I can best tolerate.
If there are any remarks as to how I have set up my training and whether it looks good as a starting point I would love to hear it and thanks again for the help.