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Hip Impingement (Femoroacetabular Impingement) Physiotherapy
Hip impingement involves a change in the shape of the surface of the hip
joint that increases its risk to damage, resulting in hip joint stiffness and hip pain.
Hip impingement is a process that oftentimes happens prior to hip osteoarthritis. It
most often occurs in young, active people. A recent study found that 87%
of teens and adults with hip pain showed evidence of hip impingement on
diagnostic images taken of their hip joints.
To treat hip impingement,
our senior physiotherapists prescribe stretches and strengthening exercises to
better balance the muscles around the hip to protect it, and use manual
therapies to help restore range of motion and increase comfort.
What is Hip Impingement?
There are 2 types of hip impingement; they may occur alone or together.
- In pincer-type impingement, the hip socket (acetabulum), which is
usually angled forward, may be angled toward the back, or protruding
bone may be present on the pelvis side of the hip joint making the
socket a deeper recess that covers more of the ball or head of the femur
- The overgrown bone or incorrect angle of the socket causes the
labrum, a rim of connective tissue around the edge of the hip socket, to
be pinched. Over time, this extra pressure to the labrum when flexing
(moving the leg forward) leads to wear and tear that can cause
inflammation and could result in a tear. If this condition persists,
eventually the cartilage that lines the hip joint can become worn and
- This condition affects men and women equally; symptoms often begin early, appearing at any time between 15 to 50 years of age.
- In cam-type impingement, the shape of the bone around the head of
the femur—the ball at the top of the bone in the thigh—is misshapen. It
can vary from the normal round ball shape, or have overgrown bone formed
at the top and front. The nickname “pistol grip” deformity is given to
the appearance of the bony overgrowth on x-rays.
- The overgrown or misshapen bone contacts the cartilage that lines
the hip socket, and can cause it to peel away from the bone in the
socket. The labrum can become worn, frayed, or torn as well.
- This condition affects men to women at a ratio of 3 to 1; symptoms often manifest during the teen years and 20s.
Signs and Symptoms of hip impingement
Hip impingement may cause you to experience:
- Stiffness or deep aching pain in the front or side of the hip or front of the upper thigh while resting.
- Sharp, stabbing pain when standing up from a chair, squatting,
rising from a squat, running, "cutting," jumping, twisting, pivoting, or
making lateral motions.
- Hip pain described in a specific location by making a "C" with the
thumb and hand and placing it on the fold at the front and side of the
hip, known as the "C-sign."
- Pain that most often starts gradually, but can also remain after another injury resolves.
- Pain that increases with prolonged sitting or forward leaning.
- Feeling less flexible at the hips, including a decreased ability to turn your thigh inward on the painful side.
How Is It Diagnosed?
Our senior physiotherapist will evaluate the range of motion (movement)
of the hip and surrounding joints, and test the strength of the muscles
in that area.
We will feel the hip joint and surrounding
muscles to evaluate their condition.
The examination will include
observing how you move, standing from a sitting position, walking,
running, or squatting, as appropriate. We may
perform special tests to help determine whether the hip is the source of
your symptoms. For instance, we may gently roll your leg in
and out (the “log roll” test), or bend your hip up and in while turning
the lower leg out to the side (the "FADDIR" test) to assess your
If further diagnosis is needed, your doctor may order diagnostic
tests to help identify any joint changes, including
resonance imaging (MRI) or
- diagnostic injections
Hip impingement can
occur at the same time as low back pain, buttock pain, or pelvic pain, or from
conditions such as bursitis or groin strain. The final diagnosis of hip
impingement may take some time, especially when other conditions are
how our senior physiotherapists can help
Without Surgery (Conservative Management)
When an active individual develops hip pain, but does not have severe
symptoms or joint damage, the recommended treatment is hip pain physiotherapy.
The following interventions can help decrease pain, improve movement,
and avoid the progression of hip impingement and the need for surgery:
- Improving the strength of your hips and trunk. Strengthening of the
hips and trunk can reduce abnormal forces on the already injured joint
and help with strategies to compensate.
- Improving hip muscle flexibility and joint mobility. Stretching
tight muscles can reduce abnormal forces that cause pain with motion.
Joint mobilization may help ease pain from the hip joint; however, these
treatments do not always help range of motion, especially if the shape
of the bone at the hip joint has changed.
- Improving tolerance of daily activities. We can
consider your job and recreational activities and offer advice
regarding maintaining postures that are healthier for your hip and
activity modification. Often this involves limiting the amount of
bending at the hip to avoid further hip damage.
Following Hip Surgery
Surgery for hip impingement is performed with arthroscopy.
This is a
minimally invasive type of surgery, where the surgeon makes small
incisions in the skin and inserts pencil-sized instruments into the
joint to repair damage. The surgeon may
- perform 1 or several techniques
during your procedure as needed
- may remove or reshape the
bone on the pelvis or femur side of the joint and
- repair or remove the
damaged labrum or cartilage of the hip joint.
Postsurgical physiotherapy varies based on the procedure performed. It may include:
- Ensuring your safety as you heal. We may
recommend that you limit the amount of weight you put on the operated
leg if there was a repair of the labrum. You may wear a brace to help
limit the amount of bending at the hip. You might also use crutches to
avoid overloading the leg if the bone on the femur was reshaped.
- Improving your range of motion, strength, and balance. We will guide you through safe range-of-motion, strengthening,
and balance activities to improve your movement as quickly as possible
while allowing the surgical site to heal properly.
- Instructions on returning to an active lifestyle. Most people return
to normal daily activities about 3 months after surgery, and to
high-level activities and sports 4 to 6 months after surgery. We will recommend a gradual return to activity based on
your condition—research shows that 60% to 90% of athletes return to
their previous playing ability depending on the surgical procedure
performed and the sport.
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At the first session, our specialist physiotherapists will carry out a thorough
assessment, helping them to select the most appropriate treatment to
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Follow up sessions are inline to provide
expert treatment for your pain as well as prescribing specific
exercises to reduce your risk of re-injury and giving you a long term
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