Hip Pain During Squats and Deadlifts? Why Your Glutes Need a PT Check

You're mid-set on squats or deadlifts when you feel it: a pinching sensation deep in the front of your hip, or a dull ache on the outside. You adjust your stance, try to "stretch it out" between sets, but the pain keeps returning. By the end of your workout, your hip feels stiff and irritated.

If this sounds familiar, you're not alone. Hip pain during lifting is one of the most common complaints we see at Nashville Physical Therapy & Performance as people ramp up spring training. And while the pain might feel like it's coming from your hip joint, the real problem is usually a few inches away: weak or poorly functioning glutes.

Let's talk about why hip pain happens during squats and deadlifts, why your glutes are likely the culprit, and what you can do about it. Hip Pain During Squats and Deadlifts? Why Your Glutes Need a PT Check:

The Two Types of Hip Pain During Lifting

Hip pain during squats and deadlifts typically presents in one of two ways, and distinguishing between them helps identify the cause:

Anterior Hip Pain (Front of the Hip)

This feels like pinching, catching, or sharp pain deep in the hip crease, especially at the bottom of a squat or when you hinge forward. It's often worse with deeper ranges of motion.

Common causes: Hip flexor tendinopathy, femoral acetabular impingement (FAI), labral issues, or compensatory overload from poor glute activation.

Lateral Hip Pain (Outside of the Hip)

This feels like a dull ache or burning on the outside of your hip, often radiating toward your buttock or outer thigh. It may be worse when standing on one leg or when pressing through the movement.

Common causes: Gluteus medius tendinopathy, trochanteric bursitis, or IT band tension from weak hip stabilizers.

While these present differently, they often share a common root cause: your glutes aren't doing their job, forcing other structures to compensate and become overloaded.

Why Glute Dysfunction Causes Hip Pain

Your glutes (gluteus maximus, medius, and minimus) are the largest, most powerful muscle group in your body. They're responsible for hip extension (driving your hips forward), hip abduction (moving your leg away from your body), and hip external rotation (turning your leg outward).

During squats and deadlifts, your glutes should be primary movers. But when they're weak, inhibited, or not firing properly, other structures have to pick up the slack:

Scenario 1: Weak Glutes During Squats

When you squat, your glutes should control hip flexion on the way down and drive hip extension on the way up. If they're weak, your hip flexors work overtime to stabilize your pelvis, leading to overload and anterior hip pain. Your lower back may also compensate, increasing injury risk there too.

Scenario 2: Poor Glute Medius Function

Your gluteus medius stabilizes your pelvis during single-leg loading. Every time you shift weight onto one leg during a squat or deadlift, glute medius prevents your pelvis from dropping to the opposite side. When it's weak, your hip joint experiences abnormal stress, your IT band and lateral hip structures become overloaded, and you develop lateral hip pain.

Research published in the Journal of Orthopaedic & Sports Physical Therapy found that individuals with hip pain during squatting had significantly reduced glute activation compared to pain-free controls.[^1] Fix the glute activation, and the hip pain often resolves.

The Self-Assessment: Are Your Glutes the Problem?

Try these three tests to assess whether weak or dysfunctional glutes are contributing to your hip pain:

Test 1: Single-Leg Bridge

Lie on your back, one knee bent with foot flat on the ground, the other leg extended straight. Press through your planted foot to lift your hips, keeping your pelvis level. Hold for 5 seconds. Do 10 reps per side.

What to look for: Can you complete 10 reps without cramping in your hamstring? Does your pelvis stay level, or does one side drop? Do you feel your glute working, or mostly your hamstring and lower back?

If you cramp, your pelvis tilts, or you don't feel your glute, you have weak glute max activation.

Test 2: Single-Leg Stand

Stand on one leg for 30 seconds. Watch yourself in a mirror or have someone observe you.

What to look for: Does your pelvis drop on the non-stance side? Does your hip shift far to the side? Do you feel your lateral hip working hard to maintain position?

If your pelvis drops or shifts excessively, you have weak glute medius function.

Test 3: The Squat Test

Perform 10 bodyweight squats while watching yourself in a mirror or recording yourself from the front.

What to look for: Do your knees cave inward during the squat? Do you feel hip pinching at the bottom? Does one hip feel like it's working harder than the other?

Knees caving inward indicates weak hip external rotators and glute medius. Hip pinching suggests poor glute activation allowing excessive anterior hip compression.

The Most Common Lifting Technique Errors That Overload the Hip

Even if your glutes are reasonably strong, poor technique can prevent them from working properly and shift load to your hip joint:

Error 1: Narrow Stance Squatting

If your feet are too close together, your hip has to flex more deeply at the bottom of the squat, increasing anterior hip compression. Additionally, a narrow stance makes it harder for your glutes to contribute to the movement.

Fix: Experiment with a shoulder-width or slightly wider stance with toes turned out 15-30 degrees. This allows your hips to move into the space between your legs rather than compressing at the front of the joint.

Error 2: Pushing Knees Too Far Forward

While some forward knee travel is normal and healthy, excessive forward knee movement shifts the load to your quads and reduces glute involvement. This often causes anterior hip pinching.

