Hip Impingement: Causes, Symptoms, and Treatment Options

In this video, I’m going to tell you about hip impingement and everything that you need to know about your hip pain. I’ll be talking about the symptoms and diagnosis as well as the treatment options for it and what happens if you don’t treat it correctly.

My name is Dr. David Middaugh, and I’m a specialist physical therapist at El Paso manual physical therapy. And this channel is dedicated to helping people stay healthy, active and mobile, while avoiding unnecessary surgery, injections and pain medications. Please consider subscribing to our channel so that you don’t miss out on any of the helpful videos we post every week.

So let’s answer this question, what is hip impingement? And to explain, I’m going to bring over my skeleton, she can see a hip joint here. Now here’s the hip joint, this would be your left hip, there’s a ball and there’s a socket inside this pelvis bone. This is the femur bone or the thigh bone. And what you need to know about hip impingement is you get pinching or impingement, when the edge of this thigh bone right here starts to rub against the edge of the socket right here. This is the most common place to get hip impingement.

In fact, I’ve never seen hip impingement on any other part of the hip joint. So as a result of that people typically describe having symptoms in this area. I’ll show you more about where that is exactly in here in just a moment. What you need to know is right on the edge of the bone here is a big chunk of cartilage called the hip labrum. And that helps to deepen the socket and give the joint some more stability. And that labrum can sometimes get hurt and become a labral tear.

But typically, in hip impingement syndrome, there has not been a labrum tear yet, but that’s something that could eventually happen. Another question we need to answer is, is hip impingement. The same as FAI.

FAI stands for femoral acetabular impingement. And the short answer is yes, it absolutely is the same thing. It’s just the medical term for it. femoral means femur, and acetabulum is the medical name for the socket part of the joint. So femoral acetabular impingement is the exact same thing as hip impingement. Now to give you a bit more details about what can happen with hip impingement, when these bones rub on each other, they can start to react just like your skin reacts.

Whenever you get too much pressure on a certain area of the skin. You get something called calluses your skin thickens, like I have some calluses right here from doing exercises. And it’s a normal response of our tissues to thicken in an effort to protect themselves.

So infemoral acetabular impingement or hip impingement, sometimes when they diagnose it after looking at X rays, they’ll find that there’s thickening of the bone on either the socket edge right here, they call that a pincer deformity where the edge looks like it’s protruding out a bit more, or a cam deformity where the edge of the femur here is thickened. And that thickening gives the femur an odd shape instead of it being a nice round ball that fits into the socket, it’s more of a oval or oblong shape.

So those are the different variations of femoral acetabular impingement, or hip impingement, the most common symptoms that you’re going to experience if you’re dealing with femoral acetabular impingement or hip impingement is going to be stiffness. By far I hear this as the most common symptom. People that have this problem, they go to stand up after having sat for a while, usually 30 minutes, 60 minutes or more is enough. And then when they get up, they feel like their hip is stuck. And they have to kind of walk like this and let it eventually straighten outs.

Oftentimes, this happens in people younger than 40 years old. Because if you’re older than 40 years old, more into your 50s and 60s and up, then this is more like arthritis. And so people that are younger than 40 start to think that they have hip arthritis. In fact, doctors will even sometimes diagnose the person with hip arthritis when in fact it is not hip arthritis yet. It’s in hip impingement syndrome. And the pain is usually located right where the thigh meets the body right where the hip folds right here on the front, because that’s where the ball is meeting the socket and rubbing against it.

So the pain will be right here right in the front. And it gets worse with more activity. So for somebody who’s particularly active, like they like to walk a lot, hike, jog, or just be on their feet doing things. The longer they’re on their feet. The longer they’re walking, we’re exercising, especially with more vigorous activity, the hip pain tends to worsen, and it even begins to bother them at night. And when they’re just doing nothing sitting at rest, then the stiffness increases the intensity of it, and how long it takes for it to come on after sitting will shorten as well.

And another possible symptom of this is crossing your leg can reproduce the pain and there’s different ways to cross your legs. If you cross your legs like this with the knee kind of sticking out. It doesn’t tend to bother the hip impingement as much might. But what definitely bothers it is if you cross your legs with your knee over knee like this because you’re moving the thigh bone across, and you’re pinching the hip just a bit more.

So when you cross the leg over, like this, the ball meets the edge of the socket a lot sooner, and it starts to aggravate it. Now the next question we need to answer is how is hip impingement or femoral acetabular, impingement diagnosed and the number one way that it’s done is through X ray.

But the secondary way would be through clinical examination. In other words, healthcare expert examining you check in how your hips moving, asking you questions, getting a full idea for your situation, and then they would give you the diagnosis. Next, let’s talk about the causes of hip impingement syndrome.

Now, the more rare cause is going to be genetic deformities. Some people are just born with a slightly abnormally shaped ball and socket joint. And as they age begins to affect them, some people have hip dysplasia, and that can begin to set this off as well. But if you’ve never been told that you have a hip problem growing up as a child, and you’re in your 20s 30s, or even into your 40s now and you’re starting to get these hip impingement syndromes, chances are that you have not had a genetic deformity. They’re quite rare.

