Assessing Movement Patterns

Considering our client is feeling discomfort or pain in the hips when they are squatting, it’s intuitive to spend all of our time looking at the squat pattern to uncover some clues. Although it only makes sense to replicate the pattern that the pain is present (or is caused by), it can be insightful to take a step back and analyze other movement patterns that offer a similar stimulus. It can give you alternative perspectives into how the client frequently compensates or where the client is truly struggling with their proprioception.

Similar movement patterns to assess include split squats, hinging (deadlifts, good mornings, or potentially even a low bar squat, which, in my opinion, is more of a hinge than a squat), and alternative variations of the squat (sumo squat, goblet squats, front squats, back squats, cyclist squat, etc).

Evaluating ROM Imbalances

The hip is a complex structure that most coaches only truly scratch the surface of understanding. While it’s almost instinctual to instantly start looking at the particular muscles that need to be addressed, I find that it’s even more helpful to look at the particular function of the joints that need attention. This approach will help you recognize how the joints are limited in their capacity and what muscles may be under or overworked as a result.

There are a few simple ways to evaluate the ROM of the hips: visual observation, internal/external rotation testing, and range of motion tests. Visual Observation – When you’re watching someone move, pay particular attention to how they initiate their hip movements. Is one side initiating more readily than the other? Are they able to achieve full depth or is there

Here are the main focus points to be conscious of:

Hip Rotation (IR)

It’s common for coaches to see the squat patterns as ones that simply challenge the hips in varying levels of flexion. What they don’t take into account is the fact that the femoral head will rotate within the acetabulum throughout the squat pattern. Without the capacity to do so, the femur will get “caught” and begin to force a higher output from surrounding muscles and/or joints to help support the increasing demand. An important reminder here is that IR is one of the most common restrictions we see across the board, and most people never address it. Want your client to feel epic in their hips - improve their IR.
 

Note: This ROM deficiency will often cause pain in the lateral hip/TFL area.

Pelvic Control

As a coach, I’m confident that you’ve seen it and likely see it every day. A client starts their squat pattern, whether it's a bodyweight squat, front squat, or back squat, by extending their low back and sticking their arse out as far as they can. What follows is a shallow squat and a butt wink fault that can likely be avoided or at least delayed in their squat pattern.

What’s happening here is that the client starts the squat pattern off by jamming their pelvis into a deep anterior tilt which forces their hips into flexion. Once they begin their squat, at that point, they’ve already nearly met their maximum hip flexion capacity, which has them reaching their end range early in the squat, and reducing the amount of depth they’re able to achieve.

In order to reach more depth, they can’t pull the ROM from their hips, so they pull it from the lumbar spine instead to compensate. Pelvic control is often overlooked but is an important component of the squat pattern that can play a large role in the amount of unnecessary stress being placed on the hips.

Note: This ROM deficiency will often cause pain in the anterior hip/hip flexor area

Ankle Dorsiflexion

Yes, the ankles can cause hip pain in a squat. Similar to the pelvic control example above, if the client is unable to bring their knees past their toes (ankle dorsiflexion), then they will be required to compensate at the hips, causing them to reach max hip flexion early in the pattern. This places quite a bit of unnecessary stress on the hips and low back as a result.

It might be helpful to keep in mind that ankle dorsiflexion is a wildly common mobility weakness for most people; it’s pretty safe to assume that working on this definitely won’t hurt the situation!

Note: This ROM deficiency will often cause pain in the anterior hip/hip flexor area