Hip impingement syndrome

What is hip impingement syndrome?

This occurs when the hip muscles do not coordinate well to support the hip in its joint, leading to irritation within the hip joint.

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What are the causes of hip impingement syndrome?

It is caused by a lack of effectiveness in the muscles that support and stabilize the hip. This can happen after resuming an activity or increasing the frequency of an activity.

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Here are some classic examples:

• Resuming cross-country skiing in the winter
• Increasing the length or frequency of outdoor walks
• Resuming running in the spring
• Being more active after being more sedentary
• Starting to walk again after surgery or removal of a cast

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What are the risk factors for developing hip impingement syndrome?

Certain elements can increase the chances of having this type of pathology, such as:

• Having experienced an episode of hip or lower back pain
• Having been sedentary, bedridden, or immobilized for several weeks
• Having had a hip injury in the past

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What causes pain in hip impingement syndrome?

Impingement can cause excessive stress on different parts of the hip, which could irritate one or more of the following structures:

• The joint capsule and ligaments
• Muscles such as the psoas, internal and external obliques, and quadriceps
• The femoral or sciatic nerve

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The pain can therefore vary depending on the structure that is irritated.

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What are the symptoms of hip impingement syndrome?

The most common symptoms are:

• Pain in the groin or on the side of the hip
  
  • The pain may also be felt in the buttock or thigh
• The pain is often increased after weight-bearing activities:
  
  • Running
  • Walking (worse with long strides)
  • Doing squats (worse if the squats are deep)
  • Hiking up a mountain
• Decreased mobility and stiffness in the hip
• There may be cracking, clicking, or popping sensations in the hip during certain movements

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How is hip impingement syndrome diagnosed?

Diagnosis is possible based on the history of symptoms and a clinical examination.

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When to see a physiotherapist for hip impingement syndrome?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for hip impingement syndrome?

Your physiotherapist will perform an assessment to determine the cause of your irritation and will evaluate the following elements:

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• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Mobilize your hip to reduce pain and improve your range of motion.
• Provide you with specific exercises to retrain the control of your hip movements.
• Give you exercises to regain mobility, reduce pain and regain your muscle strength.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

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What to do at home for hip impingement syndrome?

Temporarily stop doing movements that cause too much pain, and then gradually start doing them again. Here are some tips that may help:

• Engage in transfer activities that reduce stress on the hip, such as swimming.
• Avoid the following positions:
  
  • Standing while leaning to one side.
  • Sitting with your legs crossed.
• If you are unable to sleep on your back, place at least a pillow between your thighs when lying on your side.
• If you are a runner, incorporate walking minutes into your running outings
• Do gluteal strengthening exercises.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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Sources

• Macfarlane RJ, Haddad FS. The diagnosis and management of femoro-acetabular impingement. The Annals of The Royal College of Surgeons of England. 2010 Jul;92(5):363-7.
• Grant AD, Sala DA, Schwarzkopf R. Femoro-acetabular impingement: the diagnosis—a review. Journal of children’s orthopaedics. 2012 Mar 1;6(1):1-2.
• Pun S, Kumar D, Lane NE. Femoroacetabular impingement. Arthritis & rheumatology (Hoboken, NJ). 2015 Jan;67(1):17.

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