How To Move Without Pain

Hip Impingement Pain Relief

by Meghan Griech, PT, DPT, cert MDT, CKTP

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Hip impingement, more commonly referred to as femoral acetabular impingement (FAI), can develop for many different reasons. The exact cause is usually unknown, yet there are two specific types of FAI that can occur. The pain that occurs with FAI can often be annoying to debilitating depending on the types of activities you enjoy and the amount of pain you are in.

FAI can occur due movement within the joint caused by the shape of the femoral head or from an overgrowth of the anterior (front) hip tissues causing a pinching of the tissues during certain movements.

The hip joint is a ball-and-socket joint that attaches the femur (thigh bone) to the pelvis. The hip is one of the most mobile joints in the human body, with abilities to move forward, backward, rotate, and a combination of movements. The movement of the femoral head (ball-shaped structure at the top of the thigh bone) and the acetabulum (socket in the pelvis) depends on the joint being congruent in shape, and the tissue surrounding the joint needs to be structurally strong; otherwise adverse movements or pinching of structures can occur.

The names of these two main types of FAI described above are CAM and Pincer, yet you can have a combination of these also. A CAM Impingement is caused by a deformity of the femoral head (ball). In this type of impingement, the ball has a more oval than round appearance which creates friction when the ball hits the edge of the acetabulum (socket). For many people, the abnormal shape is thought to have been present since birth. It is also possible to develop this abnormal shape over time due to repetitive stresses, and is seen more frequently in young athletes that participate in sports involving a lot of twisting of the hip and squatting.

Pincer, on the other hand, occurs when the acetabulum (socket) is abnormally shaped. The acetabulum may cover the head of the femur too much, creating friction when the edge of the acetabulum hits the head/neck of the femur.  Often times, bending the hip greater than 90*(bringing the knee higher than hip) causes an increase in pain in the front of the hip. 

Most patients with FAI experience pain or stiffness in the groin or front of the thigh.

While the CAM style of impingement pain most often occurs due to repeated irritation of the tissue in certain positions, it is also most prevalent in middle-aged women. The pincer type of impingement most often occurs during a child’s development where extra bone growth in the hip socket

Normally, the ball glides smoothly within the socket, but a problem with this joint can interfere with smooth motion. Trauma from repetitive hip flexion damages the cartilage of the socket, leading to hip impingement or femoral acetabular impingement (FAI). It is believed to be a major cause of early osteoarthritis of the hip, particularly in those under age 40.

Hip impingement can lead to loss of rotation of the hip, especially internal (turning the hip in). That triggers pain in the groin area during or after flexing the hip, such as when you sit for long periods of time, run or jump. Over time, impingement of the hip may cause small tears in the labrum, the fibrous ring of cartilage surrounding the hip socket that acts as a suction cup to hold the femoral head in the socket.  Hip impingement also may damage the protective cartilage that covers the ends of the bones in the joint, called articular cartilage. That can wear down the cartilage over time and eventually may lead to osteoarthritis. 

Those with hip pain and concerned about loss of motion of their hip, should focus on maintaining their current motion while trying to move in ways that don’t aggravate their pain. 

What you can do

Maintaining mobility while reducing irritation to the hip is key. Modifying your daily, job-related, and sports activities will be beneficial to reduce tissue inflammation, tissue stress, and progressive pain. Reducing the amount of time sitting in one position will alleviate tissue pain from compression forces.  If you are having pain in the front of your hip while walking, shortening your stride length may reduce tissue pressure and possible pinching.

Complete activities focused on improving lower-extremity muscle flexibility and joint movement will be beneficial. Stretching tight muscles around the hip will reduce abnormal forces that cause pain with motion. Stretching other joints, especially those related to walking (knee, ankle, foot), also may decrease stress at the hip. 

Improving the strength of your lower extremities and trunk will help to reduce added stress and overworked muscles around the hip. Strengthening the hips and trunk can reduce abnormal forces on the already injured joint. 

Try icing when the pain is very limiting and painful, especially if it is causing you to limp. Changes in walking ability, can lead to adverse joint pressures of other joints leading to secondary irritations or increased risks of falls. 

When all else fails, ask for help. Talk to your primary care physician about options, which may include, medication, injections or physical therapy. 

*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result.  This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional.  No guarantees of specific results are expressly made or implied with this article.

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