Question on Squat

[GesD]

Dear Coach Rip,

Last year I started doing Starting Strength and lasted on the novice phase for about 5 months. My best numbers were: Squat 275, Deadlift 340, Bench Press 185, Press 125. However, towards the end I began to develop a sort of pinching pain in the left side of my hip where my femur meets my acetabulum everytime I squatted. It really didn't affect the deadlift because of the hip angle.
So, I went and took an MRI and everything checked out fine. The pain still didnt go away so I then I took an X-ray. The doc referred me to an orthopedic doctor. The ortho doc told me I had this condition called FAI, short for Femoral Acetabular Impingement. He basically told me that when I squat the head of the femur abnormally rubs in the joint causing excessive friction and in turn a pinching pain. Long story short he told me not to squat and take 6 months off from lifting. Also, that when I start again be sure to Leg Press instead of Squat.
Now 6 months later I restarted the novice phase substituting leg press for squats and have progessed rather well. I currently leg press 635 after two months back, but really want to get back into squatting because coach there is really no substitute for them. I was really pissed when he told me not to do them because they were what I looked forward to everytime I got to the gym. My goal is to Squat 495lb and I got cut off only halfway there.
If you could me any advice coach because lifting has become my life I want to become a C.S.C.S and not only train adults, but children as well and teach them the correct ways to execute all the basic barbell lifts.
How should I go about trying to incorporate the squats again, and also now that im pretty far along in the novice phase what do I do when I have to switch the other lifts into the intermediate phase? Do I keep squatting for linear progress every workout while i vary the other lifts from a workout to workout basis to the weekly basis.

Thanks again,
Dave

[Mark Rippetoe]

It is important to know the basis for the FAI diagnosis. Was it something he saw on the film or the MRI, or did he just pull this out of his ass? You may have to ask for clarification, and that may be hard to obtain. In any case I'd try to squat, and modify the stance angle and width until the impingement -- if that's actually what it is -- is relieved.

[GesD]

Dear Coach,

He observed it from the X-ray. How do you think I should work the squats back into the program? Should I slowly phase out the leg press or drop it completely? Also, for putting the squats back in should I just warm up to a weight where the bar speeds slowly noticable and linearly progress up from there?

Thanks again,
Dave

[Mark Rippetoe]

Just start back and work up in a linear fashion like you did the first time. But this time the progression proceed faster. Remember that you're going to have to adjust your stance and knee position to find a pain-free position. It is odd that leg presses do not hurt. Is this actually true?

[Steve in ATL]

It is important to know the basis for the FAI diagnosis. Was it something he saw on the film or the MRI, or did he just pull this out of his ass? You may have to ask for clarification, and that may be hard to obtain. In any case I'd try to squat, and modify the stance angle and width until the impingement -- if that's actually what it is -- is relieved.


Rip,

If you recall I went through this exact problem last winter. Osteophytes on the femoral neck of each leg and all, along with (minor) torn labrae in the hips.

I will reiterate what I said before: the single most important cue (for me) for relief of the pain was "KNEES OUT." The OP's mileage may vary, But I suggest that he have more rigorous work-up. The gold standard for diagnosing these impingement / labral tear issues is a CT scan with dye injected into the hip. They mix (lidocaine? Novocaine? not sure which) into the injected dye, and have the patient do some range-of-motion exercises in the 15-20 minutes after. If the pain is relieved, and the CT scan confirms, then you have your diagnosis.


Just start back and work up in a linear fashion like to did the first time. But this time the progression proceed faster. Remember that you're going to have to adjust your stance and knee position to find a pain-free position. It is odd that leg presses do not hurt. Is this actually true?

I've noticed that a lot of people, when they leg press, tend to allow their lower back to round slightly. This is easy to do as the entire back is supported rather than having an unforgiving metric fuckton of weight on your shoulders. In so doing, this would allow the trainee to prevent the hip joint from closing to the degree that it does on a properly executed squat, from my observation.

[Mark Rippetoe]

I remembered that one of you guys had written about it before. Thanks for reminding me, and for your input.