What’s more likely affecting you because this is the most common cause for hip impingement syndrome is a muscle imbalance. If you look at the ball and socket joints, and you think about the muscles that are surrounding it, so here’s your right hip joint right here, on the back of the joint here, you’re going to have tons of glute muscles, all the butt muscles back here, is glute minimus, glute Maximus, Medius piriformis in there, and there’s a bunch of other little rotator muscles that all help to control and stabilize this ball and socket joint here.

And then on the outside, you have some more muscles. In the front, you have some more muscles as well. So there’s tons of muscles all around this area that helped to control the ball and socket joints. And if there’s an imbalance between the muscles on the front, on the outside, on the back, and then you have groin muscles as well that affect the hip joints.

If those muscles are out of balance, it can then cause the ball to shift forward in the socket and create that impingement right there. So how is hip impingement treated? If you see your doctor for this problem, the number one recommendation that probably going to have for you is oral pain medications or you know something that you take by mouth for pain relief.

Usually, some sort of NSAIDs like ibuprofen, naproxen, or they may give you a steroid pack as well to reduce inflammation. Some doctors might recommend having a hip injection of cortisone, cortisone is an anti-inflammatory and pain reliever. And the idea with both of these medications, both oral and the injected pain medication is simply to relieve the pain and reduce inflammation. But it does not fix the muscle imbalance or change the genetic structure of your ball and socket joint.

They’re truly short-term solutions. And they’re just meant to allow you to get through the next few days, weeks or months depending on how long the medication lasts. In extreme situations, your doctor might refer you to a hip surgeon, and the hip surgeon my recommended surgery, where they shave off extra parts of bone that had developed on the ball right here as well as on the on the socket side of the joint in order to allow more freedom of movement in the joints.

They won’t recommend a hip joint replacement at this point. Because most people that are dealing with hip impingement don’t have hip arthritis yet, and their ball and socket joint cartilage is actually good. It’s just the alignment of the ball and socket is not good. But let’s think about this for a second. If you saw your surgeon and your surgeon wants to do a surgery where they shave off edges of bone, and if you’ve got some massive growth of bone, then I can understand that.

But if it’s an alignment problem, you don’t really have that big of a change in the shapes of your bone at the hip socket joint, the ball and socket joint, then there’s got to be some muscle imbalance that needs to be treated non surgically through exercise, usually by strengthening the weaker muscles. And that can actually help to align the ball and socket joint. We do that here all the time at El Paso Manual Physical Therapy. And that brings me to the next recommendation that your doctor might have for you.

They might send you to a physical therapist. And what you need to understand if you do get sent to physical therapy by your doctor is that most physical therapists specialize in helping people after they’ve had a surgery like a hip replacement, or some other surgery that’s commonly done and physical therapists when they graduate school are typically really good at handling people that have just had surgery.

But if you’re looking to avoid surgery and get this problem addressed by fixing the muscle imbalances, most physical therapists aren’t going to really know where to start. They’ll give you exercises and they’ll probably run you through circuits of exercises. but usually they’re just trying to exhaust all the muscle options in the area and strengthen them without paying close attention to which muscles are truly weak and which ones are strong and checking the full hip range of motion to improve that.

I recommend finding a specialist like myself, I’m a manual physical therapist and I specialize in helping people avoid surgery. So make sure you do your research before going to the physical therapist. Now what happens if the hip impingement is not treated properly? Well, hip impingement is one of the first steps moving towards hip arthritis. If this problem persists for the next few years, maybe decade or two, then it is highly likely that you’re going to get hip arthritis.

What people often do when they don’t get resolution of their hip impingement syndrome is they become less active because it aggravates them to be more active. So they avoid doing any physical activity that strains are hip joints, that pushes them and they end up getting out of shape and weaker, which perpetuates or makes worse, the muscle imbalance that gotten the hip impingement in the first place.

So they’re on the highway to hip arthritis most of the time. And if you’ve got hip arthritis, and that doesn’t get under control, then the next step is looking at a hip replacement surgery. All the while the muscle imbalance has not been addressed most of the time in these individuals. And speaking of muscle imbalances, I’ve got a video that can help you address the root problem of most hip problems. That muscle imbalance.

Go check it out in the description below. It’s called How to correct the root cause of most hip problems. And now if you think that you’re getting hip arthritis, maybe you’re a little bit older, you’re past 40. Maybe you’re in your 50s or 60s watching this, then there’s more probability that you have some hip arthritis developing, and you need to treat it just slightly different because you’re going to have losses of motion that you need to deal with.

We’ve got tons of videos on hip arthritis problems; you can check out our playlist for hip arthritis help also linked down in the description below. Hope you like this video. If you did, give us a thumbs up please share this with somebody that you think might be dealing with a hip impingement problem or is wondering what the heck femoral acetabular impingement syndrome is so that they can get some clarity about this.

And if you haven’t already, please consider subscribing to our channel so you don’t miss out on any of our helpful videos. Thanks so much for watching, and we’ll see in the next video friends. bye