Hip impingement also known as femoroacetabular impingement (FAI) is a common hip complaint. The hip joint is a ball-and-socket joint, because the ball-like top of your thigh bone (Femur) fits into a cup-like area within your pelvis (Acetabulum)
There are two main types of FAI. The first is caused by a deformity of the femoral head (ball).
The second, occurs when the acetabulum (cup) is abnormally shaped. This causes the hip not to glide / track normally, irritating the soft tissues around the hip causing pain and swelling to develop.
Although for many people, the abnormal shape is thought to have been present since birth there is a possibility these changes occur over time.
FAI can also be affected by your occupation or your sporting hobbies, past injury/trauma to your hip such as a fracture, dislocation, or infection and the muscular control you have around your hip.
The most common symptoms of hip impingement are:
- Pain in the groin / front of the thigh
- Stiffness in the groin / front of the thigh
- Reduced ability to bend the hip at the waist (knee to chest)
- Pain is worse with or after activity
- Stiffness worse with inactivity
- Increased symptoms when putting shoes or socks on the affected side
- Walking or standing for longer periods
- Increased symptoms getting in or out of the car
Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.
An image/scan is generally not needed to confirm FAI. One may be performed if the Health Care Professional needs further information to finalise the diagnosis or if surgery is being considered.
The primary aim of treatment is to help manage your pain. This allows you to move more and help you return to normal activities sooner. Initial treatment therefore is aimed at pain control. This might involve pain medication, or the use of heat or cold treatments.
Once your pain is under control, working on the movement and strength of your hip is what will help long term.
You can help to reduce pain, ease stiffness, strengthen your muscles and improve overall general fitness by keeping active. Below are some basic exercises specific to your hip to get you started.
It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.
The number (reps) and frequency (sets) of exercises suggested here are a guide, and should be performed to your personal tolerable pain levels. This means repetitions will vary between individuals and you should only go as far as is reasonably comfortable for you.
Pelvic tilts
Lie on your back with your knees bent and feet flat on the floor. Pull your bellybutton towards your spine and clench your buttock muscles to roll the tail bone up off the floor. The majority of the effort should come from your abdominal and buttock muscles. Your lower back should press firmly into the floor. Relax and repeat.
Heel slides
Lie on your back with your legs straight out in front of you. Ensure you point your knees and toes directly up to the ceiling. Exhale and tighten your abdominal and pelvic floor muscles, stabilising your trunk and your pelvis. Simultaneously slide one heel along the floor towards your buttock. Hold this position as you inhale. Exhale and slide the foot back down to the starting position. Make sure your knee continues to point directly up to the ceiling throughout this entire movement.
Bent knee fall out
Lie on your back with your legs bent and your feet on the floor and your knees at hips-width apart. Initiate the core stability muscles, then gradually drop one knee out to the side. The aim of this exercise is to keep the pelvis level, and the stationary leg still. Imagine headlights on each hip bone pointing directly up to the ceiling. Do not allow these headlights to rotate from this point. Control the movement as you bring the knee back in, and repeat with the other leg.
Unless you have a serious injury or have sudden continuous severe pain, you can usually treat your hip pain without having to see your doctor. If after 2 weeks of treating yourself you feel the pain isn’t any better or is worsening, you should see a Health Care Professional.
You should also see a Health Care Professional if you:
- Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
- Have pain that has rapidly deteriorated or suddenly worsened despite self help
- Have pain, tingling, numbness or weakness in your legs or feet
- Develop sudden stiffness in the hip resulting in a complete loss of movement
- Are noticing changes to your balance or walking pattern
- Are feeling clumsy or are falling more often
- Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
- Feel unwell, have a fever, or unexplained weight loss
- Are experiencing significant and regular changes to your usual sleeping pattern
- Have a history of recent injury (e.g. from a road traffic accident or a fall) or a history of hip surgery
- Have a new and visible deformed or misshapen hip or leg
If you do not have any of the above, you may be able to effectively self-manage your condition