People who are experiencing hip and/or pelvic pain often struggle to know which gym exercises are best and which gym exercises they should avoid with hip pain. There is no single answer for everyone, but here we will provide some guidelines to assist you in finding a program that suits you and your hips best.
The first important message here is that for most gym exercises, it is not about “AVOIDING” exercises but about “MODIFYING” exercises to suit your body and the severity of your hip pain.
Movement is important. Motion is lotion! Stopping exercise altogether is rarely helpful and may in fact worsen things over time as you get slowly weaker. If your hips hurt during or after the gym, try modifying rather than stopping your exercise program altogether. You can modify your program not only through the exercises you chose, but also by altering how much weight you use, how long and how often you train for, and how many repetitions you complete. Controlling these ‘loads’ at the gym is an important part of the ‘load management’ component of rehabilitation for hip pain.
You might want to read more about the benefits of activity versus how rest and you know if you are doing too much or too little in this previous blog “I have hip pain – What is the best activity for hip pain or is rest best?”
Recovering from Gluteal Tendinopathy, Trochanteric Bursitis or GTPS
FIRST LESSON IS FREE!
Today’s blog is the first in a 2-part blog series. This blog will look at some key gym exercises that commonly irritate hip pain. The second blog (out next month) will look at ways you can modify exercises to reduce hip pain at or after the gym.
In this blog we will review some of the most common lower body gym exercises. We will explain:
At all times we strongly advise you discuss the suggestions in this blog with a Hip Pain Professional, someone who has a good understanding of managing hip conditions like yours and the rehabilitation you would be best to undertake to achieve your individual short and long-term goals.
The exercises we will pay particular attention to in this blog are:
Leg press is an exercise you might need to reconsider if you do this exercise regularly and experience aggravation of your hip pain during or after the gym. Leg press is an exercise performed in sitting on an incline, horizontal or supine leg press machine. The exercise is all about pressing out with the legs by straightening (extending) the knees, usually from a bent hip and knee position. It is maybe one of the best knee extension strengthening exercises and can also be great for strengthening the gluteal muscles, however the type of leg press machine you use when doing this exercise can vastly change the amount of bend required in the hips and knees and therefore the forces that are transmitted through these joints as well as the low back.
For those with hip pain, the incline leg press is often considered to be one of the most provocative forms of the leg press exercise. This is due to the high amounts of flexion range that the hip is having to travel through during this exercise. Even from the start position with the knees fully straightened, the hips are at 90° flexion (thighs at right angles to the body). As the knees bend and travel towards the chest, the hips need to bend to their maximal or near-maximal point People with certain hip conditions and shapes of their hip bones may be at risk of pain aggravation or injury with this type of exercise, particularly when performed with high weights, speed, and/or repetitions.
Some people experience a flare up after a single session of leg press, but often the irritation is cumulative – the more you do, the more irritated the hip becomes over time.
Deep hip flexion (positions where the knee is close to the chest) can be irritating for hip pain due to high compression of structures at the front of the hip and traction or stretch at the back of the hip. In this position, the labrum – the fibrous cartilage that sits around the edge of the hip socket, and sometimes muscles at the front of the hip can be repeatedly over-compressed or ‘pinched’. A little of this type of force is usually tolerated but if repeated and performed with high weights, it can be very provocative for these structures.
At the back of the hip, the opposite situation is occurring, the fibrous capsule of the back of the hip joint is on high stretch. For most people this is fine, but for some people with less bony or capsular support at the back of the hip, the hip may not tolerate very much of this type of exercise. With less bony and capsular support, the deep muscles at the back of the hip may need to work much harder in deep hip flexion. This in turn may irritate the neighbouring sciatic nerve deep in the buttock.
For other people who might have muscle or tendon conditions at the hip, pushing against a large weight from that super-flexed position is hard work and can irritate relatively weak muscles or tendons. Exercising in middle ranges is easier and better tolerated initially than exercises that move through the extremes of range.
Below we list some of the key hip conditions that may be aggravated by leg press. Please note that not everyone with these conditions will have difficulty with leg press but having one of these conditions may increase the likelihood that your pain is aggravated by leg press. Exercise type, technique and equipment selection should be optimised for each specific person. Getting the help of a Hip Pain Professional can be extremely useful in providing individualised advice as to the gym exercise you should avoid for hip pain both in the short and long term.
