20 Aug Hip Impingement!
Hip pain is a common issue we see here in the clinic. Patients can complain of a ‘pinching’ when doing things like squats, getting in and out of the car or just simply sitting in a soft chair or crossing their legs. Now just because you get a pinch in the hip every now and then when you’re working out certainly doesn’t mean that you have a significant injury or issue that needs specific rehab. As everyone is made differently, hip joint shape and your overall makeup play a large role in what feels comfortable when squatting and what will feel a bit unpleasant. Things like how tall you are, your inherent movement patterns, your ankle range of movement and how long your femur (upper leg bone) is in relation to your tibia (lower leg bone) can have a significant impact on your ideal squatting setup. A few easy ways to get on top of the intermittent pinch include basic hip/ankle mobility work, modifying your foot positioning (width and rotation) and attempting different squat types (i.e. high bar vs low bar vs front squat).
Those with long standing hip pain will often present with Femoroacetabular Impingement Syndrome (FAIS). Generally, people with FAIS will complain about a position dependent pain deep in the hip which is worse with flexion (knee closer to chest) and inward rotation. Although pain is felt in the hip, it can also be felt in the back, buttock and thigh and for this reason it is important to get a thorough assessment to eliminate any other possible diagnosis. People with FAIS can also experience a clicking, catching or locking and will generally feel increased stiffness of the joint. When assessing clinically, if we suspect FAIS we want to rule out any other contributor and in particular look for reduced range of movement and pain provocation with impingement testing.
As the above symptoms can also be attributed to osteoarthritis (OA) of the hip joint, it is important to have an X-ray not only to rule out OA or any other possible contributor to your stiffness, but to look for bony changes that are consistent with FAIS (cam or pincer morphology see below). If your symptoms, clinical signs and X-ray are in line with what we expect, then your diagnosis is FAIS.
Management of FAIS is usually dependent on the severity of your symptoms, the impact it is having on your day to day life and your specific goals. FAIS can be treated through either physiotherapy led rehabilitation, or via surgery and post-op rehab. The decision of what path to take is specific to every person and should be made in partnership with you, your physiotherapist and/or sports physician. Most cases can be rehabbed conservatively without the need for surgical intervention. As with most injuries the initial focus is on calming symptoms, before starting with mobility exercises and strengthening work targeting the hip but also addressing the entire body. Strength work will progress via deeper range of movement and increased load then incorporate speed and sports specific work.
Hip ‘impingement’ symptoms are a continuum and may require simple modifications to your training such as mobility work and setup changes. More persistent and aggravated symptoms require further treatment, be it conservative rehabilitation or surgical intervention. Management depends on your current situation and your goals and as such it is important that a collaborative approach is taken when deciding on a management plan. If you are currently dealing with hip pain, whether it is for some minor technique modification or a full rehabilitation plan, the physiotherapists here at Enhance Physiotherapy have you covered!