What is a hip impingement?
Hip impingement, known medically as femoroacetabular impingement (FAI), is a common cause of hip and groin pain in adolescents and young to middle aged adults. FAI is caused by an abnormal hip shape that causes “pinching” or interference (impingement) between the two bones that make up your hip joint.
Your hip is a classic ball and socket joint. The top of your upper leg bone, called the femur, makes up the ball and connects to the acetabulum which is the part of your pelvis that serves as the socket. The part of the femur that directly connects to the acetabulum is known as the femoral head. The femoral neck connects the femoral head to the shaft (long portion) of the femur. Between the femoral head and the acetabulum, you have a piece of cartilage called the acetabular labrum which serves to deepen the joint surface, provide stability by generating a small vacuum to keep the socket in place, and absorb compressive forces. The labrum is crescent shaped and wraps directly around the acetabulum’s outer rim.
Conditions associated with a Hip Impingement
FAI impingement might not account for all the pain you are feeling in your hips, it is also quite common for damage to cartilage like the labrum. The articular cartilage that covers both the femoral head and acetabulum, which serves to provide cushion to the joint and allow the hip to move smoothly, may also be eroded or damaged. Hip FAI may play a role in the development of hip osteoarthritis due to wear and tear on cartilage from impingement.
Hip Impingement Causes
There are many causes of hip impingement For instance, exposure to repetitive hip rotation (twisting) and hip flexion (moving the leg up towards your chest), like when you play most sports, increases your risk. You have a much higher risk of developing FAI if you have or had a sibling with FAI, hip disorder in childhood, poor bone alignment following a femoral neck fracture, or surgical over-correction. Hip impingement is also most common in younger males and athletes.
Types of hip impingement
Femoroacetabular impingement is characterized into three types. You may be diagnosed by your physician with a cam type, a pincer type, or a mixed type bone deformities.
Cam Type Impingement:
Cam type impingement involves the change from a normal spherical shape of the femoral head and/or widening of the femoral neck. Thus, cam FAI is the result of excessive bone growth at the femoral head-neck junction. Cam type impingement is often associated with development of hip arthritis.
Pincer type impingement:
Pincer type impingement occurs when the rim of the acetabulum has more bone than normal and the femoral head fits poorly into the acetabulum. Cam impingement is more common in males while pincer is more common in females.
Mixed type impingement:
The most common form of FAI is the third type called mixed. The mixed type is a combination of cam and pincer affecting both the femoral head and acetabulum.
Physical therapy evaluation for femoroacetabular impingement
Upon your evaluation, expect to receive a lot of questions from your physical therapist (PT) as part of what is called the subjective examination. Bring in any medical history information you may have such as a medication list, imaging results (MRI or x-ray), and any other documents related to your condition that your physician has provided to you. Your physical therapist will gather information to better understand your primary complaint and nature of your pain. This is your opportunity to tell your physical therapist all the details regarding your condition such as what makes the pain worse or better, when the pain started, what you believed caused the pain, etc. Your physical therapist will make it a priority to identify your rehab goals. You may also fill out a questionnaire related to your hip pain and how it affects your daily activities.
Prior to detailed testing of the hip joint, your physical therapist will attempt to rule out pain originating from nearby joints such as the lower back or knee. Next, your PT will complete muscle strength testing, flexibility testing, balance testing, assess the way you walk, and examine bony and muscle structures. You may also perform a squat or step up/down to simulate functional movements performed in everyday life. Your physical therapist will use the results of your examination and map out a plan to guide the treatment toward your specific goals and limitations. Your physical therapist may also provide you with a home exercise program to start exercises and stretches like the ones described in the next section below. Lastly, your physical therapist will educate you on activities and exercises to avoid.
Exercises and Stretches for Hip Impingement
Exercises you can include into your program will depend on your experience and how well you perform the starting exercises.
Beginner Level Exercises:
If you are a beginner, you should aim for at least 12-15 repetitions for 2-3 sets per exercise. Stretches should be carried out for at least 30 seconds for 3 sets. Exercises for you at this beginning stage includes:
- Seated isometric hip flexion
- Sitting figure four stretch
- Standing weight shifts on foam
- Hamstring and quadriceps stretches
- Tandem walk
- Seated or standing marches
- Transverse abdominis activation.
Intermediate Level Exercises:
Intermediate level patients can add the following exercises once beginner exercises are completed successfully. Continue with the same repetitions and sets as beginner level until you increase/add weight or change the resistance band to a more challenging color/level. Perform 8-12 repetitions for 3-5 sets for each exercise thereafter. Continue to hold the stretches for at least 30 seconds.
- Side bridges
- Figure four stretch in standing
- Supine or standing hip flexion with TheraBand
- Bridges with transverse abdominis activation
- Step ups/downs
- Squats to comfortable depth
- Clamshells and reverse clamshells
- Hip hikes
- Hip abduction
- Four way sliding disc in standing
- Side steps.
Advanced Level Exercises:
Individuals who have successfully executed beginner and intermediate exercises can progress to advanced level exercises. The recommended repetitions are 8-12 repetitions for 3-5 sets with increasing levels of resistance as tolerated.
- Fire hydrants
- Monster walks
- Ipsilateral Romanian deadlift with dowel
- Side bridges with stability ball
- Lateral step downs with sliding disc
- Standing hip flexion with TheraBand
- Single leg balance exercises
- Multi-directional jumps
- Single leg squats
- Reverse lunges
- Rear Foot elevated split squat
- Bridge with hamstring curl on stability ball while performing TA activation.
How long will Hip Impingement rehab take?
Everyone is different and heals at different rates but on average individuals should see peak results between 6-8 weeks. You should make sure you are getting adequate sleep, nutrition, and rest based on your physical therapists recommendations in order to allow tissue healing to occur as quickly as possible. You should expect to see improvements in strength with a possible decrease in pain in just a few weeks. During rehab, you should refrain from aggravating activities such as participating in sports. Intensity and frequency of exercises that provoke symptoms should be decreased or even removed entirely. Your physical therapist will assist you in identifying movements that should be minimized such as running, jumping, climbing stairs, cutting, and other quick, high impact movements.
For an individualized treatment plan to assist you with hip impingement or any kind of hip pain, consult with one of our physical therapists in Chicago, IL (virtually via our telehealth platform or in person) by calling us at (312) 374-5399 or by scheduling an appointment online. Remember to also check out our Facebook, Instagram, and Twitter pages for more fun facts and articles on nutrition, physical therapy, and exercise!
Written by Mason Baker
Edited by Alexander Franz
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES
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