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Jon is a fit 30 year old with functional Hip Pain or FAI

Jan 06th, 2016

Hi,

Over the past few months I’ve been having problems with hip pain (right hip) triggered by exercise. I say hip pain because the pain is located at the top of my thigh almost underneath the hip flexor about an inch round to the groin. The pain is a sharp pain and occurs when I do core exercises such as sit ups, burpees and squat trusts (squat thrusts being the worst trigger). Once I’ve triggered the pain anything that involves me raising my knee or jogging hurts in the hip to the extent that I have to stop exercising. The pain subsides after a few days of rest but then returns within 10-15 mins of doing any of the exercises I mention above. I’ve tried rolling with a foam roller but struggle to find the right bit to roll and struggle to find a tender spot when poking it.

By way of my fitness background: for a few years now I have been a regular at British Military Fitness (BMF) sessions. I average 3 sessions a week in the advanced group (a green if you’re familiar with BMF). I’ve been in that group for about a year now. I also train with free weights at home a couple of times a week (bench press, squats, rows etc) – the squats don’t trigger the pain. Between the two methods of training I don’t train on more than 5 days a week to ensure I get 2 days of rest. Before I got the pain in my right hip I had the same pain in my left hip but not as bad and it went away after a couple of weeks of rest and hasn’t come back (not sure if that it relevant or not). I haven’t had anything like this before so seems strange to me that in a short space of time I get problems in both (albeit only recurring pain in one).

Is it just a case that I need to rest more, or is there something that I should be doing differently. Either way I’d really like to know what the cause of the problem is, how to prevent it and what to do when it happens.

I’m just at a good level of fitness and I’d really like to maintain it.

As a final thought on background info I’m 30.

Grateful for any pointers.

Thanks Jon

Jan 06th, 2016

The Guru Responded:

Hi Jon

 

We love BMF – and know all about the green tops!

 

It sounds as if you’ve got a functional, rather than structural FAI (femoral acetabular impingement) rather than anything amiss with the soft tissues. It why you can’t seem to poke it or rolling has very little affect.

 

FAI sounds slightly scary, but like most people with FAI the issue is not with your structural anatomy but rather what you do with your anatomy. What’s common is that you have too much joint play in your hip (this is not the same as too much range of hip joint motion) because you don’t move well enough elsewhere and so you hip is forced to accommodate. Your body cleverly detects that you’ve got too much joint play and tries to limit this excessive joint play motion by protectively stiffening up the muscles around the hip. This cases excessive compression through the hip and the surrounding structures – so any movement that further increases hip joint compression (hip flexion) will increase your discomfort.

 

Lots, if not all of your training appears to be strength orientated – I’m not sure you’re doing anything to improve the control of what you’re doing such as stability work….(good) Pilates is key.

 

You’ll feel like your doing nothing – no puffing, no panting, no sweating but I don’t reckon you’ll be much cop at it! You’ve got bags of strength, you’re got bags of endurance,  but you haven’t got great control of the movement you’ve got. You need this – rest won’t give you this and fitness has very little part to play in this either.

 

You essentially need to have the ability to move better, to have greater control of what you’ve got, to ensure that you use all of your joints optimally. There are lots of interesting, anecdotal correlations between thoracic spine motion, spinal posture and adverse hip mechanics – and you most likely fall into this pattern. There is loads that can be done – and lots of stuff that you need to do to prevent tissue overload.

 

The Guru

Six Physio

 

Jon thanks the Guru:

 

Thanks for your reply.

 

Is this a condition that can come on even after a number of years of no problems?

 

Are there any particular Pilates ‘moves’ that would help with FAI? I’m sure I won’t be that good at it, not only because my flexibility is non existant!

 

Thanks again.

 

The Guru has some more info:

 

Yes, absolutely.

 

There’s pretty much always a straw that breaks the camels back. No matter how much we want to “blame” a  particular incident, they just don’t (or very rarely) exist (or make much clinical sense!)

 

There are plenty of Pilates shapes that you can cut, but it’s not about the shape – it’s about how you cut it! This needs coaching. Start easy, get control, progress.

 

You lack of flexibility will be “stiff” muscles protecting mobile joints or “tight” muscles over stiff joints. One needs stretching, one needs retraining – got to do the right stuff to the right bit….

The Guru

 

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