Hip Impingement (Part 1)

Have you ever felt a pinching deep in the front of your hip?

It may be more noticeable in specific positions, like when you get into your car or at the bottom of a squat. Sometimes you might feel it refer into your groin or upper thigh?

What you might be experiencing is what we call hip impingement. It’s more fancy complicated name is femoroacetabular impingement, shortened to FAI.

WHAT IS IMPINGEMENT?

Let’s break it down and first take a look at the anatomy. The hip is a ball and socket joint. Normally the ball (head of the femur) smoothly slides & moves around the socket (acetabulum). With hip impingement this relationship gets disrupted, and for a medley of reasons, there is abnormal contact between the ball and socket.  Over time this can damage the joint itself, the labrum (a ring of cartilage that makes the socket deeper) or can put pressure on surrounding soft tissues. These are the things that end up resulting in the pain & dysfunction associated with impingement.

WHY?

Hip Impingement can occur for a number of reasons:

  1. Your body morphology: You can totally blame mum & dad for this one. Basically the way your skeleton developed can place you at greater risk of suffering hip impingement. There are two scenarios. A pincer lesion occurs when there is a bony abnormality in the acetabulum, for example your socket may be deeper that normal. A Cam lesion occurs when your femoral head is not round and can’t rotate smoothly around in the socket. It’s not uncommon to see a combination of both Cam & Pincer lesions. You can still work on surrounding soft tissues, improve joint mobility and muscle activation to help combat the symptoms of impingement – however structurally the underlying cause may be out of your hands.
  2. Tight Hip Muscles: If you have super tight glutes, TFL and other hip muscles this can place you at an increased risk of FAI. Targeted releases & mobility work to loosen overactive muscles can unload the area and improve impingement symptoms.
  3. Muscle Strength & Activation: If you’re getting the pinch at the bottom of a squat it may simply be the way you’re squatting. Technique is important especially if you have a pre-disposition for impingement. Correcting inefficient motor patterns & strengthening weak areas can go a long way at reducing impingement related pain.

SYMPTOMS

The symptoms for FAI can vary significantly from person to person. Pain at the front of your hip that can extend either into the groin or the top of the thigh is the most common presentation. Traditionally pain will be sharper pain with certain movements, most likely hip flexion (think knee to chest) combined with rotation. In a sportsmen often repetitive twisting, pivoting and turning can be an irritating factor. Sometimes you may experience a dull aching pain post activity / exercise.

There are certain tests that your physiotherapist can do to replicate these impinging positions which can help with the initial diagnosis.

TREATMENT

Probably one of the main reasons why many of you are reading this – what can you do?

First and foremost you need to figure out what activities in your day to day life whether it be work or play that are aggravating your hip. For example if certain positions in yoga set your pain off, its probably a good idea to avoid those poses in the short term to allow the irritated structures to settle down. Sessions with a physio may involve a combination of the following;

  • Soft tissue releases
  • Dry needling to target overactive muscles
  • Hip joint distraction techniques
  • Assessment of underlying biomechanical imbalances & exercise prescription.

If the pain is quite acute you could consider a course of non-steroidal anti-inflammatory medications (NSAIDs) to help with pain management. We always recommend you speak to a medical practitioner before starting on these and remember this is a short term solution, if you want the problem to stay away you need to make sure you find the underlying cause of you pain.

The longer term management for impingement usually requires a targeted strength and mobility program. The areas that need work will vary from person to person and your physio can guide you as to what combination will work best for you. The effectiveness of these exercises may depend on whether your impingement is structural or positional in nature.

Stay tuned for next weeks post where we will go into some of the best exercises to address hip impingement!