Most commonly, hip impingement is a pinching sensation in the front of the hip occurring when you bring your knee towards your chest and is often associated with a loss of range of motion in this direction. This is referred to as anterior hip impingement. Read on to learn more.
What causes hip impingement?
There are several causes of hip impingement and several contributing factors to each cause.
- Femoroacetabular impingement (FAI):
Femoroacetabular impingement refers to bony impingement at the front of the hip due to abnormal variations in the shape of the hip socket and the leg bone that sits within it. This can occur at any age from adolescence on and can only be confirmed by imaging of the hip such as X-Rays, MRIs or CT scans.
As we get older, osteoarthritis typically will cause bony lipping and spurring at the edges of joints. When osteoarthritis affects the hip joint these bony changes can bump into each other causing a pinching sensation and loss of range of motion. While age and degree of stiffness will be a clue, X-Rays are typically used to confirm and quantify the presence of hip osteoarthritis.
3. Acetabular labral tear:
The acetabular labrum is a soft cartilage rim at the edge of the hip joint which performs an important role in maintaining a seal for the lubrication and stability of the joint. Sometimes the labrum can become frayed, torn or detached which can cause hip pain including hip impingement. The incidence of labral tears increases with age but occasionally occurs in athletes causing persistent hip and groin pain. Acetabular labral tears can only be confirmed by MRI, often aided by the use of a contrast dye.
4. Hip tendinopathy or hip bursitis:
Sometimes when you have a soft tissue problem such as hip flexor tendinopathy or bursitis at the front of the hip this irritated tissue will hurt simply because it is squished by bringing the knee to the chest. In this case, the problem is outside the hip joint but is still being pinched when the knee is raised towards the chest. The problem may not be caused by hip flexion but the motion is an aggravator.
5. Functional hip impingement :
It may be that in some people, problems with the biomechanics of the hip such as strength imbalances around the hip or inflexibility in the hip joint capsule, gluteal or external rotator muscles may alter the joint biomechanics in a way that increases the pinching effect on any structures on the front of the hip. This is determined by ruling out other causes above and by assessing the mobility, strength and function of the hip in a physical exam.
How is hip impingement treated?
How hip impingement is treated will depend on the cause. A thorough physical exam will be necessary and sometimes imaging of the hip joint will be needed to fully understand the cause. Most of the causes listed above can achieve significant relief by improving the biomechanics of the hip joint using manual therapy techniques to treat muscle tightness and joint mobility problems. Massage therapy, Active Release Technique (ART), Intramuscular stimulation (IMS) as well as joint manipulation or mobilizations are all examples of techniques used by the clinicians at MSK Clinics. Specific stretching and strengthening exercises are also vital to improving the joint’s function.
In cases where these treatments don’t give satisfactory relief then referral to a hip surgeon may be necessary but conservative (non-surgical) treatments are typically thoroughly explored first.
We can help!
Many, but not all of the hip conditions listed above will benefit greatly from the various services provided by the clinicians at MSK Clinics. Specific and proper application of massage, Active Release Techniques (ART), stretching, strengthening, manipulation and custom orthotics will be helpful for many causes of hip pain.
Each of these conditions will present in its own way and can be difficult to diagnose confidently. Furthermore, each one will require a unique treatment approach. If you are experiencing hip pain, book an appointment with one of our doctors of chiropractic to receive a thorough history and physical exam. They will ensure the appropriate care is matched to your particular hip condition and, if needed, will refer you to your family physician for imaging or further consultation.
2880 West 4th ave. #101
Vancouver, BC V6K 1R2
1033 Davie Street, Suite 410
Vancouver, BC V6E 1M7