Hip Impingement in runners

hip impingement

Hip impingement, also known as femoroacetabular impingement (FAI), typically affects young, active individuals, but it can occur at any age. It is often seen in athletes, dancers, and people with structural abnormalities in the hip joint. The friction caused by impingement can result in labral tears, cartilage damage, and osteoarthritis if left untreated.


What is hip impingement?

Hip impingement, or femoroacetabular impingement (FAI), is a condition characterized by extra bone growth around the hip joint. This excess bone growth can lead to friction and impingement of the soft tissues in the hip, including the labrum and cartilage. There are three types of hip impingement: cam impingement, pincer impingement, and mixed impingement.

There are three main types of hip impingement:

  1. Cam: characterized by a bony overgrowth on the head of the femur.
  2. Pincer: involves a bony overgrowth on the acetabulum.
  3. Mixed: a combination of both cam and pincer types.

Hip impingement affects particularly the young adult population and cam-type impingement is more prevalent in men, whereas women are more prone to experiencing pincer-type impingement.

Common exercises that may cause pain include deep squats and lunges.

Causes of hip impingement

Hip impingement can have several causes, including structural abnormalities in the hip joint, genetics, and repetitive hip movements. Structural abnormalities, such as a misshapen femoral head or acetabulum, can increase the risk of impingement. These abnormalities can be present from birth or develop over time due to wear and tear.

Genetics also play a role in hip impingement. Certain genetic factors can predispose individuals to develop excess bone growth around the hip joint. Additionally, activities that involve repetitive hip movements, such as dancing or sports that require frequent hip rotation, can contribute to the development of hip impingement.


Risk factors for hip impingement

Several factors can increase an individual’s risk of developing hip impingement. These include:

  1. Age: Hip impingement is more common in young adults, as it often develops during periods of rapid growth.
  2. Gender: Males are more likely to develop hip impingement than females.
  3. Structural abnormalities: People with structural abnormalities in the hip joint, such as a misshapen femoral head or acetabulum, have an increased risk of impingement.
  4. Family history: Individuals with a family history of hip impingement or related conditions, such as hip dysplasia, may be more prone to developing impingement.
  5. Repetitive hip movements: Activities that involve frequent hip rotation or repetitive movements can contribute to the development of hip impingement.
  6. Sports and dance: Athletes and dancers, who frequently perform movements that put stress on the hip joint, are at a higher risk of developing hip impingement.


Symptoms of hip impingement

Hip impingement can cause a variety of symptoms that can greatly impact an individual’s quality of life. Common symptoms include:

  1. Groin pain: Pain in the front of the hip or groin area is one of the most common symptoms of hip impingement. The pain may be dull or sharp and can worsen with certain movements, such as flexing the hip or rotating the leg.
  2. Limited range of motion: Individuals with hip impingement may experience a reduced range of motion in the hip joint. This can make activities like squatting, sitting cross-legged, or bending forward difficult or painful.
  3. Stiffness: Hip impingement can cause stiffness in the hip joint, making it challenging to move the leg freely.
  4. Clicking or locking sensation: Some individuals with hip impingement may experience a clicking or locking sensation in the hip joint during movement. This can be accompanied by pain or discomfort.


Diagnosing hip impingement

If you are experiencing symptoms of hip impingement, it is essential to seek medical evaluation for an accurate diagnosis. A healthcare professional will typically conduct a physical examination and may order additional tests to confirm the presence of hip impingement.

During the physical examination, the healthcare professional will assess your range of motion, perform specific hip maneuvers, and evaluate your pain response. They may also order imaging tests, such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans, to get a detailed view of the hip joint and identify any structural abnormalities or bone growth.


Treatment options for hip impingement

The treatment options for hip impingement depend on the severity of the condition and the individual’s symptoms. The primary goals of treatment are to reduce pain, improve joint function, and prevent further damage to the hip joint. Treatment options may include non-surgical approaches, such as physical therapy and medication, or surgical intervention in more severe cases.


Non-surgical treatment options

Non-surgical treatment options are often the first line of treatment for hip impingement. These approaches aim to relieve pain, improve hip function, and strengthen the surrounding muscles. Non-surgical treatment options may include:

  1. Physical therapy: A physical therapist can develop an individualized exercise program to strengthen the muscles around the hip joint, improve flexibility, and correct any movement imbalances that may contribute to impingement.
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter or prescription NSAIDs, such as ibuprofen or naproxen, can help reduce pain and inflammation in the hip joint.
  3. Corticosteroid injections: In some cases, corticosteroid injections may be recommended to reduce inflammation and provide temporary pain relief. These injections are typically administered directly into the hip joint under the guidance of imaging techniques.


Surgical treatment options

If non-surgical treatment options do not provide sufficient relief or if the hip impingement is severe, surgical intervention may be necessary. The specific surgical procedure will depend on the type and extent of impingement, as well as any associated hip damage. Surgical treatment options for hip impingement may include:

  1. Arthroscopy: Arthroscopic surgery is a minimally invasive procedure that involves making small incisions and using a tiny camera (arthroscope) to visualize and repair any structural abnormalities in the hip joint. This procedure aims to remove excess bone growth, repair labral tears, and improve joint function.
    • Patients with substantial arthritis, hip dysplasia, or significant inflammation in the hip may not find arthroscopy beneficial. In such cases, a total hip replacement might be necessary, and there’s also the possibility that individuals who have undergone arthroscopy may eventually require a hip replacement.
    • A recent study showed most elite athletes who underwent hip arthroscopy for Femoroacetabular Impingement Syndrome did not return to the same level of sport, but the majority were satisfied with the outcome of surgery
  2. Osteotomy: In cases where there are significant structural abnormalities, an osteotomy may be performed. This procedure involves cutting and repositioning the bones of the hip joint to alleviate impingement and improve joint alignment.


Rehabilitation and recovery after hip impingement treatment

After surgical treatment for hip impingement, a comprehensive rehabilitation program is essential for optimal recovery. The rehabilitation process will typically involve physical therapy to restore strength, flexibility, and range of motion in the hip joint. The physical therapist will guide the individual through specific exercises and activities designed to promote healing and prevent further hip damage.

Recovery times can vary depending on the extent of the surgical procedure and the individual’s overall health. It is crucial to follow the rehabilitation program diligently and attend all follow-up appointments to monitor progress and address any concerns.


Prevention tips for hip impingement.

While hip impingement cannot always be prevented, certain measures can help reduce the risk of developing the condition or worsening existing impingement. These include:

  1. Maintaining a healthy weight: Excess body weight can put additional stress on the hip joint, increasing the risk of impingement. Maintaining a healthy weight can help reduce this risk.
  2. Avoiding repetitive hip movements: If you participate in activities that involve repetitive hip movements, take regular breaks and avoid overexertion to minimize the risk of hip impingement.
  3. Practicing proper technique: Whether it’s sports, dance, or other physical activities, using proper technique and form can help prevent unnecessary strain on the hip joint.
  4. Listening to your body: If you experience any hip pain or discomfort, pay attention to your body’s signals and avoid pushing through the pain. Rest and seek medical evaluation if necessary.

In conclusion, hip impingement is a common condition that can cause pain and limited mobility in the hip joint. It is essential to recognize the symptoms and seek medical evaluation for an accurate diagnosis. Treatment options range from non-surgical approaches, such as physical therapy and medication, to surgical intervention in more severe cases. Following a comprehensive rehabilitation program after treatment is crucial for optimal recovery. By taking preventive measures and practicing proper technique, you can reduce the risk of developing hip impingement or worsening existing impingement. Remember to consult with a qualified healthcare professional for personalized advice and treatment options.