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Hip Impingement

The hip joint is where the proximal end of the femur (thigh bone) meets the acetabulum of the pelvis. It is typically referred to as a ball-and-socket joint, with the ball being the head of the femur (femoral head) and the socket being the acetabulum of the pelvic bone.

Both the acetabulum of the pelvis and head of the femur are lined with a layer of articular hyaline cartilage. Its principal function is to provide lubrication for low friction when the joint surfaces of the femur/acetabulum glide past one another and to facilitate load transmission during weight-bearing and dynamic activities.

Causes

Hip impingement can occur for various reasons. Hip impingement can occur when:

  • there is abnormal contact between the femoral head and the acetabulum of the pelvis due to a deformity of the femoral head (cam impingement) or socket (pincer impingement)
  • there is damage to the articular hyaline cartilage or labral cartilage (ring of cartilage on the outside rim of the socket)
  • there is osteoarthritis of the hip joint
  • there is overuse of the hip flexor/quadricep muscle group (iliopsoas, tensor fascia lata, rectus femoris)
  • the pelvis is fixed into an anterior pelvic tilt (forward rotation of the pelvic bone – ilium)

Signs and Symptoms

Hip impingement can manifest in different presentations but most individuals will experience a deep pain in the groin with hip movement. Occasionally, the groin pain can be accompanied by clicking, locking, or catching when there is involvement of the labral cartilage.

Prolonged weight-bearing and walking can aggravate the symptoms and when it does, the individual may walk with a slimp limp due to pain. On observation, individuals may display a Trendelenburg sign, in which the hip drops down on one leg when standing on the other leg. For example, the left hip will drop when standing on the right leg and vice versa with walking.

Conservative Management

In the early phase of rehabilitation, the main goals would be to reduce pain/inflammation while performing pain-free range of motion exercises. If the pelvis is in an anterior pelvic tilt, corrective exercises would be given to encourage posterior pelvic tilt and vice versa. Soft tissue therapy of the hip flexor and quadricep group, acupuncture, and other manual therapy techniques can aid in pain reduction.

The second phase of rehabilitation would focus more on strengthening the muscles that surround the hip joint while progressing the range of motion exercises. There will be more focus on strengthening the gluteal muscle groups (the hip extensors, hip abductors, and hip external rotators) and core stabilisation while concurrently improving flexibility.

The last phase of rehabilitation will focus on sport-specific exercises which will aim to incorporate movement patterns in the exercises specific to the sport or activity that the individual wants to return to.

Please consult with your medical doctor, or north Toronto chiropractor, physiotherapist, or athletic therapist at Lawrence Park Health Clinic for information about hip impingement. The advice in this blog or any previous or future blogs, is not intended to replace the advice, examination, diagnosis or treatment by, a licensed healthcare practitioner.

Reference

Brukner, Peter & Khan, Karim. Clinical Sports Medicine, Revised Third Edition (2006).

Author: Clarence Lau, BSc (Hons), MPhtySt

Toronto Registered Physiotherapist | Acupuncture Provider

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