Hip Pain? You May Have an Impingement

Hip pain can be nagging, frustrating, and even downright debilitating. This pain can stop you from playing your favorite sports because it hurts during or afterwards, it can hurt during housework or yardwork, getting in and out of the car, or even just rolling over in bed. What’s worse, is there are so many causes and reasons for hip pain, that it is difficult to know why your hip hurts and how to get it to stop!

Although we do not have the time in this blog to address all types of hip pain, we will address one in particular that we are seeing more and more in our clinic: Femoroacetabular Impingement, or simply known as FAI or a hip impingement for short.

What is FAI and what causes the pain?

The hip joint is a ball and socket joint, where a ball (femoral head) at the top of the femur (your thigh bone) sits inside the a socket, aka  the acetabulum. This allows for a wide range of motion at the hip allowing us to move our leg in multiple directions as needed for activities such as walking, running, squatting, bridging and so forth.

A FAI occurs when there is an abnormal structure to the hip joint and basically comes in 3 types:

• Cam impingement – the ball at the top of the femur (femoral head) does not have a perfectly round shape. This creates friction at the edges of the socket (acetabulum) as the ball is not able to easily roll and glides within the joint.
• Pincer impingement – the socket (acetabulum) is too large or protrudes, covering the femoral head too much. This creates friction as the excessive size of the acetabulum impinges on the neck of the femur.
• Combination - This is when both types of impingement are present

Due to the dysfunctional joint mechanics caused by the misshapen femoral head or acetabulum, labral tears can be quite common in those with FAIs.  

What are some common signs and symptoms of FAI?

Those with FAIs may experience one or many of the following symptoms, ranging from mild to severe:

• Pain and stiffness in the front of the hip.
• Increased pain or inability to bring the knees to the chest, across the body, or turn the leg inwards.
• Hip Stiffness when bending the at the hip as in squatting, cycling, or tying your shoelaces.
• Pain after sitting for a long period of time or inability to sit on the ground.
• Aching in the front of the hip when walking or running up stairs or hills.

How can you manage the symptoms of FAI and get back to normal activities?

Symptoms of FAI do not mean the end of doing the activities that you love and may be treated in the following ways depending on presentation and severity:

A Physical Therapist can perform a thorough examination to identify the FAI and the correct treatment approaches to manage the condition based on the individual. Management strategies may include:

• Activity modification – learning to move in ways that will not compromise the structure of the joint and avoid repetitively aggravating the condition, while still engaging in the atcivities you love.
• Mobility exercises – ensuring you have enough motion in the muscles, tendons, and ligaments of the hip and joint above and below for optimal movements.
• Strengthening – identifying and strengthening key muscles that support and stabilize the hip to help reduce friction and shearing in the joint by gaining control.

Speaking with your Physical Therapist and/or Physician about methods to reduce inflammation may also help with acute or chronic pain.

If all else fails, surgery may be an option as a last resort.

If you are experiencing hip pain contacting your local physical therapist for an individualized examination and program should be your first step.

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