What is hip impingement? Our overview and exercises for recovery
Are you experiencing hip pain? Whether it’s a sharp pain in your hip or hip pain you have when sitting, you might be dealing with hip impingement. Here, we go over what hip impingement is, what causes it, and how our physiotherapists and sports medicine experts at Endeavour diagnose and treat it. We’ll cover topics and questions including:
- What is hip impingement?
- Types of hip impingement
- Symptoms and causes of hip impingement
- How do you test for and diagnose hip impingement?
- How is hip impingement treated and fixed? Surgical and non-surgical options
- Hip impingement exercises, and exercises to avoid
What is hip impingement? Is it the same as femoroacetabular impingement?
The team “hip impingement” is really a catch-all phrase for symptoms of restricted range of motion or pain on the front of your hip—whether a pinching sensation, a sharp pain in your hip, or an achiness. The pain might go into your groin, down the front of your thigh, or could wrap around the outside of your hip.
It’s important to note that the general definition of hip impingement is distinct and different from femoroacetabular impingement (FAI). FAI may or may not have symptoms, but is something that can be seen on X-rays or MRIs with a structural change in your bone or joint that creates a physical blockage of the hip, as opposed to a soft tissue restriction, which is what you’d see in the first type of impingement we described.
What are the types of hip impingement?
While you may see the two terms — impingement, and femoroacetabular impingement/ FAI — being used interchangeably, they can mean very different things. Most of what we’ll go through here refers to the first type. As we mentioned above, “hip impingement” is often used as a catch-all term for a pinching or aching sensation at the front or inside of your hip joint, and it can have a huge variety of causes, which we’ll go into below.
On the other hand, a diagnosis of FAI usually requires some sort of imaging such as an X -ray or MRI, and generally involves some changes in the bone or hip joint itself. In short, hip impingement is more of a symptom, whereas FAI is a structural diagnosis.
What are the symptoms of hip impingement?
Again, typical hip impingement symptoms are a pinching sensation or an achy sensation at the front of your hip. It sometimes radiates in a little bit toward the inside and the groin, and sometimes toward the outside. In FAI, you may or may not actually have symptoms, or might not have them on both sides of your hip.
You can have FAI without the symptoms of pinching, and you can have symptoms of pinching without the structural condition of FAI, which is why it’s really important to consult with a professional, like the team at our Toronto rehab clinic to ensure a proper diagnosis and treatment that considers all the different factors involved.
What causes hip impingement?
There are many different causes of hip impingement, and it really depends on the person.
It could be (but isn’t always) related to structure and the anatomy of your hip joint. For example: the angle of your femur, or the size and shape of your hip’s ball-and-socket joint—the acetabulum is the socket portion, the ball is the femoral head. These are all factors that can influence your hip’s alignment and increase the likelihood of you experiencing a pinching sensation.
We often see people who are putting a heavy load on their hip joint: for example, high-impact athletes like runners, or athletes who play sports with a lot of cutting and rotational stresses on the hip such as soccer, basketball and ultimate frisbee. We also see people experiencing hip impingement who play sports that involve them having their knees up higher than their chest a lot of the time, like hockey or cycling.
We also see a loss of hip mobility and range of motion as another common cause, whether it’s because of tightness around the muscles, overload or a structural condition. If there are fewer ways for your hip to move, the ways that it does move are more likely to get worn down or irritated over time.
Any irritation to your joint, or any existing joint conditions that you have, can also be a culprit behind hip pain. For example, with arthritis there is wear and tear on some of the cartilage or other structures relating to your hip joint, which can be a factor in causing a pinching sensation on the front of the hip. Other things like a torn labrum (the cartilage that runs along the socket of your hip joint) can contribute too.
How is hip impingement tested for and diagnosed?
As we talked about above, there are so many different factors and sources that could be contributing to someone experiencing hip impingement, so the first step when you come into our rehab clinic at Endeavour will be working to identify what the cause is for you. This then will inform how we address hip impingement for you specifically—more on that below!
Usually, someone first coming in with hip impingement symptoms has a specific issue such as the pinching or achiness around their hip that we’ve talked about. It’s also usually tied to certain ranges of motion. When doing a hip impingement test, we’ll look at a few different movements, such as:
- Hip flexion: Bringing your knee up towards your chest
- Rotational movements: Rotating your hip and leg inwards and outwards in different positions
- Functional movements, such as a squat or sprinting
All of this will give our physiotherapists or sports medicine experts information about which structures in your hip are being pulled on or stressed, and about what types of movements aggravate symptoms.