Conditions that may be aggravated by leg press include:
Recovering from Gluteal Tendinopathy, Trochanteric Bursitis or GTPS
FIRST LESSON IS FREE!
As discussed for pain at the front of the hip, this list of conditions is a general guideline only.
Conditions that may be aggravated by leg press include:
Deadlifts are often discussed in relation to back pain but overlooked when it comes to hip and pelvic pain. A deadlift requires that you lift a weight using multiple, large muscle groups. Deadlifts are good for strengthening the back of the upper thigh, hip and trunk. They are performed with a “hip hinge” type of movement and as such can put a lot of demand of the hip and pelvic region.
Once again, deep hip flexion can irritate pain at the front of the hip due to compression of structures at the front of the hip. This is most likely in traditional lifts from the floor, where the hips are more bent – thighs closer to the body.
For those that have limited hip bend due to hip stiffness or hamstring tightness in the back of the thigh, a compensatory technique can be to tilt the pelvis backward and bend the back more. For some people with back pain this may be irritating but this is a very individual thing, and some will be more irritated by a super-extended back position during deadlift.
The front of the hip may also be irritated at the other end of the movement, as the back, hips and knees fully straighten. Over straightening (extending) the hip in this position can result in greater forces through the front of the joint which in turn may result in an exacerbation of pain at the front of the hip. Many trainers encourage a “hip thrust” forward at the end, exaggerating this movement, potentially further aggravating pain for those at risk of this type of problem.
As discussed in leg press, deep flexion positions can also overload and aggravate the back of the hip joint, the muscles that support the back of the hip and the neighbouring sciatic nerve. In addition, the hamstring tendons may be overloaded in the deadlift. At the bottom of the lift with the hips bent and knees relatively straighter, the hamstrings muscles at the back of the thigh will be on stretch and the tendons wrap around the back of the sitting bones (ischial tuberosities). For those with hamstring tendinopathy, this combination of compression of the tendon against the underlying bone and strong hamstring muscle contraction can be very aggravating.
Conditions linked with pain at the front of the hip may be irritated at the bottom of the deadlift (impingement) or hip thrusting at the top of the lift (hyper-extension).
Conditions that may be aggravated by deadlifts include:
Compared to squat technique, the hip hinge action of the deadlift places higher loads on the hip and lower loads on the knee. In terms of targeted strengthening of the extensor muscles of the back of the hip, the gluteus maximus, hamstrings and adductor magnus (large inner thigh muscle), this can be very beneficial. However, in some situations this increased load may result in an irritation of pain.
Conditions that may be aggravated by deadlifts include:
The Rear Foot Elevated Split Squat or Bulgarian Split Squat is another exercise to consider when thinking about gym exercises to modify to reduce hip pain. This exercise is basically a single leg squat with the other foot resting on a bench or box behind. The exercise is often performed holding free weights, using a weighted bar or in a Smiths machine.
The Rear Foot Elevated Split Squat or Bulgarian Split Squat can irritate either the front or back hip or the pelvis for different reasons. As we have just discussed above for leg press, deep hip flexion (knee close the chest) can, for some people, result in irritating impingement or compression of the structures at the front of the hip. The gluteal muscles at the back and side of the front hip are also working very hard in this exercise. Weak muscles or painful tendons may not tolerate a hard workout in this exercise.
On the side of the back leg, the front of the hip and thigh is often on a lot of stretch. Both the ligaments at the front of the hip joint and the muscles and tendons that cross the front of the hip and thigh are on stretch. The muscles can also be working really hard at the bottom of the squat. The further you are away from the bench or box and the lower you squat, the higher the forces at the front of the hip and thigh.
Not only hip pain but pelvic and groin pain can also be irritated by the Bulgarian Split Squat. This is due to the ‘split’ position – one leg forward and one leg back. This places twisting forces across the pelvis, loading the sacroiliac joints either side of the sacrum (tailbone) at the back of the pelvis and the pubic joint at the front of the pelvis. The ligaments of the pelvis are very strong, so this is usually only a problem for people with pre-existing pelvic conditions. The groin muscles supporting the front of the pelvis may also be overloaded with certain techniques and usually when muscle strength and control is not ideal around the hips and pelvis.
