What is hip impingement and how to treat it?

Hip impingement or Femoroacetabular Impingement Syndrome (FAIS) is usually a persistent condition caused by different malformations of the femoral head or acetabulum (the ball and socket joint, that is your hip). It tends to get worse gradually over time.

It can create soft tissue irritation, when a small portion of soft tissues get pinched between two bony segments of the hip joint. If left untreated or not managed well, it may lead to early signs of degeneration or osteoarthritis of the hip.

Which sports can cause hip impingement?

Cycling can be a particularly aggravating activity for hip impingement syndrome, due to the repetitive flexion movement of the hip, which may make symptoms worse. Some triathletes also can struggle with running and doing those longer events.

What are the symptoms of hip impingement?

Here’s what to look out for and how best to manage any symptoms, which include:

• Pain in the groin or front of the thigh, hip or buttock.
• The pain may be a dull constant ache that may go up and down in intensity, with different activities. Some often experience intermittent sharp pains at the front of the hip.
• Stiffness or reduced range of movement of the hip.
• Symptoms of ‘clicking, locking or catching or giving way’.

Activities that may make symptoms more prevalent may include sitting for prolonged periods of time, steps or stairs, excessive activity or repetitive high-intensity sport. You may need to rest from certain aggravating activities to help the pain to settle down.

You may be more at risk of developing this condition if you started sport young, or have been diagnosed with a previous hip condition or pathology early on in life or at birth, such as a hip developmental condition called hip dysplasia (when the ball and socket of your hip joint don’t fit well together or dislocate).

If you are experiencing other symptoms with your pain such as the below, then these are symptoms that cause more of a concern and I would advise you speak with your GP or NHS 111 service as soon as possible.

• Pain that wakes you in the night.
• Unexplained weight loss.
• Night sweats.
• Feeling unwell.
• Fever or illness.
• The joint feeling hot, red or swollen.

How do you know if you have a hip impingement?

If you think you may have this condition it is always best to speak with a health professional, your GP or First Contact Physiotherapist, they will be able to assess your hip and organise any relevant investigations for you.

It can often be diagnosed by taking information about your current and past symptoms, checking your range of movement and strength, and an x-ray. Highlighting the bone structure of the hip joint can be helpful in diagnosing the condition.

MRI is not often required, unless you see a specialist and you find your symptoms are not settling and becoming more persistent over time.

Physiotherapists can do one or two biomechanical tests, within their assessment, to determine if they think you have symptoms of hip impingement.

How do you manage and help to reduce your symptoms?

A physiotherapist or general practitioner should be able to offer personalised advice for managing your symptoms, however if you find yourself in pain and not sure what to do for the best, these simple steps can be helpful initially.

• Rest from that particular activity or exercise that maybe making it worse.
• Talk with a pharmacist about your symptoms and what medication that can be given in the interim to settle your pain and help you to be able to move more normally.
• Keep up your normal day to day activities as much as possible.
• Gentle heat or cold application maybe helpful in reducing pain.
• Maintaining non-aggravating exercise can also be helpful in reducing the symptoms.

You can help reduce your symptoms by spending less time in sitting positions, or activities that are too repetitive in nature. Triathlon training may have to be reduced or adjusted with guidance from a physiotherapist, especially if cycling or running is an aggravating factor.

The majority of people that have symptoms from this condition are managed with treatment and exercises from a physiotherapist. These exercises will involve strengthening muscles around the knee, hip and pelvis.

Trying to address your own personal weaknesses in your biomechanics is a great place to start to help this condition. A physiotherapist would assess which areas of your body you may have some weakness in or lack of range of movement to help improve the pain.

A physiotherapist or osteopath may also use manual techniques like soft tissue massage or joint mobilisation to help your symptoms.
In some instances, if physiotherapy isn’t helpful, then surgery may be a more suitable option. The outcomes from surgery for hip impingement are usually successful and helpful in reducing pain. You would discuss your suitability for this with a specialist orthopaedic consultant.

Most surgeries now are done via arthroscopy for this condition and recovery outcomes are good with most athletes returning to sport fairly quickly.

What exercises are good for hip impingement?

Usually concentrating on core strength is a great place to start for this condition, as your hip and lower back muscles attach around your pelvis, and in keeping these strong it will help offer support around your hip. Exercises such as:

• Double leg bridges
• Single leg bridges
• Clams with and without resistance bands
• Lateral resistance band walking
• Superman
• Pelvic floor exercises

Stretching exercises can also be helpful, working around the hamstrings, hip flexors and lower back. If you find any of these exercises aggravating, make sure to consult with a physiotherapist before continuing with them.

There are many progressions to these exercises so you are able to adapt them to your capabilities. Realistically, to get the best out of any rehab a physiotherapy assessment is highly beneficial for tailoring to your own individual needs.

Overall, it’s important to recognise that there are many things that you can do to help with this particular condition and keep going with what you enjoy in life, and that’s including triathlon!