A Guide to Physical Therapy for Hip Impingement
Hip impingement, also known as femoroacetabular impingement (FAI), is a condition that can cause pain and limited mobility in the hip. In this guide, we will discuss what hip impingement is, its symptoms, causes, diagnosis, conservative treatment options, and prevention tips.
Hip impingement is most common in young athletes, but can happen to anyone. Plus, it is correlated to the development of hip arthritis later in life. Conservative management with a CityPT physical therapist can help reduce dysfunction and pain to maximize the quality of life.1
- Understanding Hip Impingement
- Symptoms of Hip Impingement (FAI)
- Causes of Femoroacetabular Impingement
- Diagnosing Hip Impingement
- What to Expect from Physical Therapy for Hip Impingement
- Do I Need Surgery for Hip Impingement?
- Tips for Preventing Hip Impingement
- Get Hip Pain Relief
Hip impingement (FAI) is a condition that occurs when the ball (head of the femur) and socket (acetabulum) of the hip joint are in abnormal contact with each other during daily activities. Symptoms are most common with hip flexion and internal rotation.
There are two types of hip impingement:
- Cam-type impingement: This occurs when the femoral head is abnormally shaped. It can cause damage to the hip joint cartilage over time.
- Pincer-type impingement: This occurs when the socket edge protrudes and rubs against the femoral head. This can be due to bony overgrowth of the pelvis that "deepens" the socket of the hip or a change in the normal angle of the socket.
The most common symptoms of FAI include:2
- Pain in the hip that gets worse with activity
- Difficulty and/or pain with particular daily activities, positions, and/or sports
- Pain in the groin, outer thigh, or buttock
- Pain can also radiate down into the knee
- Stiffness and decreased range of motion in the hip
- A snapping or clicking sensation in the hip
- Weakness in the muscles around the hip or core
Most often, the onset of hip impingement involves a variety of factors and cannot be pinpointed to one specific cause.
Risk factors and possible contributors for developing FAI include:3
- Participation in high-impact sports such as football, hockey, soccer, and running that require repetitive high-force hip rotation and flexion
- Previous hip injury or surgery
- Family history of hip impingement or arthritis
- Age (more common in young adults)
- Gender (more common in males)
- Weak muscles around the hip — particularly of the deep rotators
- Joint stiffness
- Childhood hip diseases, such as Legge-Calve-Perthes disease or a slipped capital femoral epiphysis
- Poor healing (malunion) after a fracture of the head of the femur
- Over-correction of surgical repairs for hip dysplasia
There isn't one gold standard for diagnosing hip impingement. This is important to understand since imaging of the hip can reveal evidence of FAI in people without any pain or hip symptoms.2
What's most important in diagnosing hip impingement is looking at symptoms and clinical findings from an in-depth evaluation. A CityPT physical therapist is best equipped to complete this evaluation since they can do so at any time or place. During this time, they will be assessing important factors such as:
- Your symptoms and how long you have been experiencing them
- What makes your symptoms better or worse
- Your medical history (including any previous hip surgeries, injuries, or conditions)
- Family history of hip problems or arthritis
- Participation in sports and/or other physical activities
- Overall health and lifestyle habits
- Physical examination of your hip, including range of motion, strength, special tests, and functional tests
After taking a thorough history and completing a remote or in-person physical examination, your PT can refer you to your doctor for imaging studies, if needed. Tests like an X-ray or MRI can further evaluate the structures around your hip and rule out another possible hip pathology.
Managing hip impingement is often about managing symptoms caused by a weak and stiff hip — all while protecting the tissues that are prone to pinching and irritation. Appropriate treatment options include:
- Gentle manual therapy to increase hip joint range of motion and decrease stiffness
- Stretching and strengthening exercises — with an emphasis on neuromuscular control of the muscle around the hip and core
- Modalities such as heat, ice, or electrical stimulation for short pain relief (if needed)
- Education on optimal mechanics during activities and exercises to avoid aggravating your symptoms
- Activity modification or avoidance of activities and positions that worsen your pain or compromise local impinged tissues
The long-term goal of physical therapy for hip impingement is to help you return to the activities you enjoy without pain or fear of further injury. It may need to be paired with other modalities such as injections to yield optimal healing and results.2
While hip arthroscopy surgery is relatively common for hip impingement, the research is limited in supporting this option for long-term benefits.4 Thus, invasive surgery should be reserved for those who have failed a trial of conservative care (including physical therapy) and still have significant pain or functional limitations.
If you do undergo surgery, a physical therapy program with a CityPT physical therapist is crucial for maximizing your outcomes and hip health.
Since the primary causes of hip impingement are not well understood, prevention can be complicated as well. Overall, it's most important to keep the hips (and core) strong and coordinated to prevent unnecessary strain on the joint. You should talk to your clinician if you are at risk for hip impingement and want guidance.
Additionally, leading a healthy lifestyle with a focus on good nutrition, sleep, and mental health can boost tissue health, and healing capabilities, and help you live your life to the fullest with a lower risk of pain.
If you have hip pain, are concerned about developing hip pain, or it is getting worse — it's time to get support you deserve.
Working with a CityPT physical therapist can help you find the best way to manage your hip impingement symptoms. Book an in-person or virtual appointment today to get started as soon as possible.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
O'Rourke RJ, El Bitar Y. Femoroacetabular Impingement. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547699/ ↩
Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016; 50(19):1169-76. ↩ ↩2 ↩3
Physiopedia. Femoroacetabular impingment. Physiopedia.com Accessed September 13, 2022. https://www.physio-pedia.com/Femoroacetabular_Impingement ↩
Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med. 2018 Feb 1:363546517751912. ↩