The Best Methods for Hip Impingement Injury Management

By: Rebecca Moore |

When we were kids, we learned that square pegs don’t fit into round holes, and round pegs don’t fit into square holes. Unfortunately, our hips never got the memo.

Femoroacetabular impingement, commonly referred to as hip impingement, is the result of dysfunctional contact between the ball and socket of the hip joint. This injury can go undetected for years in active adolescents and young adults, but as these patients age, the prolonged friction causes cartilage and joint damage, resulting in a great deal of pain in the groin, hip and thigh, limitations in range of motion and potentially osteoarthritis. Today, we’ll explore the two main types of hip impingement, and the evidence-based injury management methods for each condition.

How to Treat 2 Main Types of Hip Impingement

Before we dive into the best treatment options for each condition, it’s important to note that, for each, starting with non-surgical interventions is a great place to start. According to one study, arthroscopic hip surgery has risen 18-fold in the past decade, which has resulted in an increase of clinical trials comparing surgery with non-operative management.₁ To compliment this, a recent review of applicable literature suggested that physical therapy and activity modification can confer some benefit to patients.₂ Treating patients conservatively can be done with:

Rest - Resting the hip joint can alleviate symptoms like pain and swelling before treatment.
Change in activity - If certain movements or activities are causing symptoms, you may want to recommend ways to change or avoid the behavior.
Therapeutic exercise - Exercises that strengthen the muscles that support the hip or increase range of motion can relieve stress and pain within the joint.

However, surgical interventions are commonplace among patients with hip impingement. Here are the evidence-based recommendations for addressing cam or pincer impingement.

Cam Impingement

Cam impingement occurs when the femoral head is not perfectly round, keeping it from moving smoothly within the hip socket. Groin pain and osteoarthritis of the hip are common symptoms.

“Patients suffering from this condition are mainly young and experience pain when the hip is moved through internal rotation and adduction at 90° of hip flexion. In this condition, in predisposed patients, anomalous contact between the femoral head-neck junction and acetabular rim develops… Many patients with femoroacetabular impingement may have developed significant secondary joint damage at a younger age when participating in sports, as a result of them pushing their bodies beyond the reduced physiological limits imposed by the altered joint morphology.” ₃

Cam-Type Treatment Options

After non-surgical interventions like rest, change in activity and therapeutic exercise have not resulted in a significant decrease in pain, surgery would be the next necessary step.

In recent years, surgical hip dislocation, an open procedure, has been replaced with the arthroscopic equivalent. With a smaller incision, shorter hospitalization time, faster rehabilitation and a slightly lower complication rate, arthroscopic surgery is can be a superior treatment method; however, data suggests that arthroscopy should be avoided in patients over 50 years of age with risk factors for early osteoarthritis, like high BMI and a significantly increased alpha angle.₃

Pincer Impingement

Pincer impingement occurs when the bone of the hip socket has grown to extend too far over the femoral head, restraining the hip joint from smooth movement.

“It can be caused by anatomical abnormalities of the acetabulum or the femoral neck, by malorientation of the acetabulum, and by torsional abnormalities of the neck and femoral shaft. These orientation and torsion abnormalities can be constitutional or post-traumatic, e.g. the result of femoral or acetabular fractures. They may also be secondary to surgical procedures, in particular to acetabular and femoral osteotomies. Finally, in subjects who practice certain sports, such as gymnastics, martial arts and dance, in which the athletic movements are characterized by repeated and sudden maximum joint excursions, pincer femoroacetabular impingement can have a functional cause.” ₄

Pincer-Type Treatment Options

Again, if non-surgical methods don’t satisfy pain symptoms, your patients will require surgical intervention. Acetabular osteochondroplasty is the procedure of choice for pincer impingement, resulting in the smoothing of the acetabular rim.₄

The Best Exercises for Hip Impingement Rehabilitation

Whether you’re conservatively treating hip impingement or rehabilitating post-op, having an arsenal of exercises that strengthen and better mobilize the joint and surrounding muscles will empower your patients to safely return to activity and everyday life. In these episodes of the Injury Management Series, Mike Voight PT, DHSc, OCS, SCS, ATC, CSCS, FAPTA shares his five favorite functional exercises for patients of all ages and abilities. Grab a TheraBand CLX Band, a CLX Door Anchor and some Stability Trainers and get started today!

Check out the full playlist of his exercises and try them out with your patients!

Save and use this PDF to incorporate these exercises into your practice for patients of all ages!

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