We see a lot of patients with hip impingement. Some patients with impingement also have a labral tear, but you can have impingement without a torn labrum.
The first thing we tell our patients that it’s very common to have an impingement and many of them are pain-free. Research(1) shows that 73% of people without hip pain have abnormalities on their MRI and 69% of people without pain have a labrum tear.
The next thing we do is educate our patients on how temporary to remove some painful triggers. We find out what is aggravating their pain and look for alternatives. Usually that means:
- make sure they change positions frequently during the day; especially if they sit a lot at work.
- stop stretching the hip flexors
- No, or changed, squatting
Many patients respond that treatment that help improves a balance between mobility and strength, that improves overall strength in the lower quadrant, and that teaches patients proper mechanics with lifting activities. Every hip is different and we all move different and therefore not one treatment helps everyone.
STOP STRETCHING THE HIP FLEXOR
Many people with hip pain feel a tightness in their groin area and start stretching their hip flexors. This rarely helps and often makes the problem worse. Patients with hip impingement often have weak hip muscles and have a lot of flexibility in their soft tissues. This allows for the femur (thigh bone) to be positioned anteriorly resulting in weakness and lengthening of the iliopsoas muscle. What tends to get tight is the hamstrings and adductors. According to research (2) most patients need to improve core and hip muscle strength.
GOOD EXERCISES FOR HIP IMPINGEMENT
Patient need to start working on:
- Correctly pattern the hip hinge
- Dowel hip hinge
- Single leg hip hinge
- Strengthen your psoas, glutes and hamstrings
- Bridging, single bridge
- Hip 2-way
Remember that everyone’s skeletal anatomy is different. Some folks will have a wide stance, others vary narrow. Some athletes turn their toes forward and others more outward. As long as the mechanics are clean and the movement pain-free. A good squat involves heels remaining on the ground, a neutral spinal position (not over arched or rounded), and knees tracking over toes. Some things to work on:
- Keeping torso erect
- Goblet squats
- Front squats
- Improving DF mobility in ankle
- Or use lifting shoes
- Find the painful part of the squat: just stay shy of that position and hold the squat for 30-45 seconds in that position. Isometrics can help relieve pain and help the athlete truly “own that part of the squat”
- Keeping torso erect
- Register, B., Pennock, A. T., Ho, C. P., Strickland, C. D., Lawand, A., & Philippon, M. J. (2012). Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study. The American Journal of Sports Medicine, 40(12), 2720–2724.
- Kalisvaart MM, Safran MR. Microinstability of the hip-it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg. 2015;2(2):123-35.