Hip impingement, or more formally… femoral-acetabular impingement (FAI), is a common issue for many folks. Hip impingement often feels like sharp pain in the hip during activities or might even be present during bouts of inactivity (like sitting).
Prevalence varies with studies suggesting 3-10% of the U.S. population can experience hip impingement (hip pain symptoms + signs + imaging). StatPearls+1. PubMed+2Mayo Clinic+2. In one non-U.S. (Canada) study of white adults aged 20-49, the prevalence of FAI syndrome (symptoms + signs + imaging) was about 3.0 % (95% CI 1.5-4.5%). PubMed
It’s worth noting that folks can have imaging consistent with FAI and not be experiencing pain.
What is Hip Impingement?
It’s important to first understand what we mean by “hip joint”. Using the picture below, the hip joint would be the area where the femoral head sits in the acetabulum. Mechanically, hip impingement happens when the ball and socket of the hip joint don’t move together as smoothly as they should. Over time, this hip joint incongruency can cause friction, pain, reduced mobility and even arthritic changes in the hip joint.
The Two Primary Types of Hip Impingement
Cam Impingement: occurs when the ball of the femur (labeled femoral head in picture below) isn’t perfectly round. When you flex or rotate your hip, the femoral head can rub against the edge of the socket, irritating the cartilage and labrum. Cam shapes are often found in people who were active in sports growing up. Years of repetitive motion such as deep hip flexion might facilitate bone remodeling over time.
Pincer Impingement: occurs when the hip socket (labeled acetabulum in picture below) has too much coverage over the ball. That extra bone can “pinch” soft tissue during movement. Some individuals have both cam and pincer features, which can make hip flexion (like the bottom of a squat) feel tight or painful.
Supporting Structures
The hip joint is lined with cartilage, and a ring of tissue called the labrum. These structures provide cushioning, suctioning, and stabilization roles for the hip joint. Many professionals also feel that the labrum may serve a proprioceptive role for the hip similar to the ACL (anterior cruciate ligament) of the knee. This suggests that treatment and healing times may be lengthier than previously thought.
In addition to cartilage and labral tissue, surrounding hip musculature such as glutes, deep hip rotators, and pelvic muscles play a huge role in controlling hip motion. Strong, coordinated muscles help distribute load or work evenly across the joint and might reduce shear forces on sensitive tissues. With inadequate muscular support, joint forces may be increased, leading to increased pain and dysfunction over time. It’s also worth noting that glute muscle function and strength seems to be particularly important in hip preservation / and the treatment of hip impingement.
Conservative Management
While some cases of hip impingement require surgical intervention, many athletes (~ 60%) do well with a conservative, strength-based approach that aims to restore force production, stability, and functional range of motion about the hip(s).
Here are the key elements of a program aimed at the conservative management of hip impingement:
Strength Training
Strength training should restore, preserve, or perhaps increase pain-free range of motion. Programming should utilize large, compound exercises that are scalable in load and range of motion. Some examples we like include:
hip thrusts
split squat variations
rack pulls
box squats.
Range of Motion
Range of Motion (ROM) in the management of hip impingement is going to largely target internal rotation (IR). Not only has limited hip IR been correlated to long term hip degeneration, other areas of the body are often compromised with limited hip internal rotation (IR). For example, relationships between decreased hip IR and increased low back / knee injuries have been established in the research.
Mobility
Unlike passive flexibility (i.e., ROM), mobility is actively controlled movement through various joint ranges of motion. Think controlled articular rotations (CARs). These movements help teach strength and awareness at the joint level. Many athletes (particularly young ones) have difficulty isolating a joint and moving segmentally. A good example here would be an athlete that is unable to hinge through his/her hips without accompanying lumbar flexion. If you’ve ever coached a youth athlete, you know exactly what I’m talking about here.
Intelligent Program Design
Coaches should modify squat depth, stance width, and frequency when symptoms flare up. It’s unlikely the conservative management experience will be pain-free but continuing to push through discomfort without modification usually doesn’t produce the outcome we’re looking for. Additionally, coaches should closely monitor training volume and intensity. For more on these ideas, you can check my previous article on Programming Principles
The Big Picture
Hip impingement doesn’t have to be a career-ending diagnosis or a reason to stop training. I repeat, you should not stop training. With the right approach, focused strength work, restored rotation, and smart programming, you can move better, protect your joints, and continue building strength for years to come.
If hip tightness, pinching, or limited motion has slowed your progress, our team can help. We specialize in guiding lifters over 40 through smart, sustainable training that produces results.
Book a Meeting with one of our coaches and let’s talk about how we can get you moving.
