Hip Impingement

What is hip impingement?

What is “femoroacetabular impingement”? Femoro = thigh bone. Acetabulum = socket of the hip joint. The hip joint is a ball and socket joint with a fair amount of movement; internal and external rotation, flexion and extension – all pretty impressive. But what if you’ve got anatomical differences which inhibit movement slightly? That’s where the ‘impingement’ comes in, the pinching or squashing of tissues or structures in body, in this instance it’s the pressing of the thigh bone into the hip bone.

Have you ever felt a sharp pain as if your hip is pinching at the top of your thigh? The sensation usually occurs when you hip is in flexion, when you’ve got your knee high up to your chest, or you’re sat in a deep squat position for instance. The most common area of pain is at the front of the hip, however some people can experience it on the side of the hip and deep into the buttock region. It is described as a deep aching sensation and often there is no history of trauma. It usually occurs after activities that involve repetitive extreme movements, for example hockey players and dancers who have to pivot a lot through the hips. If you experience any other symptoms such as clicking or feeling of instability then you need to get your hip assessed by a health professional (we can do that for you). Let’s look at the anatomy of the hip-thigh joint.

Hip impingement

Anatomy of the femoroacetabular joint

In the diagram above, you can see the head of the femur where it inserts into the hip (the acetabulum). There’s natural variation in all of us, in our bones, soft tissue structures and organs – nothing scary, but sometimes it can cause difference in movement patterns. For instance the angle between the femoral neck axis and the axis of the femur can be different amongst us and this can be a cause of variation in movement in our squat patterns or how the thigh moves. The variations are known as coxa vara, coxa valga and then normal which is 110°. As shown in the diagram below.

Hip impingement

The 3 variations of how the femoral neck and head can be of the femur


With these variations, you might experience some pinching but you might find that adjusting your squat stance, or rotating your pelvis posteriorally will help give more space to the femur to move. Just because you have an anatomical difference doesn’t mean you can’t or shouldn’t squat! You just need to find a way that allows you to do it pain free – as I’ve said, everyone moves differently and it’s all about finding out how your body moves and working with it, not against it. That’s part of our job! Helping you to identify these areas and help you work on them.

So what about bony anatomical differences that aren’t necessarily as easy to adjust and work with? There are 2 main types of femoroacetabular impingement (FAI), which are Cam and Pincer, as shown in the diagram below.

Bone variations of the femur, showing the normal structure and the cam variation structure


The pincer variation of the acetabulum (hip socket)

As you can see from the diagram, the cam variation has more growth on the femoral neck and head, leaving it less room in the hip socket to move as freely as the normal variation would. Whereas the pincer variation has more growth of the acetabulum (hip socket) giving a much ‘deeper’ socket and again reducing the range of motion that you might expect from a normal hip joint. Sometimes you’ll get a mixture of the two, where growth of the femoral neck, head and acetabulum is present, but to determine which one you have, will need an X-Ray. What do I do if I think I’ve got this? First of all – this isn’t the end of the world, many people will have this and perhaps not even know, but if you’re into your sport and feeling like this is limiting you or giving persistent pain then there are things which can be done.

First, take a look at all our hip mobility videos on Facebook, Click here to visit our Facebook page., in particular our banded hip distraction video but also Natalie’s Facebook lives on hip mobility. If the bones are the factors limiting movement or you generally get pain in the hip during stretching or squatting, chances are you’re not going to want to do those movements! But if we properly mobilise the joint, give it some freedom in all the soft tissue structures then suddenly you’ll have a lot more freedom in range of motion – despite having some impingement, there’s always more room you can make! Don’t let soft tissue restrictions stop you from doing something you enjoy when there’s work that can be done to help. Check out my video from last year about squat biomechanics, skip to 2:40-3:20 and try the hip scour exercise and you can find the best stance for your squats to give the least (or no!) pain.

Second – come and see us, we’ll have a good look at your hip movement and give some more personalised advice to really get in and mobilise things so you can feel free-r and more athletic again! Book online now to get your hips assessed and functioning better – Book my appointment now!