By Nick Mazzone PT, DPT, CSCS
What is hip impingement?
Femoracetabular impingement (FAI) is a condition in which bone spurs grow on the joint surfaces of the hip. These bone spurs eventually lead to irritation of the structures at the hip, which may lead to soft tissue damage such as labrum tears and potentially arthritis.
The two types of FAI are cam lesions and pincer lesions. Cam lesions develop on the head of the femur, therefore affecting the shape of the bone. Pincer lesions form on the pelvic surface of the hip joint. There are also situations in which both of these types of lesions are present.
What causes FAI?
Cam and pincer lesions may form due to abnormal development of the hip joint during childhood. They may also develop after prolonged pressure on the front of the hip joint over time due to asymmetries in muscle strength among the prime movers of the hip (for example, overactive hip flexors and underactive glutes).
What can be done to improve FAI?
It is imperative that we address the strength deficits present in this situation. If you have weak gluteus maximus muscles and your hip flexors are overactive, you would expect the hip joint to be sitting in a suboptimal position during functional tasks. In this scenario, you would see the femur sitting in front of its optimal position in the socket. For this reason, you want to strengthen the gluteus maximus muscles in order to realign the hip joint and prevent excessive pressure on the structures in front of the hip. Sometimes it is indicated to stretch the hip flexors, but that should be dependent on the physical therapist’s evaluation. Just because a muscle is overactive and tense does not mean it is short of length. It is also important that we strengthen the lower abdominal muscles to help stabilize the pelvis. This should help decrease the tension in the hip flexor muscles which may have been acting as a pelvic stabilizer (thus leading to overactivity).
How can PT help?
Your physical therapist will develop a specific treatment plan according to the findings of the clinical exam. While two people may both be diagnosed with hip impingement, they may present in completely different ways and with different impairments to address. For this reason, it is important to be evaluated and treated with a plan specific to you and not a general exercise plan. Your specific treatment plan is aimed at helping you return to your prior level of physical activity without pain.
Check out this video that shows three simple exercises you can do to help improve your symptoms from hip impingement:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Femoroacetabular Impingement - OrthoInfo - AAOS. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement
Main photo retrieved from https://reverehealth.com/live-better/what-is-hip-impingement/
Photo of bridging exercise retrieved from http://www.womenshealthmag.co.uk/fitness/find-a-workout/4456/how-to-do-glute-bridges/
Photo of cam and pincer lesions retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement
Photo of muscle asymmetries retrieved from http://www.racquetfit.com/articles/Coaching/controlling_your_posture_and_the_serve
Photo of plank exercise retrieved from https://www.waysandhow.com/good-reasons-plank-daily-6-benefits-planks-exercise/
Photo of runner retrieved from http://lisabaylis.com/2017/07/15/running-for-wellness/