I have started feeling pain in my right hip around a year and a half ago, and within a few months went to an orthopedist and was sent to do an MRI. The results of the MRI showed that I had a partial tear in the upper-front area of the labrum, and that I have CAM type FAI hip impingement. The orthopedist told me that the injury was not severe enough for him to recommend surgery for it, and he then sent me to do physiotherapy. I have been doing it for the past year (Mainly band exercises, though I have not been very consistent with them), and the only other form of leg exercises I have been doing since then are leg extensions and lying leg curls.
It has been around a year and a half since I first started feeling the pain (And last squatted or deadlifted any significant weight), and I still feel the pain today (It is not very painful in my day-to-day life, though certain movements cause pain, and squatting to sufficient depth even without weight causes pain).
My questions are: 1. Can I deadlift despite this injury or is it not recommended?
2. How can I recover from this injury, should I keep doing physiotherapy more consistently (even though I have been doing it on and off for the past year without any progression), or should I go back to the orthopedist to see if surgery is the better solution?
3. Whether I do or don’t end up having surgery, will I ever be able to squat normally? I am asking this because of a video I saw where Eric Helms talked about having the same injury, and he said that he has gotten surgery and since then has not been lifting heavy weight with the low-bar squat and has instead switched to doing mainly front-squats and other variations of the squat because of concern to the health of his joints.
Any help would be much appreciated, thanks in advance!
Hey Ben Cohen - thanks for the information and sorry to hear about your experience. We will need a consultation to provide individual advice. However, based on what you’ve outlined here, I’ll do my best to answer your questions:
You are fine to deadlift. Start light (even a kettlebell deadlift is a start) and build up over time.
If you’ve solely been doing banded and machine exercises and a discussion hasn’t occurred about getting you back to your desired training movements, then I struggle to see the need to go back but ultimately this is your decision.
Nothing you’ve said thus far leads me to think you can’t squat again like you want. This will probably take some time to work through with appropriately dosed exercise. I get that may not be what you want to hear given you/ve already been working through this for a year or so.
I highly recommend getting a consultation + programming with us so we can provide more individualized advice and guidance. If you are interested, please complete our intake paperwork HERE.
I have listened to the podcast about the topic and it was very interesting and informative and I now feel I have a better grasp of the situation.
As for point number 2 and the reason I have not been back to training, I forgot to mention that I joined the army shortly after starting physiotherapy and haven’t been able to train consistently, and this was also hampered by the whole covid situation.
Just to give an update, I went back to my physiotherapist today in order to work out a training plan now that I can go back to the gym, and he suggested I start training with a leg press in a reduced ROM and minimal weight, and from there build the weight up until a reasonable amount of weight. From there he said I should start and work on expanding the ROM I can do without pain, and then slowly reintroduce squatting with the same method being applied. In addition, he suggested I keep on doing the stretches and band exercises in order to strengthen the muscles around the labrum and the hip joint, and said I could incorporate other leg exercises that don’t cause pain such as leg extensions, leg curls and calf raises. He also said that he doesn’t suggest that I do deadlift in this point in time, as he said I should first get back into training, and that when we get to the point where I can start leg pressing through the whole range of motion I can go back to deadlifting as well.
As for the consult, I will sure take a look at it! Though, in the meantime I was wondering whether the current plan I have outlaid sounds like a reasonable plan in order to get back into training?
Aside from my personal injury, I had a question about hip impingement injuries in general. The thing is, I can’t quite understand how physiotherapy by itself can prevent further injuries in the future. The reason being, is that if I have understood correctly, an overgrowth of bone spurs caused an irregular hip structure which then caused a labral tear. Though, if the hip structure is not changed and only the muscles around the hip joint are strengthened through physiotherapy and general exercise, what is preventing the same injury from happening again once I start squatting again?
Yeah, without consulting with you I can’t say what specific recommendations would be appropriate. We have general guidelines in the article, Pain in training: what do? Shortening range of motion isn’t my go to approach but may be necessary from time to time. I don’t typically recommend avoiding a movement in these scenarios (like the deadlift) but rather finding tolerable loading for you.
Ultimately these are topics that we can work through via a consultation. Briefly, one vantage point provides the premise the imaging findings are problems needing correcting but the other vantage point, the findings are adaptations occurring over time based on life experiences and activities. There is a strong case for conservative management in these scenarios but the key here is what does conservative management actually mean and look like. Part of that process should involve discussing your symptomatic pain experience, meaning assigned, and how you’ve been responding while outlining a game plan for activity dosage specific to the activities you want to be able to do.
I had Cam lesions in both legs. I had surgery to fix a labral tear and shave one of them down. It helped some but wasn’t a game changer. What ultimately made a huge difference for me was switching from squats to paused squats. Now I’m just doing a simple LP on squats so your outcome might be a lot different. But you might try giving paused or tempo variations a try for most of your volume. They seem to produce a lot less strain on the joint for me and I’m hitting PRs pain free after multiple failed attempts to train with pain with regular squats.