Because hip impingement can have so many different causes, it requires a process of what we call “differential diagnosis”: identifying carefully which of the possible contributors exist, and ultimately what will guide us in addressing the problem. As part of this process, we’ll consider factors like a hip flexor injury (the muscles at the front of your hip), quad-related injuries (for example, knee injuries or a muscle pull in the quads), and groin injuries (such as muscle pulls or a tendon injury). As well, arthritic changes to the hip joint can limit your range of motions and cause symptoms in your hip area. We might see this in someone who’s had a long history of high impact or is increasing in age, and through follow-up testing, we can explore whether arthritis is playing a role.
Labral tears (the ring of cartilage following the outside of your hip joint socket) are another injury that could be a factor and are best diagnosed via MRI. This could be from a traumatic injury but could also come from wear and tear over time, and could be what’s causing you to have hip impingement type symptoms.
Finally, we do see many situations where there are none of the above factors at play: no muscle tears or pulls, no arthritic changes, and so on; rather, there is nerve irritation. When there’s overload on the joint and muscles in your hip over a long period of time, the nerves can get really hypersensitive and become more vulnerable to sending pain signals to your brain. Basically, it’s your nerves expressing their concern about the overload in that tissue! In these cases, we can address this nerve irritation quickly and effectively with a combination of treatment techniques—more on that below!
All of the above are pieces of the puzzle that we’ll put together to determine how we’re going to work with you to address what’s going on.
How is hip impingement treated and fixed?
Treatment for hip impingement starts with identifying the cause of the problem and all the different factors at play. Usually, our treatment approach will involve a combination of four different categories:
- Improving tissue mobility: In cases where there’s muscle and joint restriction contributing to hip impingement symptoms, we’ll work to address this through things such as muscle release, manual therapy, electro acupuncture and stretching exercises, all aimed at improving the mobility of the hip joint.
- Reducing nerve sensitization: Nerve irritation can be a big part of why someone may be experiencing hip impingement symptoms. We’ll address this through electroacupuncture and manual therapy, as well as exercises.
- Improving muscle activation: We’ll work to improve the coordination of your muscles and the strength of your muscles as they relate to your hip. There are the hip flexors, the groin and quads, but also your gluteal muscles and core muscles, especially the muscles that rotate your torso. By ensuring these muscles are strong and know when to activate, they’ll be better equipped to protect your hips and handle forces placed on it.
- Improving movement quality and addressing movement imbalances: The way people move determines how our body responds. For example, if you’re running in a way that puts stress on your hip, it’ll respond by tightening, which can contribute to hip impingement. We’ll work to identify movement faults or inefficiencies and address them through a combination of exercise and guided movement, better preparing your muscles to handle the forces placed on them.
In more extreme cases where the structural issues with your hip joint are the limiting factor, arthroscopic surgery may be an option considered by your health care team, usually a last resort. A surgeon can shave off pieces of bone or cartilage that are contributing to the physical blockage in your joint. Following any hip surgery, an intensive rehabilitation process is required to address the four important treatment considerations listed above.
What are some exercises for hip impingement?
In terms of exercises that are beneficial for hip impingement, here are some of our suggestions:
- Planks and mountain climbers, which activate your core while also activating the hip flexors and the muscles at the front of your hip, helping improve your core strength
- Rotational exercises with resistance bands, medicine balls and cable machines, helping improve your rational core strength
- Lunges, which help work on your hip control
- Squatting at different speeds, which work on the control of movement in different positions and ranges of motion
- Any exercises that strength the groin, such as pulling resistance bands across your body with your leg, or side (adductor) planks where your weight rests on the inside of your upper leg, which is placed on a chair or bench
- Single-leg bridges to help strength your glutes
In terms of exercises to avoid, you’ll want to avoid any exercises that really aggravate your hip impingement symptoms, such as ones that have you going into deep hip flexion positions.
A good exercise program, like one our physiotherapists or sports medicine experts will design for you, is one that addresses all the different muscles and areas of your body, so you’re not working on any one muscle in isolation.
Looking for a physiotherapy clinic in Toronto or have more questions? Contact us at Endeavour to learn more and book your treatment.
Disclaimer
The medical information on this blog is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-therapist relationship and should not be used as a substitute for professional diagnosis and treatment.
Please consult your health care provider before making any health care decisions or for guidance about a specific medical condition. Endeavour Sports Performance and Rehabilitation and its practitioners expressly disclaim responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this article.