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The hip joint is where the top end of the femur (thigh bone) meets the acetabulum socket 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. Hip pain is commonly happens with impingement.
Both the acetabulum of the pelvis and head of the femur are covered 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.
Hip impingement can occur for various reasons. Hip impingement can occur because of:
– 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)
– Damage to the articular hyaline cartilage or labral cartilage (ring of cartilage on the outside rim of the socket)
– Osteoarthritis of the hip joint causing hip pain
Overuse of the hip flexor/quadricep muscle group (iliopsoas, tensor fascia lata, rectus femoris)
– 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 slim 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.
How is hip impingement managed without a surgery?
In the early phase of rehabilitation, the main goals would be to reduce pain and 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 quadriceps 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 stabilization 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.
To learn more about how physiotherapy can help with hip impingment, please call our Toronto physiotherapist at 416-444-4800 for a free consultation or to book an appointment.
By Clarence Lau,
Orthopaedic & sports physiotherapist