What Causes Hip Impingement, and How Do I Fix It?

Femoroacetabular impingement sounds daunting at first — as do most other diagnoses with intimidatingly long names. Which is why most people shorten it to “FAI” or “hip impingement” instead.

Regardless of what you call it, FAI is a relatively common diagnosis, especially in a world of desk jobs and sedentary lifestyles.

The problem being: even though it’s common, not a lot of people know what it is or why they have it, let alone how to get rid of it.

And that’s precisely why we’ve written this blog. No matter how common a diagnosis may be, that knowledge will only take you so far without understanding all the in’s and out’s of the issue!

So, without further ado, here’s your comprehensive breakdown of all things hip impingement.

What Is Hip Impingement?

Referring to FAI as “hip impingement” is more than just for convenience; it’s also a pretty straightforward description of what the diagnosis is.

Impingement occurs when a small portion of soft tissue gets pinched between two bony segments of a joint. And in the case of your hip joint, this occurs between your acetabulum (the actual hip socket) and the head and neck of your femur:

What Does a Hip Impingement Feel Like?

Simply put, a hip impingement feels like what it is: a pinching pain in the hip.

It most commonly occurs on the front side of your hip and often comes paired with pain or stiffness around the groin. Though, depending on the type of impingement that develops, you may also experience pain on the backside of the hip bone as well.

As for the type of pain you may experience, people typically identify it as one of two sensations: either a dull and achy pain, or a sharp pang inside the joint. For some, it presents as a constant pain, where others may feel it come and go with certain activities.

The frequency and quality of pain primarily depends on how aggravated the tissue becomes. In some cases, an impingement may be more like a self-limiting condition, where you can work through the pain or aggravation. But, if the pinching is intense, or the tissue becomes particularly inflamed, your pain receptors will likely signal you to stop and take a break from whatever activity you’re doing.

What Causes Hip Impingement?

There are two main reasons why your hip socket may develop an impingement: structural abnormalities in the bony anatomy, and biomechanical deficiencies.

Let’s tackle the former category first…

If you Google “hip impingement,” you’re practically guaranteed to come across articles or diagrams distinguishing a “cam impingement” from a “pincer impingement.” Both of these terms refer to small, bony anomalies that disrupt the smooth range of motion within the hip socket and joint itself.

The difference between the two is simply based on where they’re located — a cam impingement involves a bony protrusion somewhere along the femoral head or neck, while a pincer impingement is a protrusion within the acetabular rim.

Either of these impingement variations can be treated with surgical removal, but they often don’t require invasive measures. More than anything, these bits of excess bone simply create less space for joint motion, increasing the chances that your bones come together and compress the soft tissue.

But, here’s the kicker: not everyone with a hip impingement has these bony protrusions…

More often than not, an impingement is brought on by biomechanical deficiencies that impact your hip’s range of motion.

The primary culprits here are weak glute muscles and poor muscular control and strength in the deep abdominal muscles (i.e., the transverse abdominis and the obliques).

Perhaps it seems strange that your buttocks and ab muscles can cause pain in your hip joint — it’s certainly not the most intuitive correlation, but here’s the gist of it:

Both of these muscle groups connect to either your hip or thigh bones (the pelvis and femur, respectively). If either group presents deficiencies, like poor activation or insufficient strength, it can lead to compensatory movements that limit your hip joint so it can’t properly move through its range of motion, leading to that pinching of the soft tissue.

(And don’t worry — we’ll review some of the most common compensations in more detail in the treatment section later in this article.)

How to Test for Hip Impingement

Of course, diagnosing a pathology requires more than just symptomatic pain.

Even though that telltale pinching sensation at the hip is a solid indicator, there are several ways to assess your joint’s range of motion for more accurate identification.

Many people assume that imaging and MRI scans are required for diagnosing a hip impingement, but they’re only relevant if you present either of those bony obstructions (cam or pincer).

Instead, medical professionals commonly utilize one of two biomechanical assessments based on where you feel the pinching or pain: the FADIR and FABER tests.

(Do keep in mind: these assessments may seem relatively simple to execute, it’s best to work with a medical profession who can facilitate the test. This will not only ensure that you’re performing the motions correctly, but it also eliminates any potential of worsening the injury.)

For those who experience symptoms in the front of their hip or in the groin area, you’d go through the FADIR assessment, which stands for flexion, adduction, and internal rotation. When combined, these are the primary movement patterns that can aggravate the tissue if you present impingement.

This test is performed with you lying on your back. Your legs should be straight and relaxed. Then, your practitioner will raise your affected leg up towards your chest and across the body, bending the knee and hip at about 90 degrees. Experiencing any pain with this motion is characteristically associated with hip impingement.

Conversely, with pain felt in the backside of the hip, you’d go through the FABER assessment, which recruits flexion, abduction, and external rotation motions instead.

This test will also be performed as you’re lying on your back. But, instead of bringing the knee up and inwards, your practitioner will bring the ankle of your affected leg onto the thigh of your other leg. Then, they will prompt you to let your leg drop down or relax in this position. This will rotate your knee outwards while your foot and calf move inward.

It’s important to note that experiencing pain with the FABER test can actually be indicative of other potential pathologies, like issues in the sacroiliac joint. The key indicator for impingment is a specific pinching sensation in the back of your hip alongside pressure in your crossed leg — your practitioner can help you sort out and interpret your symptoms.

How to Fix Hip Impingement

Since hip impingement is most frequently caused by biomechanical impairments, you can probably infer what the best solution is…

Tackling those impairments, head on!

As with many pathologies, the most effective way to eliminate hip impingement is to directly address the root cause, rather than simply alleviating the symptoms.

In our clinic, we’ve found that the following impairments are the most common culprits associated with hip impingement: anterior pelvic tilt, pelvic drop, and thigh adduction.

Keep in mind that, because these impairments are distinct from one another, they each require their own progressive treatment plans. There’s no singular solution that can tackle all three issues at once, so it’s vital to speak with a medical professional or a movement specialist! They can not only diagnose the issue, but they’ll also help you identify what specific movements or anatomical structures require attention for a full recovery.

And while we’re unable to provide specific treatment plans for each impairment — at least, without further evaluation — there are several essential components that you’ll likely see throughout your plan of care:

  1. Reducing inflammation of the soft tissue,
  2. Regaining hip range of motion,
  3. Restoring glute activation,
  4. Building glute strength,
  5. Improving muscular & alignment control through movement.

The duration or intensity of each component are dependent on your current movement capabilities. But, with proper assessment and the right team to support you through your treatment, targeting your biomechanics will result in long-term relief from your symptoms.

Say Goodbye to FAI!

In today’s day and age, it can be difficult to avoid sedentary positions or habits that can contribute to issues like hip impingement.

But, that doesn’t mean it’s inevitable.The trick to identifying — and more importantly, alleviating — common diagnoses like hip impingement is to learn why they happen. (On a general level, and specific to your experience.)

Once you harbor that knowledge, you’re on your way to setting a game plan for your recovery and returning to a pain-free lifestyle!

By Dr. Torey Page DPT OCS

Dr. Page is recognized as a specialist in evaluation and rehabilitation of the lower extremity, spine, and shoulder. He has had years of experience working as a physical therapist and as a strength and conditioning coach, so he is well-versed in the analysis of human movement and biomechanics (as well as advanced training in running mechanics and return to sport training). Torey has advised a wide range of clients, from sports teams to triathletes to the Woodside Fire Department. In his spare time, he enjoys spending time with his wife Joey, their beautiful daughter Savannah, and their dog Gatsby.

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