While not everyone with the conditions below will experience aggravation of symptoms with this exercise, consider modifying the exercise if you are having difficulty at or after the gym.
Conditions that may be aggravated by Rear Foot Elevated Split Squats include:
The potential for exacerbation of hip pain on the back leg, or elevated leg side, is usually dependent on the degree of hip extension (how far back the leg is placed) and how much work this side is doing – some people overpush through the back leg. In the rear foot elevated split squat, the shoulder, hip and back knee should remain in a fairly straight line.
Conditions that may be aggravated by Rear Foot Elevated Split Squats include:
This is an exercise that can be problematic for pregnant women, particularly later in pregnancy when the pelvic joints become more mobile. Modifications are usually required as the pregnancy progresses.
Conditions that may be aggravated by Rear Foot Elevated Split Squats include:
Recovering from Gluteal Tendinopathy, Trochanteric Bursitis or GTPS
FIRST LESSON IS FREE!
Many people jump on the bike as part of general fitness, but also as an alternative to walking or running should these activities irritate an issue. Reclined bikes are often touted as being the better option when injured – but this is more usually only specific to back injuries. In fact for hips, a more upright bike may be the better option.
The reclined or recumbent bikes particularly tend to move the hips into more flexion (thighs come closer to the chest) than an upright bike. On an upright bike, a low seat or if the handlebars are too far forward or you tend to lean forward a lot while cycling, the high hip flexion can also result in irritating compression at the front of the hips for some people.
Cycling technique can also have an impact. If the knees tend to drop in, or if you do a spin class and come out of the saddle and shift your pelvis excessively side to side, this can also irritate gluteal tendon pain at the side of the hips.
With all bikes be aware of pressure pain resulting from the seat – this can often exacerbate issues in the lower and upper buttock regions and the saddle region.
Conditions that may be aggravated by stationary cycling include:
Conditions that may be aggravated by stationary cycling include:
Pain at the back of the hip may occur with high hip flexion with a recumbent bike or upright bike leaning forward. On an upright bike, reaching to the pedals due to a seat that’s too high, while also leaning forward may irritate the hamstring tendons and/or the sciatic nerve.
Conditions that may be aggravated by stationary cycling include:
The pressure of sitting for prolonged periods cycling may irritate the saddle region, either at the front when cycling on an upright bike leaning forward, or at the back of the saddle region more commonly when cycling on a recumbent bike.
Conditions that may be aggravated by stationary cycling include:
Treadmill walking can for some people be more irritating for those with hip pain that walking outside. Speed, stride length, heaviness of impact and the incline may need to be considered and modified if your hip pain is being irritated by walking or running on a treadmill. We have previously written a blog with some great tips for modifying walking and running, “3 Simple Strategies to Reduce Hip Pain with Walking and Running”. Head to this blog for further information – click here to read more.
In answer to the question “Which gym exercises should I avoid for hip pain”, we hope this blog has provided you with helpful information. This is a general guide only and with any uncertainties or if pain persists then make sure you get the help of a Hip Pain Professional someone that knows hips. And don’t forget, don’t stop, it’s not about avoiding exercise but modifying your exercise to what your body can manage at the moment and then gradually working to improve your physical capacity. Make sure you visit next month for our follow up blog where we provide more details on ways to modify these gym exercises for hip pain. Sign up to our newsletter and we’ll let you know when it’s published.
Recovering from Gluteal Tendinopathy, Trochanteric Bursitis or GTPS
FIRST LESSON IS FREE!
Can stretching Make Hip Pain Worse? In this blog we will provide you with a summary of the areas and types of hip pain that may be made worse by stretching. Understand which hip stretches
Top Tips for Hip Pain Relief Sitting, when Socialising or Travelling Learn ideas for how you might reduce your pain when sitting, a position you need for doing so much in life.
Top Tips on Hip Pain Relief Sleeping – Learn How Sleep is essential for wellbeing. Yet hip and pelvic pain can leave you struggling to find a comfortable position – we will help you with a few simple ideas.
I have hip pain – What is the best activity for hip pain or is rest best? In this blog we will discuss how much you are doing of something and is that too much or too little!
3 Simple Strategies to Reduce Hip Pain with Walking and Running In this blog we share 3 simple strategies to reduce pain when running or walking that we find helpful for people with many different hip conditions
References
Authors
This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.
Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.
Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.
