Do you ever wonder what the pinching pain is in the front of your hip? It’s probably not a “pulled hip flexor”…
One possibility that you might not have heard of is hip impingement, also known as femoroacetabular impingement syndrome (or FAI). FAI is a relatively new concept in the orthopedic and rehabilitation realm, but we see it frequently in the clinic; and fortunately, it generally responds very well to physical therapy intervention.
The typical presentation of hip impingement is anterior (front) hip or groin pain in increasing degrees of hip flexion, such as during a deep squat or a high kick. It is typically experienced as a sharp pinching sensation localized to the anterior hip, with dull aching afterwards. Occasionally, a click or “snap” can be associated with hip impingement. Most people locate the pain by placing their hand on their hip and describing the pain as being between their thumb and fingers.
Soccer players may notice increased pain after shooting practice. Weight-lifters may notice increased pain after heavy squats, lunges, or dead lifts. Even long car-rides or prolonged sitting can provoke symptoms.
Hip impingement occurs when the head/neck of the femur (thigh bone) contacts the rim of the socket during certain movements between the leg and pelvis. The area of impingement can become inflamed, irritated, and painful.
This impingement condition can occur due to abnormal anatomy at the ball-and-socket hip joint, as shown in the images below. Two common types of bone formations that contribute to impingement include the Pincer and Cam lesions. One or a combination of both conditions may predispose an individual to experiencing symptoms from hip impingement.
Hip impingement can also occur biomechanically, such as when the pelvis is tipped too far anteriorly. This situation may occur as a result of insufficient abdominal (core) and gluteal strength, or due to muscle imbalance from shortened hip flexor muscles. The image below shows a common presentation that we see in young athletes – the pelvis rotated/tilted anteriorly as a result of muscle imbalance and poor core control.
If you have the bone structure to predispose you to hip impingement, this does not mean you will always have pain. However, repetitive movements into impingement positions may cause a flare-up of pain or symptoms.
Why is hip impingement important to avoid?
Repetitive impingement in the hip joint can lead to pain, cartilage degeneration, labral tears, and development of early hip arthritis. If the condition persists, secondary effects such as muscle inhibition, weakness, and altered mechanics through the lower extremity can lead to dysfunction at the knee as well.
How is it treated?
Modification of certain activities and correcting exercise technique is important for resolving pain associated with hip impingement. For example, deep squats, which bring the hip into angles of flexion greater than 90 degrees, are likely to aggravate the condition. A simple modification is decreasing the depth of the squat, which still allows you to strengthen, but without worsening the problem.
Control the biomechanical impingement as much as possible and you can function at a very high level, painfree!
Rehab should focus on improving gluteal and abdominal strength, hip control, and flexibility on all sides of the hip and leg. Manual therapy may be needed to alleviate soft tissue restrictions through the front of the hip. Joint distraction techniques, are usually very effective for unloading the hip joint to resolve the condition. Athletes should work on improving landing and cutting mechanics to reduce the amount of impingement that occurs during their sport.
If cartilage damage or bony abnormalities are too severe, surgery may be necessary to clear the anatomical cause of hip impingement. Extensive rehab would follow surgery to facilitate healing and address muscle imbalance, posture, and movement patterns. The ultimate goal is to prevent the painful condition from returning.
If you think you might be suffering from hip impingement, the best thing to do for the quickest recovery is to have a thorough evaluation by a sports physical therapist. Not every patient is the same, so your case of impingement may have different causes than someone else.