Hip Impingement

The hip joint consists of the femur and acetabulum (part of the pelvis). In between the femur and the pelvis is articular cartilage that has a ring of strong cartilage known as the labrum. The labrum encircles that acetabulum and functions to keep the femur in the acetabulum, and to ensure smooth and painless motion when we walk and bear weight by preventing bone on bone contact. Hip Impingement, medically referred to as Femoracetuabular Impingement (FAI), is a condition of the hip in which part of the femur hits against the pelvis or part of the pelvis catches against the femur. FAI occurs when there is abnormal bone growth or bone spurs on either the femur or the pelvis. The bone spurs cause the two bones to rub against one another during movements and crush the underlying cartilage and labrum causing pain. There are 3 types of impingement. The first is a pincher impingement. In this condition the bone spur is on the acetabulum of the pelvis. When an individual moves their leg the femur will hit the extended bone spur and compress the labrum causing pain. The second type of impingement is called a cam impingement. In this impingement the extended bone or bone spur is on the femur. Similarly when an individual moves their leg the bone spur on the femur will hit against the pelvis and compress the cartilage underneath causing pain. The third type of impingement is a combined impingement in which both pincer and cam deformities are present.  FAI is thought to develop from abnormal bone growth during childhood. Symptoms associated with FAI vary greatly and some with FAI may never develop symptoms while others will have significant pain and deformity within the hip due to the bones compressing on one another and compressing the underlying cartilage and labrum.  

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In physical therapy we cannot necessarily change the shape of the bone that is causing the impingement but we can work to improve the mobility of the hip joint, stretch the muscles that surround the joint, and strengthen the hip muscles to absorb force. All of these techniques can help reduce pain levels in individuals who have FAI. If physical therapy does not fix the hip pain then the patient may be a candidate for surgery in which the surgeon will repair any damage to the labrum and reshape the bones so they no longer compress the labrum in the future. For examples of how we treat FAI in our clinic please see some of the photos below. If you would like to schedule an appointment please reach out to us.