Fix: Think "hips back" as you initiate the squat. Imagine sitting into a chair behind you. This loads your glutes and reduces excessive hip flexion.

Error 3: Not Creating External Rotation Torque

Many lifters simply stand and squat straight down. But creating outward rotational force at your hips ("spreading the floor apart" with your feet) activates your glutes and creates hip stability.

Fix: As you squat, imagine trying to twist your feet away from each other (though they won't actually move). This creates external rotation torque and activates your glutes throughout the movement.

Error 4: Deadlifting With All Lower Back, No Hip Drive

Many people perform deadlifts by extending their spine rather than driving their hips forward. This shifts load away from the glutes and onto the lower back and anterior hip.

Fix: Think about aggressively squeezing your glutes and driving your hips forward into the bar. The movement should finish with strong glute contraction, not by leaning back.

Exercises to Activate and Strengthen Your Glutes

Before you can expect your glutes to work properly during heavy lifting, you need to ensure they can activate correctly. Here are four essential exercises:

1. Glute Bridge with Band Around Knees

Lie on your back, knees bent, feet flat on ground. Place a resistance band around your knees. Press your knees outward against the band while lifting your hips. Hold at the top for 2 seconds, squeezing your glutes hard. Lower slowly.

Why it works: Teaches glute max activation while simultaneously activating glute medius through the external rotation component.

2. Clamshells

Lie on your side with knees bent at 90 degrees. Keep your feet together and lift your top knee toward the ceiling, maintaining hip and core stability. Lower slowly.

Why it works: Isolates and strengthens glute medius without compensation from larger muscle groups.

3. Single-Leg Romanian Deadlift

Stand on one leg. Hinge at the hip, reaching your hand toward the ground while extending the other leg behind you. Feel the stretch in your hamstring. Return to standing by squeezing your glute.

Why it works: Builds single-leg stability, glute max strength, and improves balance simultaneously. Highly functional for lifting and sports.

4. Monster Walks

Place a resistance band around your ankles. Maintain a slight squat. Walk forward, backward, and laterally while maintaining tension on the band and preventing your knees from caving inward.

Why it works: Trains glute medius in a functional, weight-bearing position similar to actual lifting demands.

Do these exercises daily for 2 weeks before heavy lifting sessions. Most people notice significant improvement in hip pain and lifting performance within this timeframe.

Modifying Your Lifts While You Build Glute Strength

You don't have to stop squatting and deadlifting entirely while addressing glute weakness, but you do need to modify intelligently:

Reduce Depth Temporarily: If full-depth squats cause pinching, squat to a box at parallel or slightly above. This reduces hip flexion demands while allowing you to continue loading the pattern.

Reduce Load by 20-30%: Use this opportunity to focus on perfect technique with lighter weight. Groove proper movement patterns while your glutes build strength.

Add Tempo Work: Slow down your reps. A 3-second descent and 1-second pause at the bottom forces your glutes to work harder and teaches better control.

Prioritize Unilateral Work: Bulgarian split squats, step-ups, and single-leg deadlifts require more glute activation and can actually be therapeutic while you're rehabilitating hip pain.

Warm Up Glutes First: Before any lower body lifting, perform 2-3 sets of glute activation exercises. This "wakes up" the glutes and ensures they're firing during your main lifts.

When Hip Pain Needs Professional Evaluation

Most hip pain related to weak glutes improves within 3-4 weeks of consistent activation work and technique modifications. However, seek evaluation if:

• Pain is sharp, catching, or causes your hip to "give out"

• Symptoms worsen despite modifications and strengthening

• You have limited hip range of motion in multiple directions

• Pain is present during daily activities, not just lifting

• You're unsure if you're performing exercises correctly
  

At Nashville Physical Therapy & Performance, we specialize in assessing movement quality in lifters and athletes. A comprehensive hip evaluation includes strength testing, range of motion assessment, movement analysis during squats and deadlifts, and identification of specific weak links in your kinetic chain.

We can determine whether your hip pain is truly a glute activation issue or if there are other factors (hip joint pathology, mobility restrictions, motor control deficits) that need to be addressed.

Hip Pain During Squats and Deadlifts: Getting Back to Pain-Free Lifting

Hip pain during squats and deadlifts doesn't have to end your strength training goals. In most cases, it's a signal that your movement strategy needs adjustment and your glutes need targeted strengthening.

Start with the self-assessment tests. If you identified glute weakness, commit to the activation exercises for 2-3 weeks. Make the suggested technique modifications. Be patient with reduced loads while you rebuild proper movement patterns.

Your glutes are capable of incredible force production, but only if they're properly trained and integrated into your lifting movements. Invest the time now, and you'll lift stronger and pain-free for years to come.

Hip pain limiting your lifting? Schedule a movement assessment at Nashville Physical Therapy & Performance. We'll evaluate your squat and deadlift mechanics, test your glute strength, and create a personalized plan to get you back to pain-free lifting. Call us at 615-428-9213 or book online at nashvillept.com.

References

[^1]: Souza RB, Powers CM. Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(1):12-19.