8 years ago I wrote a blog post about a hip condition that I had been recently diagnosed with. I was just starting off in the fitness industry and I was also on my own voyage of personal discovery with regards to my own fitness.
Although I had been weight training for a few years already, I had very limited exposure to the barbell movements. I had played around with squats and deadlifts, but I had no idea what I was doing. Plus this was really before the point where you could easily find good information online on how to do anything. So as a result I was more or less on my own and the results were less than impressive.
The discovery of http://www.crossfit.com around 2005 really changed my life. Not only were the workouts cool, the site was full of fantastic information on how to correctly execute movements like the squat and deadlift. Nobody else was putting out information like this and I found it to be an absolute goldmine for my own training.
After watching lots of videos and reading articles on crossfit.com, it quickly dawned on me that me that I was unable to do certain movements, like the squat or deadlift with good form. I would video myself and every time my back would round in the bottom position of both movements. I assumed this was down to poor motor control or mobility, so I spent lots of time searching for solutions to these issues. Unfortunately nothing I found made any difference. I thought that there would be 1 key cue or stretch that I would implement and fix everything. Needless to say that proved to be a wildly inaccurate assumption!
Eventually I saw a physiotherapist who examined me and said that she thought something was wrong with my hips and I should get an x-ray. I had the x-ray and was diagnosed with a coxa profunda.
I won’t go into details again and you can read the original blog post here. To my surprise quite a few people read and commented on the post. It seemed that many other people have been given the same diagnosis and subsequently went online looking for help. In fact, people still comment fairly regularly now on the post, which was written 8 years ago. I suppose this is due to the fact that there is just not that much info out there on this particular topic.
So 8 years later, I thought I would write an update on how I am dealing with this issue. Let me be very clear that I am just offering my own personal experience and this should be taken in no way as medical advice for how to treat your own problems.
Even for those reading who don’t have a coxa profunda, hopefully this article provides some ideas on how to train around physical limitations. Having trained people for 10 years now, it is my experience that almost everyone is dealing with some kind of limitation. It might be temporary (like an injury) or chronic, but the point is that it should not be seen as a major setback. It is simply an opportunity to learn about what works best for the individual.
When I was diagnosed I was told that at some point I would need to get my hips replaced. It was a question of when, not if. I was also told not to do any weight bearing exercise and only focus on swimming or cycling or take glucosamine. Suffice to say that I found this advice less than useful and proceeded to ignore it completely.
As an aside, I do understand that doctors need to cover themselves when patients ask “can I do this”. Dr Smith tells young Johnny that deadlifting is fine. Young Johnny then goes and blows his back out by doing deadlifts with the worst form imaginable. Who gets the blame? Why Dr Smith of course because he said it would be ok! Doctors can’t be responsible for how their patients put their advice into practice, nonetheless it can be very frustrating when the advice is basically to do nothing.
So I was prepared to be told that I would not be able to strength train any more and that did not worry me. My strategy was simply to find a way to modify movements so I could do them with good form and try to learn about and work on mobility as much as possible. I felt that as long as I took things easy and had a smart approach, I would do way more good than harm. I also had a phone call with Kelly Starrett (which I wrote about here) and he confirmed that I was on the right track with my thinking. Kelly is one of fitness heroes and his teaching has had a massive effect on everything I do. So to get that confirmation from him was a huge motivator for me.
8 years later, my strategy has not really changed and it has borne fruit. I try to avoid any movements that put me into a compromised range of motion at the hip. Unfortunately this meant that many of the main movements in CrossFit had to be adapted. Back squats, deadlifts, cleans, snatches, wall balls were all difficult for me. As a result, I just changed them to movements I could control. So for example I primarily use the trap bar when I deadlift. I sub in the hang versions of the clean and snatch. I do front squats instead of back squats. I don’t do any running, but that is because I fucking hate running and not because I fear injury!
My main fear when I went back to training was injury. I herniated discs in my back when I was younger due to the lack of mobility in my hips, and that was I place where I never wanted to go back. I am happy to report that over the last 8 years I have been pretty much injury free. I have had an issue with my right ankle which I believe is linked to my coxa profunda. It flares up every now and again but other than that I have not had any major injuries.
I try to set myself regular training goals which usually feature doing some kind of competition where I can test myself. I am now confident enough to realise that if I want to do a competition which involves compromised movements, I do it. If 90% of my training is controlled, I have no problem doing some “crazy” stuff 10% of the time and this has worked for me
So in terms of training I think I have done a pretty good job. I also mentioned that I wanted to work on mobility and this has not been as successful. I still do a decent amount of mobility work, particularly pre-training but nowhere near as much as I should. The simple reason for this is laziness. Mobility work is boring and painful and I hate doing it so I try to get away with the bare minimum.
On the flip side, I have definitely noticed that my hips are getting more fragile. This may also be due to age (I am 42 and have certainly noticed that recovery from training is not like it was 10 years ago) but there is no question now that if I do something hard on the hips, I pay a price. For example, if I do a competition, or play a random game of football, or do too many sets/reps of a movement which is tough for me (especially the squat), I pay a price. And that price is hip pain, particularly in the night and particularly when I lie down in bed. It can get to the point where I wake up in the night and have trouble getting back to sleep due to the pain. However, I can largely manage this with training volume (limiting how many sets and reps of lower body movements I use) and by using a Compex.
I came across Compex, which is an electro muscle stimulator a few years ago. It has become a popular recovery tool in the fitness world so I figured it would be worth a try. I bought a second hand machine and began to use it and the results were fantastic. I found that if I used it on my quads after training, I had no hip pain at all in the night. Suffice to say I upgraded to the wireless machine and although it is not cheap, for me it is worth every penny.
Overall the pain is a bummer, but it also keeps me very honest and stops me from doing dumb shit.
I don’t know where I will be in 10 years time. My goal remains the same. I want to carry on training, compete every now and then in strongman or CrossFit (if I can) and stay pain free. I don’t particularly fear getting my hips replaced. In fact I am probably secretly excited about getting hips that actually work properly! However, I do want to put it off for as long as possible, and more importantly I want to be able to handle my own shit. I don’t want to be reliant on medical professionals to understand and take care of my own issues.
I guess that is my final point. Everyone is dealing with something from light knee pain to really serious chronic conditions. Ultimately we all have ownership of our own issues and that means it is up to use to deal with them. I will always be able to handle my issues better than a doctor because I am far more invested in the process and the results. I don’t think we should fear these things, but use them as an opportunity to learn and get better.