Hip Impingement

What is Hip Impingement?

Hip impingement is also known as femoroacetabular impingement (FAI). Its name derives from the structures involved including both the femur and the acetabulum. The femur is your thighbone. It is large, dense, and runs from your knee up to your hip. At the top of your femur, it is shaped like a ball (femur head) that fits directly into the acetabulum (socket). The acetabulum is a part of the pelvic bone where the femur and the pelvis meet.

Hip impingement occurs because there are unusual wear and tear of the joint which over time reshapes the joint, therefore causing an impingement. You can live for years with never knowing you have FAI as early stages are almost undetectable. Over time as the joint reshapes, symptoms may progress. First starting with hip stiffness and eventually that turns into pain.

Without proper treatment and care early on, those who suffer from FAI can develop osteoarthritis. If not properly taken care of, a total hip replacement may be needed.

What causes hip impingement?

The two types of FAI, Pincer-Type, and Cam-Type can occur alone or together. Pincer-Type is when the acetabular socket is improperly aligned, or angled, forming a deep socket, covering more of the femur head, which can add undue stress to the labrum, a cartilage-like cushion within the joint, which over time may cause the labrum to form holes and eventual tear. This type of impingement occurs equally in men and women and most often occurs between 15-50 years of age.

The Cam-Type Impingement, on the other hand, relates the deformity of the femur head, which commonly occurs because of overgrown bone on the femur head which is nicknamed “pistol grip.” The length of the femur coupled with the misshape of the ball under the image (X-Ray or MRI) looks like a pistol handle.

Similar to Pincer-Type, the Cam-Type Impingement will also wear down the labrum causing it to fray, tear, or pull away from the socket. This type of impingement occurs in men more than women, and it happens more often between your teens to your early 20s.

In rare cases, there are other disease processes that may cause femoroacetabular impingement.

  • Coxa vara is a very rare condition in children where the growth pace of the femur compared to the femur are different which leads to deformity.
  • Legg-Calve-Perthes is a disease where the ball of the femur lacks the necessary blood supply causing the femur head to die.
  • Slipped capital femoral epiphysis occurs more often in the teenage years, especially those suffering from obesity, where the femur head separates from the femur shaft near or at the growth plate.

Symptoms of Hip Impingement

FAI progresses over time. In the early stages one may have no symptoms, but as the deformity progresses, you may start to experience hip stiffness which eventually leads to hip pain. As the deformity continue to develop, the symptoms become more severe.

Often you will feel a sharp, stabbing pain in the front of the hip and groin area especially with activities such as squatting, sit to stand, running, jumping, twisting, or pivoting. There is also another symptom called the “C-sign.” The pain is in the front of the hip and the area of the size and shape of your hand shaped like a “C.”

How is hip impingement diagnosed?

FAI can be diagnosed without imaging; however, if your symptoms are significant enough, then an X-Ray or MRI (magnetic resonance imaging) may be recommended by your physician. Your physician may want to see the structural changes and determine the significance of damage due to the deformity, which will help determine if conservative care or surgery will be needed.

Addressing the early onset of hip stiffness and pain is important. Early treatment of FAI can prevent further deformity and therefore may minimize your risk of needing surgery in the future. A qualified PT can determine if your hip is pain relates to FAI, or the origin is from some other cause.

With a thorough hip exam along with reviewing your medical history, a PT will establish a plan with you. If, however, your PT believes you may have FAI and the condition has progressed enough, he or she may recommend you visit with your physician to determine the appropriate diagnosis and treatment.

In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

Treatment of Hip Impingement

If surgery is not needed, PT is found to be very effective in managing hip symptoms and slowing down or preventing further damage to the hip joint, which is done through strengthening, stretching, and retraining muscles to properly work. With FAI, it is not that uncommon to develop muscle strength imbalance causing some muscles to overwork while others underperform.

Your PT will help you manage any inflammation and will begin to build up your strength and flexibility as indicated. Generic hip exercises are stretches not recommended for this condition. A medical professional such as your PT will customize your treatment approach to specific muscles, tendons, and ligaments impacted by the FAI condition, which is critical to restoring balance and symmetry to the pelvic and hip joint.

When surgery is needed, typically it is a minimally invasive surgery. Your surgeon will reshape the hip joint, either the acetabulum socket, femur head or both depending on how deformed the joint is, which is done through microscopic surgery. He or she may also repair the damaged labrum depending on how damaged the cartilage is.

As a follow-up to surgery, PT is recommended. Especially with a repaired labrum, you may be on a weight restriction for a period to allow the joint and surrounding tissue to heal. Your PT will train you on how to properly use crutches as to minimize your weight bearing and with proper training will minimize any other types of stress caused by the use of crutches.

When appropriate, your PT will begin with gentle range-of-motion of the hip. As your tolerance improves gentle strengthening and balancing, activities will be introduced into your treatment. Over time, with the symptoms management, your strength begins to return, and your PT will advise you how to introduce functional activities back into your routine safely. Most people return to normal daily activities at about 3-months post-op. If you are very active and into sports, those higher-level activities will take place approximately 6-months post-operatively.

Next Steps

If your hip pain is sharp in nature and continues to advance in severity, it is recommended you visit with your physician. Proper diagnosis is important in determining the best treatment approach for you.

Early intervention is the key to managing FAI. The sooner you address your hip pain, the more likely conservative care will work for you. As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.

To get started with conservative care today, you can find a highly qualified PT in your area. There are many qualified PTs, so to find one near you, please click on the following link (FOTO PT database link). This link will help you find a PT that has top national rankings for treating hip pain.

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