Hip Impingement

Hip impingement is a common injury we treat at Trained Physio.  A common complaint is that ‘pinching’ pain at the front of the hips, often when doing things like squats, getting in and out of the car or even sitting cross-legged.  Does this sound like you? Continue reading……

The pain you experience may even extend into your back, buttock and/or groin and for this reason it is important to get a proper assessment to eliminate any other possible diagnosis.

What is Hip impingement?

The hip is a ball and socket joint, in which the head of the femur (the ball) sits within the acetabulum of the pelvis (the socket). This allows the hip to move through multidirectional movement and rotation. With hip impingement this movement gets disrupted causing abnormal contact between the ball and socket and put pressure on the joint or surrounding muscles.  This causes the deep, pinching type pain as well as possible locking or restriction of movement.

Hip Impingement Exercises

The shape of your hip joint and overall skeletal structure can play a major role in the comfort or discomfort you experience with squatting and other movements.  Structural factors like natural movement patterns, ankle range of motion, upper leg (femur) and lower leg (tibia) bone length and joint angles can impact your optimal biomechanics for squatting and other exercises.  Some people are just not made to move in certain ways; however, your qualified physiotherapist can perform a movement analysis to determine how hip and ankle mobility, foot position, barbell position, strengthening exercises and technique adjustments can help to prevent hip impingement. This is often enough to resolve the symptoms.

In other cases, there may be other structural issue present.  Those with longstanding hip pain may have femoroacetabular impingement (FAI).  In FAI bony spurs develop on either the femoral head (cam lesion) or acetabulum (pincer lesion).  These bony growths can make contact, typically with flexion, crossing the midline and/or inward rotation and cause impingement.  Other symptoms may include catching, locking or stiffness of the hip joint. These symptoms are also consistent with osteoarthritis and therefore important for your qualified physio to rule this or other bony changes out by performing a full assessment.

Hip Impingement Test

In the case of hip impingement, people tend to stand and sit with their hips in a position of posterior pelvic tilt causing the femoral head to slide anteriorly relative to the body midline. This puts increased pressure on the structures and muscles at the front of the hip.

This dynamic hip joint instability is typically associated with weakness of muscles surrounding the hip joint.  Typically, we see a weakness and dysfunction of the hip extensors (gluteals and hamstrings) and deep external rotators. These muscles work to pull the femoral head posteriorly- hence if these are not working well the femoral head will sit too far forward.

Hip Impingement Symptoms

As for the hip flexors, these often feel ‘tight’ and like they need to be stretched.  However, ‘tight’ does not always mean shortened and overactive.  A muscle can become tight in a stretched position also, usually meaning a muscle is actually weak and under active.  In both cases, there is an imbalance between the hip flexors and hip extensors.  We prefer to focus on building up the weaker muscles around the hip, to resolve the imbalance, rather than balancing things out by making something weaker or longer!

Hip Impingement Treatment

Physiotherapy management of FAIS or other causes of hip impingement will be very dependent on the individual and the degree to which it is impacting on your life and goals.  In most cases, Physiotherapy management in successful without the need for surgical intervention. There may be an initial need to focus on calming symptoms by removing painful triggers or altering movement patterns, followed by mobility and strengthening exercises targeting the hip but also addressing the body as a whole and any other contributing factors.

Hip impingement or pinching can occur due to a number of reasons which is why an initial assessment with one of our qualified physiotherapists is important to gain a correct diagnosis and individualised management plan.  Hip impingement symptoms fall along a continuum and therefore no rehabilitation program is identical.  If you are currently experiencing hip pain, at any point along the spectrum, book now and let one of our qualified physiotherapists get you back to feeling pain free!