Hip impingement

The hip joint is made up of your femur meeting the pelvis. The joint itself is a ball and socket joint due to the shape of the thigh bone which fits into a cup-like area within the pelvis. In normal circumstances this ball and socket joint glides smoothly within the socket however, a problem with the ball or the socket rim can interfere with the smooth motion of this joint.

Hip impingement is as a result of changes that have been caused to this joint that causes abnormal friction in the socket causing damage to the cartilage lining the socket and eventually leads to pain.

In most cases, the patients with hip impingement are young and physically active. You may have hip impingement and not know about it as it’s not painful in its early stages. Symptoms are most often present on one side of the hip and the symptoms experienced are some of the following:

• Pain in the front of the hip and/or groin area that is described as dull and achy in nature
• Pain that may radiate to the outside of the thigh
• Symptoms that are made worse with prolonged sitting and provocative activities such as sitting, climbing stairs and movements requiring flexion and rotation of the hip.
• Initially, pain may be provoked with certain movements but over time the impingement may lead to pain that affects small movements also.
• Limited range of motion of the affected hip
• Sensation of stiffness

There are two main causes of hip impingement:

Cam impingement – This is a deformity created in the ball portion of the ball and socket joint which is at the top of the femur. Any changes in the shape of the ball can cause jams in the socket when the hip is bent. This can happen during cycling or bending forwards.

Pincer Impingement – This impingement is a result of cartilage overdevelopment on the socket portion of the joint. If the rim of the socket sticks out too far as a result of a deformity, the neck portion of the thigh bone may rub against the deformity during normal movements of the hip causing pain.

On some occasions, there can be problems in both the ball and the socket joint. This can occur in conditions such as slipped capital femoral epiphysis, Legg-Calve-Perthes disease or coxa vara.
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The diagnosis of hip impingement will be based on the presenting symptoms and the completion of a complete physical examination which will include an orthopaedic assessment that may provoke some of the symptoms you are experiencing.

The diagnosis of hip impingement cannot be made solely on the basis of the sign and symptoms, so plain film imaging such as X-rays may be needed to identify any deformity within the joint and confirm the diagnosis of hip impingement.

This condition merits the consideration of non-surgical treatment first before proceeding with any invasive form of treatment.
Conservative management of this condition will consist of a personalised progressive program that includes patient education, activity restriction, stability/strengthening training and manual therapy that is provided by our practitioners depending on what they discover during the examination.

These are some of the tips you may wish to try yourself:

• Maintaining physical conditioning while avoiding activities that trigger the symptoms.
• Limit activities that cause repetitive impingement such as rotating the hips inwards and flexing them.
• Gently stretching your hip muscles
• Pilates exercises such as Glute Bridge increase the strength of your hip muscles.

If conservative treatment fails to provide you with any improvements then ultrasound-guided injection may be appropriate for you.

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Galeano NA, Guinea NS, Molinero JG, Bárez MG. Extra-articular hip impingement: A review of the literature. Radiología (English Edition). 2018 Mar 1;60(2):105-18.

Shanmugaraj A, Shell JR, Horner NS, Duong A, Simunovic N, Uchida S, Ayeni OR. How Useful Is the Flexion–Adduction–Internal Rotation Test for Diagnosing Femoroacetabular Impingement: A Systematic Review. Clinical Journal of Sport Medicine. 2020 Jan 1;30(1):76-82.

Bastos RM, de Carvalho Júnior JG, da Silva SA, Campos SF, Rosa MV, de Moraes Prianti B. Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials. Clinical rehabilitation. 2020 Nov 4:0269215520966694.