Pain in glute on lockout of squats and deadlifts Pain in glute on lockout of squats and deadlifts

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Thread: Pain in glute on lockout of squats and deadlifts

  1. #1
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    Jan 2021
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    Default Pain in glute on lockout of squats and deadlifts

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    Hello

    I have been lifting for a few years but since August I have had a sharp pain in my right glute. I think this is over the piriformis. I also had tenderness over the gluteus medius.

    i first noticed this at the top of my deadlift, when the bar passes from the mid thigh to the actual lockout. i also get it when i go to lower the bar down. i don't get the pain on setup of the lift. Pain starts to happen at 50% of one rep max.

    i also get the pain as i am locking out my squats. i can go a bit heavier with these and pains starts at around 80% of 1 rep max.

    What i have done. I have seen a doctor (around 4 months ago) who thought it could be piriformis syndrome but did not know what was causing the piriformis to be irritated. I saw a physio who didn't know either and gave me clam shell exercises and side leg raises. At this point, i was having trouble sleeping as the pain was down my outer hip and my glute would ache all day. it would also hurt if i had been sitting. I saw a sports therapist who said that my lower back, glutes and hamstrings were solid from tightness. i have had a few sessions with him and the pain eased but if i tried to lift i would just get the shooting pain. Over Christmas i stopped deadlifting for a couple of weeks to see if that helped - it did not.

    i then spoke to a biomechanics specialist (unfortunately wasn't able to see him in person) who thought that it sounded like i had, had a tear or rupture to the gluteus medius or pirformis, that had now healed but i had scar tissue causing the pain. He advised foam rolling the area at least 3 times a day and a stretch for the glute. He thought it would ease up in the next 2-3 weeks but the pain is still there when i try to lift.

    I have started from the lowest weight on my lifts and tried to build up from there slowly but the pain is getting me at exactly the same weight as before.

    I am so frustrated by it. I am at the point where the pain is not there in daily life but if i then squat or deadlift BOOM there it is!

    I have read on the forums people who seem to have been experiencing a very similar sort of issue - @blowdpanis, @matt james, @Immortal_k, but i can't see that anyone has found a way to treat this? it just seems to be an issue which stays? Has anyone recovered from this? If so are you able to give me some advice on what you did? Thanks

  2. #2
    Join Date
    Aug 2010
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    Olympia, WA
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    Deebee,

    When you have consistently received poor analysis from individuals with whom you have consulted, you are kind of left on your own to develop a course of action for recovery.

    The first thing I would consider is this: if you go back to your original post, what ties each of these aggravating movements together? Maybe a better way of putting it is: what is the movement you are conducting where you feel the pain?

    Once you pin this down, then you can deduce what is the structure that is likely the source of the pain.

    I think the chance you have a piriformis rupture is almost beyond comprehension. I am only aware of instances where the piriformis was ruptured during a total hip arthroplasty and, I believe I read one case study of a piriformis being ruptured with a traumatic posterior hip dislocation. I have reviewed thousands of MRIs in my day-to-day job, and likely hundreds of hip and glute imaging studies. I have yet to ever see any radiographic evidence of trauma to the piriformis. At the very least, it is extraordinarily rare.....at least in my experience.

    Now, the opposite is true with respect to the gluteus medius. It's like the Oprah Winfrey Show......you have a partial tear of the GM, I have a partial tear of the GM...….everyone gets a partial tear of the GM. Partial tears of the Glute Medius make up about 80% of cases of Greater Trochanteric Pain Syndrome, and partial tears are found in an exceedingly high number of imaging studies, even when the person does not have clinically correlated symptoms in the area. I also find it interesting that a biomechanics expert would suggest foam rolling as a treatment to somehow change the quality of scar tissue. The idea that soft tissue work will have a positive impact on the quality of scar tissue is not currently supported by the literature, nor does the practical application of the knowledge of the histological make-up (at least in my miniscule amount of education) of scar tissue lead one to believe that this is a possibility. Unfortunately, I believe my profession has performed this service for so long, and has parroted this explanation for so long, that it is accepted as being truth when it is utterly preposterous. Soft tissue mobilization does not "break up scar tissue". That's my story until someone provides me with compelling evidence to the contrary.

    So, that leads me back to the original two questions. According to your post, it appears that pure hip extension is the aggravating movement, and it appears to be load dependent. Given the area of symptoms and the fact that pure hip extension is the aggravating activity, I think it makes sense to assume this is glute maximus in origin. The fact that rest has not made it better, foam rolling has not made it better, and it is load dependent makes me suspect very strongly this is a proximal glute max insertional tendinopathy. I bet if you really palpate along the course of the proximal insertion, you will find that it is more painful than expected. The pain referral for tendinopathy oftentimes refers into the muscle belly, and the distal insertion is on the gluteal tuberosity and the ITB which would explain why you have some pain on the lateral thigh.

  3. #3
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    Jan 2021
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    Thank you so much for your reply Will! I really appreciate you giving your time to help.

    Yes pure hip extension seems to be the aggravating movement and it is when i add load. As well as deadlift and squat lockout, i feel aching in the glute and my piriformis is triggered if i have done a long walk which has been on an incline.

    I palpated along the proximal insertion and yes it is sore/tender. i find the glute is more sore towards the top of the hip (iliac crest?).

    I have read about all sorts of methods of rehab e.g star but i am unsure what i should be doing? would you be able to point me in the direction of something which could help with my issue?

    thanks

  4. #4
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    Tempo work really seems to be more effective than most other treatments I have seen utilized. For this particular issue, if you were a patient in my clinic, I'd probably look at doing reverse hyperextensions, loaded with some band resistance, at a 3-1-2 tempo. Prior to squatting or deadlifting, I'd do some pure hip extension isometrics at 3 positions for about 5 reps of 3 second holds. Isometrics seem to be pretty effective at producing a short term analgesic effect on these types of injuries.

  5. #5
    Join Date
    May 2019
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    Since you called me out in the original post, I'll respond. Although I don't think our injuries are the same.

    My bilateral glute medius pain, especially at lockout, seems to have been aggravated by volume at high intensity. The solution (credit to Nick D'Agostino) has been limiting my heavy sets to triples, and carefully managing volume day loads. Although, it does pop up occasionally on my final sets when I'm more fatigued. Better form (i.e. eliminating excessive knee slide) has made my hips much happier overall too.

    My left hip pain, specifically, was related to a leg length discrepancy. The correct shim while lifting (but no shim in my everyday shoes, for whatever reason) has pretty much cleared this up.

    Echoing Dr. Morris, isometrics before and sometimes between sets, were very effective in allowing me to continue training when the pain was at its worst.
    Last edited by Matt James; 01-26-2021 at 08:48 AM. Reason: Spelling

  6. #6
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    Jan 2021
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    starting strength coach development program
    Thanks Matt. I have been finding that limiting to 3 reps also helps. Glad that you have found something which works

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