written by: Dr. Jackie Ruggiero DPT
How to Improve Hip Mobility in a Deep Squat
Hi guys! This week we talked about anterior hip pain in a deep squat. One of the most common reasons behind a
complaint of “pinching” in the front of the groin is femoroacetabular impingemnt (FAI). This common hip injury
can stem from immobility, poor technique, instability, or bony abnormalities. In order to understand why you have
pain, let’s discuss the complexity of the hip joint.
Let’s Talk Anatomy
The hip joint consists of the convex head of the femur, sitting in the concave surface of the acetabulum. During a
squat, the femur rotates inside the acetabulum and the hip flexes an average of 95°
1. Hip impingement occurs when the head of the femur pinches against the rim of the acetabulum during hip flexion. This can occur for a number of
reasons ranging from the natural alignment of your femur in the hip socket to weak hip abductors leading to
excessive hip internal rotation. The femur bone has a normal degree of forward rotation, called femoral anteversion, of about 15°
2. Now let’s try something… take a few steps in place and then stand comfortably. Where do your toes point… straight ahead,
slightly pointed out, or slightly pointed in? Normal positioning would show your feet slightly “toeing out” about
15°. Femoral retroversion, or “duck feet”, is excessive out-toeing or outward rotation of the femur. This position
puts increased pressure on the front of the hip joint, leading to hip impingement.
3. How to Screen for Hip Impingement:
To test if this is the reason for YOUR pain, lets perform a few screens. A test that can easily be performed with the
help of a friend is called the Craig’s Test. This test assesses for the presence of femoral anteversion or retroversion.
First, lay on your stomach on the floor with your knees bent to 90°. Next, have a friend feel for the bony part of the
femur on the side of your hip while rotating your lower leg in and out with their other hand. Have your friend feel
for when the bony part of the femur becomes the most prominent and hold that position. A normal test would have
the lower leg pointed slightly away from the body. If the lower leg is positioned vertically or slightly toward the
body, this results in femoral retroversion.
Another test to assess femoral retroversion is called the Impingement Test, which further assesses the position of the
hip joint. First, lay on your back and have a friend bring your knee toward your chest. Check to see if you have a
“pinched or blocked” sensation as your hip is flexed. Next, have your friend bring your leg toward your chest, but
allow the leg to come out toward the side into abduction and external rotation. Is the pinching or blocked sensation
gone? This results in a positive test for femoral retroversion leading to hip impingement.
Ways to Improve Hip Pain
- Mobilize with posterior and inferior capsules
- Foam roll
Banded Hip Mobilizations
Banded hip mobilizations assist the way the femur glides in the acetabulum. During a squat the head of the femur
glides posterior in the hip socket, therefore when you mobilize the hip the band must pull posterior, or toward the
inside of your groin. The angle of pull of the band should be behind and slightly lower than the position of your hip.
Hold this position for 20 seconds and repeat these 5 times while also leaning your body forward.
Foam rolling is a great way to decrease restriction in soft tissue. To improve a deep squat and address hip
impingement, it is important to foam roll the hip flexors, quads, ITB, hip abductors, and glutes. This is performed by
laying on the foam roller and slowly moving back and forth over the affected area. Each muscle group should take
about 2 minutes, while also focusing on tender areas.
Stretching is an additional way to decrease restriction in tight muscles and improve joint mobility. The first stretch
to address is the hip flexors in a half kneeling position. With the affected knee on the ground, lean forward to stretch
the front of the hip, while simultaneously activating your glute by squeezing your butt muscles. Next, the pigeon
stretch is used to address tightness of the posterior capsule. Place the affected leg on the ground with your knee bent,
while having your opposite leg straight behind you. Lean forward so that your chest is flat on the ground and hold
this position for 30 seconds and repeat 3 times.
Finally, the best way to open the hips is with a stretch called “World’s Greatest”. Start in a deep lunge position with your affected leg forward and move toward the floor. Next, drop your opposite elbow to the ground and rotate your upper body toward the ceiling.
I hope I was able to provide everyone with some tools to help improve your ability to squat and understand YOUR
anatomy. Don’t forget to incorporate these hip mobility exercises into your routine!
Keep on moving,
Dr. Jacqueline Ruggiero, PT, DPT
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Satpathy J, Kannan A, Owen JR, et al. Hip contact stress and femoral neck retroversion: a biomechanical
study to evaluate implication of femoracetabular impingement. Journal of Hip Preservation Surgery.