Hip pain is quite a common ailment in people of all ages and can be exacerbated by sports or repetitive motion. The hip is where the top of the thigh bone joins the pelvis. The top of the thigh bone, which is the femur, has a ball-like top which fits into a cup-shaped socket in the pelvis, which is called the acetabulum. A layer of cartilage in the socket provides cushioning and support for the joint and the ball should glide smoothly within the socket during movement.
Hip impingement, or Femoroacetabular Impingement Syndrome (FAIS) occurs when there are problems with how the femur fits into the socket, often causing damage to the cartilage or causing the joint to jam. Issues can arise from a deformity of the ball at the top of the femur or a deformity of the socket, repetitive hip movement causing trauma in the joint, or extra bone growth.
Symptoms of Hip Impingement
As it often occurs gradually over time and is not painful in the early stages, it is possible to have hip impingement for years and not be aware of it. Most commonly occurring in young and active adults, anyone can suffer from the condition, and it appears to particularly affect those with a sedentary lifestyle.
Typical symptoms include:
- Pain in the front of the hip and/or in the groin regions.
- A grinding, locking, popping or clicking in the hip during movement.
- An overall decreased range of motion in the hip.
Symptoms are usually noticed during sports with multidirectional movements such as football, soccer and tennis. They are also typically felt when sitting for long periods of time or during deep squatting movements.
If you are not able to maintain your usual level of activity and are suffering any of the above symptoms, it is recommended you visit a sports physiotherapist for diagnosis and treatment. You may be experiencing hip impingement.
Physiotherapy for Hip Impingement
Hip impingement is officially diagnosed with hip physiotherapy testing and possibly also with x-rays of the hip. Scans are not always required, but x-rays can be very helpful in determining the exact cause of pain in this area by being able to see the bones and how they are connecting. Any irregularities the shape of the top of the femur or the socket will be clear. A CT scan or MRI may be recommended to assess the region in even more detail, particularly showing damage to the tissues and cartilage. Your physiotherapist can refer you directly for x-rays and they are bulk billed under Medicare.
An essential part of treating and managing hip impingement is to strengthen the hip and trunk muscles to support the hip so it is able to move better during activity. Before starting hip impingement physiotherapy, the physiotherapist will carry out some muscle testing on various muscle groups to know which ones need attention.
At Melbourne Sports Physiotherapy the team uses the AXIT testing system which has over 125 assessments that can be performed and uses technology to measure, track and monitor the client’s progress. It can determine the movement and strength differences between the hips using dynamometers and force plates, giving the relevant data for the physiotherapist to be able to compile a specific set of strength and stability exercises. It is a very efficient and accurate way to diagnose and manage hip impingement.
Once the muscle weaknesses and stability issues have been identified the set of exercises will be shown to you, with guidance given on good technique. Helpful exercises include single leg bridges, banded crab walk, standing banded hip adduction and hip twisting
Generally, 3-5 reps is considered the best range for increasing strength, and increasing the weight or resistance to ensure you are close to ‘failure’ within this range will be explained. However, consideration will be given to the individual, depending on their training experience and any current or past injuries.
Your physio will monitor your progress and increase the intensity or number of exercises over time where suitable. The exercise program will move towards a combination of movements, multidirectional training and practice in actual sport movements.
Timeframe for Treatment
Improvement of the symptoms of hip impingement will depend on how much damage has occurred, the quality of the exercise rehabilitation and the goals of the patient. Becoming pain-free in regular daily activities will be quicker to achieve than returning to particular sporting activities. As a general guide a suitable and detailed exercise program should be set for at least 12 weeks.
Sometimes further intervention may be required such as injection therapies or surgical management. Exercise will always be the key to improving the hip during movement though.
If you are experiencing hip pain, call to speak to a physiotherapist or make an appointment online – Melbourne Sports Physiotherapy are experienced with hip injuries and hip pain and are dedicated to having you moving pain-free as soon as possible. The specialists here offer a wide range of services including spine physiotherapy, physiotherapy for back pain, soft tissue therapy and much more.