Definitive Guide on Hip Impingement Physiotherapy

If you experience dull aches and sharp pain in the hip and groin area, even radiating to the leg and lower back, hip impingement could be causing it. This condition can limit your favorite activities and overall quality of life.

Femoroacetabular impingement (FAI) of the hip affects men and women in Asian countries like Singapore. It caused 0.6% of hip osteoarthritis cases, alongside developmental dysplasia. FAI can lead to a progressive decline in hip function if not managed or treated. This can cause significant pain and stiffness, making it difficult to perform everyday activities like walking, climbing stairs, or getting in and out of a car.

*Recommend to delete or replace this photo because pain shown is not really in the hip (and it says right on top "hip and groin area"

Several treatment options are available for FAI, including activity modifications, physical therapy, and surgical interventions. Depending on severity, conservative approaches like physical therapy treatment and the right exercise program help manage hip impingement, relieve pain, and improve mobility.

This article explains how hip impingement occurs, its causes and symptoms, diagnosis, and physiotherapy treatment options. We will also cover hip impingement exercises to regain strength and mobility.

What is Hip Impingement?

The hip consists of a ball-and-socket joint for a wide range of hip movements. When these hip joint structures rub abnormally, the friction damages the articular cartilage, a smooth covering of your hip bones. Consequently, it leads to pain and decreased ability to perform activities that involve hip flexion, internal rotation, or prolonged sitting.

Femoroacetabular impingement syndrome has three variations, namely pincer impingement, cam impingement, and a combination of both.

Pincer-Type Impingement

*Maybe we can include a photo here similar to the one used in Physiotherapy for hip labral tear (internal link below)

Pincer FAI occurs when the socket (acetabulum) gets too snug and develops extra bone growth, causing it to pinch the labrum - a rim of connective tissues that serve as shock absorbers in the hip. The constant rubbing and pressure may lead to wear and tear, causing inflammation and hip labral tear.

This type can manifest similar symptoms to other hip problems, but some common ones include:

• Groin pain, especially during activity or after sitting for long periods
• Stiffness in the hip, limiting your range of motion
• A catching, clicking, or locking sensation in the hip joint
• Difficulty with activities that require deep hip flexion, like squatting or putting on shoes

Physiotherapy for hip labral tear and pincer impingement can be the first course of treatment to improve pain, restore mobility, and strengthen the muscles surrounding the hip joint, potentially avoiding the need for surgery.

Cam-Type Impingement

Here, the abnormal shape of the femoral head, often with a bump on the femoral neck (proximal femur), creates friction against the socket. This type is basically the opposite of pincer impingement but mirrors the same symptoms with slight variations.

As for the combined impingement, this refers to abnormal development or growth on both the femur and the acetabulum.

How Does Hip Impingement Happen?

Hip impingement often develops in young, active individuals between the ages of 20 and 45. FAI occurs when the hip joint structures and bones are deformed, causing them to rub against each other. Repetitive activities that involve deep squats, climbing stairs, or internal rotation (like pivoting in sports) can cause biomechanical abnormalities, leading to bony overgrowth or abnormal femoral head shape.

The cause of the extra bone bump in FAI remains a mystery. Some research suggests genes might be involved, while others point to intense sports during teenage years when bones are still growing.

What Are the Symptoms of Hip Impingement?

The most common hip impingement symptom is hip pain, often described as a dull ache in the groin, thigh, lower back, buttock area, or knee. You might feel pain with specific hip movements, decreased range of motion, and a catching or clicking sensation in the hip.

To indicate pain location, people with hip impingement may form a "C" sign with their thumb and place their hand on the fold of the hip (front and side).

Hip pain from FAI often starts mild and might stay that way for a long time. However, things can take a turn for the worse quickly. The pain can become severe and stop you from enjoying sports or other activities you love.

How to Diagnose Hip Impingement

An accurate diagnosis is crucial for effective hip impingement treatment. Your doctor or physical therapist will initially conduct an interview to assess your symptoms and discuss goals for your treatment.

During your physical therapy evaluation, the therapist will assess your hip and surrounding areas to understand your pain and mobility. This might involve:

• Observing your gait: The therapist will watch you walk to identify any abnormal patterns that could be linked to your hip pain.
• Movement assessment: They will assess your ability to perform specific movements, even if not painful, like squatting. This helps identify limitations.
• Joint range of motion: They will evaluate the range of motion in both hips, your entire lower leg (from hip to toes), and your trunk.
• Muscle strength testing: The therapist will assess the strength of your hips, legs, and core muscles.
• Balance and coordination: They will evaluate your balance and coordination on each leg.
• Flexibility testing: They will assess the flexibility of your hips and other lower leg joints.
• Special tests: In addition to general assessments, the therapist might use specific tests like the "log roll" or "FADDIR" test to pinpoint the source of your hip pain. These tests involve gentle leg movements in specific directions.

To confirm FAI, doctors will likely use imaging tests like X-rays, MRIs, or CT scans of your hip. The good news? Surgery isn't always necessary. Physiotherapy offers a conservative treatment approach to manage FAI and get you back to enjoying life without invasive clinical methods.

How to Treat Hip Impingement

Broadly speaking, there are surgical and non-surgical treatments for FAI. There are two main surgical management and procedures for hip impingement if conservative treatment options do not suffice.

