Hip Impingement Syndrome: Understanding Femoroacetabular Impingement and Its Impact on Mobility

Hip impingement syndrome, also known as femoroacetabular impingement (FAI), is a common but often misunderstood cause of hip pain, particularly in active individuals. It occurs when the ball (femoral head) and socket (acetabulum) of the hip joint don’t fit together as they should, leading to abnormal friction and restricted movement. Over time, this can result in pain, inflammation, and damage to the hip joint.

In this post, we’ll take a closer look at the causes, symptoms, and treatment options for hip impingement syndrome, providing a comprehensive guide for anyone experiencing hip pain or mobility issues.

What Is Femoroacetabular Impingement (FAI)?

Femoroacetabular impingement occurs when there is abnormal contact between the femoral head and the acetabulum, the socket of the hip joint. This abnormal contact can be caused by two main types of deformities:

• Cam Impingement: This happens when the femoral head is abnormally shaped, often resembling a cam (a non-spherical shape), which causes it to rub against the acetabulum during movement.

• Pincer Impingement: In this case, the acetabulum is too deep or has an overhang, causing it to pinch the femoral head during movement.

In many cases, a combination of both cam and pincer impingement exists, which can exacerbate the symptoms and impact the function of the hip joint.

What Causes Hip Impingement Syndrome?

Hip impingement syndrome typically develops over time and is often associated with certain risk factors:

1. Genetics
   Some individuals may be born with a hip joint structure that predisposes them to FAI, such as an abnormally shaped femoral head or acetabulum.

2. Repetitive Hip Movements
   Activities that involve repetitive hip flexion, rotation, or deep squatting, such as running, cycling, ballet, or weightlifting, can increase the risk of developing hip impingement syndrome. Overuse can contribute to the abnormal wear and tear of the joint.

3. Previous Hip Injuries
   Injuries to the hip, such as fractures or dislocations, may lead to changes in the joint’s structure and contribute to the development of impingement syndrome.

4. Age
   FAI is most commonly seen in young, active individuals, particularly those between the ages of 20 and 40. As people age, the cartilage in the hip joint may wear down, further contributing to the symptoms of impingement syndrome.

Symptoms of Hip Impingement Syndrome

The symptoms of hip impingement syndrome vary, but the most common signs include:

• Hip Pain: The pain is often felt in the groin area but can also extend to the outer hip, thigh, or buttocks. The pain may worsen with certain movements, especially those that involve hip flexion, such as squatting or bending forward.

• Limited Range of Motion: People with FAI often experience a reduction in hip flexibility and difficulty performing activities that require full range of motion, such as tying shoes or performing high-impact exercises.

• Clicking or Locking Sensation: Some individuals report a clicking, popping, or locking sensation in the hip joint, particularly when moving the leg in certain ways.

• Pain After Activity: The pain typically worsens after prolonged activity or exercise, particularly activities that involve repetitive hip movements.

Diagnosing Hip Impingement Syndrome

To diagnose hip impingement syndrome, a physiotherapist or physician will conduct a thorough evaluation that may include:

1. Physical Examination: The clinician will assess the hip's range of motion and look for signs of pain or restricted movement during specific movements.

2. Imaging: X-rays and MRIs can be used to evaluate the structural abnormalities of the hip joint, including the shape of the femoral head and acetabulum, and to check for any damage to the cartilage.

3. Functional Tests: Special tests may be performed to simulate the motions that cause pain and evaluate how the joint moves under pressure.

Treatment for Hip Impingement Syndrome

The treatment for hip impingement syndrome largely depends on the severity of the condition and the specific symptoms experienced. In most cases, conservative treatments are effective in relieving pain and improving mobility.

1. Physiotherapy
   Physiotherapy is the first-line treatment for hip impingement syndrome. A physiotherapist can create a personalized rehabilitation plan to address muscle imbalances, improve joint mobility, and reduce pain. Key interventions may include:

   • Strengthening Exercises: Targeting the muscles around the hip, including the glutes, hip flexors, and core, to improve stability and support the hip joint.

   • Stretching: Increasing flexibility in the hip and surrounding muscles to alleviate tightness and reduce strain on the joint.

   • Manual Therapy: Techniques such as joint mobilizations and soft tissue massage may be used to improve hip function and reduce discomfort.

2. Activity Modification
   Modifying activities that exacerbate symptoms, such as avoiding deep squats or high-impact exercises, can help reduce strain on the hip joint. A physiotherapist can recommend alternative exercises that are less stressful on the hip.

3. Pain Management
   Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain-relieving medications may be recommended to reduce inflammation and relieve pain. In some cases, corticosteroid injections may be used to provide more targeted pain relief.

4. Surgical Intervention
   If conservative treatments do not provide relief and symptoms persist, surgery may be considered. Hip arthroscopy, a minimally invasive procedure, can be used to remove damaged tissue, reshape the femoral head, or address any bony abnormalities in the acetabulum.

Preventing Hip Impingement Syndrome

While it may not always be possible to prevent hip impingement syndrome, there are steps you can take to reduce your risk:

• Maintain a Healthy Weight: Excess weight places additional stress on the hip joint, increasing the risk of hip impingement.

• Warm-Up Properly: Always warm up before exercise to ensure your muscles and joints are prepared for activity.

• Strengthen the Hip Muscles: A strong hip stabilizer musculature helps support the hip joint and reduce the risk of injury.

• Pay Attention to Posture: Proper posture and alignment during activities like sitting, standing, and walking can reduce unnecessary stress on the hip.

Final Thoughts

Hip impingement syndrome is a common cause of hip pain, especially in active individuals. Early intervention, including physiotherapy and activity modifications, can help manage symptoms and improve mobility. If you’re experiencing hip pain or suspect you may have FAI, don’t hesitate to reach out to Muscle People Physiotherapy. Our team can provide a thorough evaluation and develop a treatment plan tailored to your needs.