You may have been recently diagnosed with a hip joint impingement or hip joint capsular restriction or even femoroacetabular impingement. Thankfully, they’re all pretty much the same thing. In this article we’ll look at this impingement from a practical perspective and what you can do to improve it.

As a general rule you’re probably suffering from some sort of hip pain, otherwise you wouldn’t be reading this! Funnily enough, most people with this problem come in to the clinic complaining of groin pain.

You may think of your hips as the bony bit on the outer point of their pelvis, however this is just the outer extremity of the femur (thigh bone). The hip joint itself is far deeper and can cause pain in the groin or buttock.

Occasionally, people can get referred pain into the thigh or knee.

 

Anatomy of the hip

The hip joint is a ball and socket type joint. It consists of 2 main bones. These are the femur (the ball) and the acetabulum (the socket).

Hip Anatomy

Around the ball and socket there is a joint capsule made of strong ligament. The joint capsule acts as a restraint to unwanted movement but also creates a balloon to stop the synovial fluid (body’s natural joint lubricant) escaping. The socket also has a fibrous tissue around it similar to a suction cap call a labrum. It’s job is to provide further stability to the ball and socket joint.

 

What is an impingement?

As a general rule impingement refers to one part of your body squashing up against or butting into another part of your body. Usually in a fashion that your body doesn’t like. As a result you can get pain and sometimes  inflammation in the area. In the hip the most common type of impingement is where the front of the femur jams into the socket as you bring your knee to your chest. Hence the groin pain and discomfort.

 

Not all anatomy is equal

Unfortunately we aren’t all perfect. Some people have hip joints that are more prone to impingement. A torn labrum may catch as you bring your knee to your chest resulting in pain or clicking. Also some people have slightly oddly shaped balls or sockets.

The ball can have a cam lesion on it which basically means part of the femur is thickened. Consequently this doesn’t allow for full movement. Similarly the acetabulum or socket can have a pincer type deformity that doesn’t allow the hip to bend fully prior to femur butting into it.

Hip Impingement

However funnily enough just because you have a cam or a pincer on x-ray doesn’t mean that you will have pain. A large study collating a whole bunch of other studies found that on average 37% of asymptomatic hips had a cam type femur.

The same study found that 67% of asymptomatic hips had a pincer type acetabulum. Remember, this is people without hip pain.

So if you get sent by your GP or physio for an x-ray and it comes back with a description of cam or pincer deformity (or both), it isn’t necessarily the problem.

However, you will still need someone to assess your hip.

I always put it to clients that they didn’t grow extra bone overnight. It was often there before their pain started and will still be there when their pain is gone.

X-rays are still useful for checking if there is cartilage loss or hip joint arthritis present. As a result are still be a useful tool to help diagnose the problem. When it comes to labral tears they will only show up on an MRI.

 

Symptoms of hip impingement

You may have pain when you bring your knee close to your chest or lifting your knee up then rotating the femur. The main ones people describe to me are:

  • Deep squats
  • Burpees
  • Getting in and out of a low car
  • Running drills with high knees
  • Getting out of a low chair
  • Putting on shoes or socks or tying shoelaces

As I mentioned before, usually you feel pain in the groin region at the front. Less often you’ll feel pain in the buttock and rarely in the knee or thigh. Often the symptoms have been gradually coming on over time and get a little better with rest but come back once you return to the activity that was causing the impingement.

 

How do we fix hip impingement?

Firstly we need to establish why your hip joint has begun impinging. The most common scenario is that the muscles or ligaments around the hip have become too tight and are no longer allowing the ball to move freely within the socket causing the pinching sensation at full hip bend.

The main stretches we would usually look at are gluteals muscles, hip flexors muscles, and some hip joint capsule stretches. You may find the hip joint even pinches doing the gluteal stretch in which case you will need to modify it in consultation with your physiotherapist.

Gluteal stretch

  1. Lie on your back with your knees bent and feet on the ground.
  2. Bring 1 knee towards your chest then across your body.
  3. With the opposite hand grab your foot in the air and pull it up and across your body. Ideally your knee should still be at 90 degrees.
  4. You should feel a pull in your buttock muscle.
  5. Hold it for 30 secs to a minute and repeat 3-4 times a day.

Gluteal Stretch

Hip flexor stretch

  1. Kneel on 1 knee on a pillow.
  2. Tuck your bottom in and under.
  3. Push your hips forward but with your bottom remaining tucked in and under.
  4. You should feel a stretch in the front of your kneeling hip and slightly down the thigh.
  5. Hold it for 30 secs to a minute and repeat 3-4 times a day.

*if you want to make this stretch harder put the back foot up on a chair or step

Hip Flexor Stretch

Hip joint stretch into external rotation

  1. Lay on your back with 1 knee bent so that your foot is next to your knee.
  2. Let the bent knee gently drop out to the side and hang.
  3. For a more intense stretch you can add a 2-3 kg weight or do a similar stretch lying on the stomach with the foot locked under the other thigh.
  4. You should feel a stretch in the front of the hip and groin.
  5. Holds for 5-10 minutes morning and night.

Hip joint stretch external rotationHip joint stretch external rotation

Hip joint stretch into internal rotation

  1. Set an office chair to knee height.
  2. Kneel 1 knee on the chair
  3. Use the back rest of the chair to rotate the knee in and foot out.
  4. You may not feel much of a stretch with this one but keep bouncing into the stretch for 2-5 minutes morning and night.

Hip internal rotation stretch hip internal rotation stretch 2

The latter 2 stretches are joint stretches. As a result it isn’t unusual to feel a bit sore afterwards as opposed to a muscle stretch that feels more relaxed.

 

Strengthen your glutes

At times you can also have a strength deficit that leads to the a hip joint impinging. The gluteal muscles are the main stabilisers for the hip. If they are not performing well you can get a hip impingement from either the femur pushing forward in the socket or the pelvis dropping on the opposite side, causing pinching in the hip joint.

Gluteal strengthening exercises come in many shapes and sizes. I recently wrote an article here on gluteal strength exercises specific to runners. However these may be a bit difficult for some so here are 2 very simple ones.

 

Standing hip abduction

  1. Tie a theraband around both your feet.
  2. Keep your hips as level possible and lift one foot out to the side and slightly backwards into the air.
  3. Slowly lower your foot back down but don’t let it touch the ground.
  4. Repeat until you get a burn in your hip and buttock.

Standing hip abduction 1Standing hip abduction 2

Hip hitches

  1. Stand with 1 foot on a step and your other foot hanging in the air facing along the length the step.
  2. Keep your knees straight and lower the foot hanging off the step towards the floor. You probably won’t make it to the ground, just lower as far as your hip and pelvis will allow without bending your knees.
  3. Then lift the same foot up as high as possible above the step keeping your knee straight and legs lined up with each other. The movement will come from your hips and pelvis.
  4. Repeat until you feel a burn in your buttock and hip musculature.

Hip hitch 1hip hitch 2

Realistically to get the best rehab there are many progressions to these exercises. Also, not all hips need stretching and not all hips need strengthening. This is where a physiotherapy assessment is highly beneficial for designing a rehab program specifically for you.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070009/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070009/

 

 

 

 

 

 

 

 

 

About Simon Davis

Simon graduated from Sydney University with a Bachelor of Applied Science (Physiotherapy) in 2007. He spent several years working on the far south coast of NSW in both the hospital and private setting whilst also enjoying seasonal physiotherapy work at Jindabyne treating ski injuries during the snow season.