Arthroscopy

This procedure is minimally invasive, using a camera and small tools inserted through tiny incisions. A surgeon can trim excess bone from the socket (pincer impingement) or reshape the femoral head (cam impingement) to create more space in the joint.

Arthroscopic surgery generally allows patients to have outpatient surgery and has a quicker recovery time.

Open Surgery

On the other hand, the open approach is a more invasive procedure requiring a larger incision. It is used for complex cases or when arthroscopy isn't suitable. This may involve more extensive bone reshaping or repair of damaged tissue, and a longer hospital stay and recovery time.

Non-Surgical Treatment

This option is typically the initial solution to managing FAI or hip impingement. Non-surgical treatment involves:

• Activity modification to prevent aggravating symptoms
• Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen and naproxen
• Steroid injections to reduce inflammation
• Physical therapy to strengthen and improve range of motion
• Both general courses of treatment help effectively reduce symptoms and treat hip impingement.

How Does Physiotherapy Help with Hip Impingement?

In Singapore, a multidisciplinary physical therapy provider like Phoenix Rehab focuses on relieving pain, improving hip mobility and stability, and restoring function. Their skilled professionals specialize in muscle, bone, and joint pain, including hip fracture physiotherapy.

Here's how physiotherapy helps with FAI:

• Decreasing Pain: Techniques like manual therapy and modalities like ice or heat can help ease pain in the early stages.
• Improving Range of Motion: Gentle stretching exercises improve hip joint mobility and decrease stiffness.
• Strengthening Muscles: Strengthening exercises for the hip and core muscles improve hip stability and joint movement, protecting the hip joint from further impingement.
• Functional Training: Exercises that mimic your daily activities or sports movements (functional training) help you return to your desired level of activity safely and efficiently.

What Does Hip Impingement Physiotherapy Involve?

Physiotherapy utilizes a multi-pronged approach to address pain, improve mobility, and strengthen the hip joint. Even physiotherapy for hip osteoarthritis, a chronic condition, proves highly effective in managing symptoms and delaying the need for surgery.

Here's a closer look at some of the key techniques your physical therapist might incorporate into your treatment plan.

Hydrotherapy

This involves using the therapeutic properties of water to manage pain and improve mobility. Exercises performed in a warm pool can be gentle on the joints, allowing for a wider range of motion without excessive strain. The buoyancy of water also helps reduce pressure on the hip joint, making it easier to move and strengthen the surrounding muscles.

Core Stability Exercises

A strong core is essential for proper body mechanics and stability. Your physical therapist will design exercises that target your core muscles, including the abdominals, obliques, and lower back. Strengthening these muscles helps provide better support for the spine and pelvis, reducing stress on the hip joint.

Proprioceptive Exercise

Proprioception (kinesthetic sense) refers to your body's awareness of joint position and movement. Exercises that challenge your balance and coordination can improve proprioception in the hip joint. This enhanced awareness helps your body control hip movement more effectively, preventing abnormal rubbing or impingement during daily activities.

Manipulation / Mobilisation

Gentle manual techniques with the guidance of your physical therapist can improve joint mobility and ease pain. These techniques might involve specific movements applied to the hip joint or surrounding soft tissues. Manual therapy can also help break down scar tissue that might be contributing to stiffness and pain.

Exercise Programs

A personalized exercise program is fundamental for hip physiotherapy designed specifically for you. This program will typically include the following exercises.

Stretching Exercises

Gentle stretches target tight muscles around the hip joint, improving flexibility and range of motion. Improved flexibility allows for better movement patterns and reduces the risk of impingement.

Strengthening Exercises

These are exercises designed to strengthen the muscles around the hip joint, including the glutes, hamstrings, quadriceps, and hip rotators. Stronger muscles provide better stability and support for the hip joint, protecting it from further impingement.

Functional Training

As you progress, your physical therapist will incorporate exercises that mimic your daily activities or sports movements. This functional training helps prepare you to return to your desired level of activity safely and efficiently. The exercises will gradually increase in complexity, mimicking the specific demands placed on your hip during your daily life.

Hip impingement physiotherapy and exercises address the various aspects of FAI, paving the way for a pain-free and active life.

Things to Consider During Hip Impingement Physiotherapy

Here are some things to keep in mind while undergoing physiotherapy for the hips.

• Relative Rest: Avoid activities that aggravate your pain, but don't become completely sedentary.
• Patient Education: Understanding your condition and treatment plan is crucial for successful recovery. Your physical therapist will educate you on proper posture, biomechanics, and exercises you can do at home.
• Listen to Your Body: Don't push yourself too hard, and gradually increase the intensity of your exercises as your pain improves.

What to Avoid

While physiotherapy helps manage FAI, certain activities can hinder your progress. These include:

• Deep Squats: Avoid deep squats or activities that cause sharp pain in the hip.
• Prolonged Sitting: Take frequent breaks to get up and move around, especially if your job involves prolonged sitting.

Why Prioritise Treatment

Ignoring hip impingement can lead to long-term complications. We've discussed how untreated FAI can contribute to osteoarthritis. Early diagnosis and physiotherapy treatment can significantly improve your patient outcomes and prevent the need for more invasive procedures like hip arthroscopy or surgery.

Conclusion

Hip impingement physiotherapy empowers you to become an active participant in your hip health. Through a personalized program and commitment to exercise, you can experience lasting pain relief, regain lost mobility and flexibility, strengthen your core, and return to normal activities.