How to Manage Hip Impingement, According to Physical Therapists

You rely on your hips to get around throughout the day, so when hip pain flares up, it can really cramp your lifestyle. A common cause of hip pain is hip impingement — when there’s extra bone in the joint that causes pinching or friction. This can make climbing stairs, bending over to tie your shoe, and even sitting uncomfortable. Or downright painful.

While hip impingement can contribute to pain and impaired function, many people have hip impingement without any symptoms. Some research has found that up to two out of three people without hip pain have hip impingement. If hip impingement is contributing to your achy hip though, exercise therapy and physical therapy can help with your symptoms.

Read on to learn more about hip impingement — what it is, what causes it, and how to manage it, especially with exercises from Hinge Health physical therapists.

What Is Hip Impingement?

Technically called femoroacetabular impingement (FAI), hip impingement is characterized by extra bone along one or both bones in the hip joint. The hip, one of the largest joints in your body, is a ball-and-socket joint. The ball part is the spherical top of the femur (thigh bone). The socket is a cup-like indentation on the lower portion of your pelvis called the acetabulum.

There are two types of hip impingement:

• Cam impingement is when the ball part of the joint isn’t perfectly round because of bone overgrowth.

• Pincer impingement is due to extra bone on the socket part of the joint.

“Cam and pincer impingement can be mixed, so you can have some bony overgrowth on both sides of the joint,” says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. “The extra bone causes abnormal contact between the hip bones and prevents them from moving smoothly during activity.” When this happens, the labrum — cartilage that lines the rim of the acetabulum — can get pinched, causing discomfort or pain in some people. Over time, this can result in tears or arthritis, but exercise and physical therapy can help relieve pain.

Hip Impingement Symptoms

Sometimes, hip impingement doesn't cause any symptoms, or they may be so mild you barely notice them. Other times, they may be due to other hip issues, like a strain, tendinitis, or arthritis. Here are some signs the pain could be due to hip impingement:

• Pain, ranging from a dull ache to sharp and shooting, in the front of the hip or the groin

• Sharp pain or pinching when you flex your hip (bring your knee toward your torso)

• Pain when sitting, climbing stairs, squatting, or bending down

• Stiffness

• A clicking or popping feeling in your hip

• Feeling of instability when bearing weight

Symptoms that should prompt a call to your doctor include severe levels of pain, inability to bear weight, your leg giving way, no improvement following conservative treatment, or progressive numbness, weakness, or tingling. These may be signs of another problem.

Hip Impingement: A Hinge Health Perspective

When you hear the words “impingement” (it even sounds painful) and “bony overgrowth,” it’s natural to feel a little panicky. “People often think, ‘Unless I fix the bony overgrowth, I’m not going to get better,’” says Dr. Kimbrough. “But remember, this is really common. All of us are built differently, and many people with these bony changes can be asymptomatic. Even though we can’t change what the imaging says, we can usually manage the symptoms conservatively and not have to jump to surgery.”

Movement is essential for relieving hip impingement pain. However, when something hurts, a natural tendency is to avoid activity, which can lead to more muscle weakness and worse symptoms. By strengthening the muscles surrounding your hips, you can create a solid foundation to support your hip joints. This can help ease pain and discomfort. 

Causes of Hip Impingement 

Here are some things that can cause hip impingement pain.

• Repetitive motion. Sports or activities that require a lot of repetitive hip flexion, like running, cycling, squatting, or twisting (e.g., golf) may aggravate symptoms.

• Too much sitting. When you’re seated, your hip is in a bent position. The longer you maintain this position, the tighter your hip flexors become, which can contribute to pain.

• Genetics. Some people may be born with slight variations in the head of their femur or the acetabulum that can create friction.

• Injury. A bony overgrowth may be present all or most of your life without any symptoms, but an injury or even a change in activity may trigger pain or other symptoms.

Hip Impingement Treatment 

Conservative treatment options for hip impingement can offer comparable improvements to surgery without the recovery time, according to research. Here’s how to start easing your pain.

• Physical therapy. A physical therapist can recommend targeted exercises and stretches tailored to your needs and assist you in working through any fears or concerns you may have about exercising when you have pain. The goal is to strengthen the muscles around the hip joint to help relieve symptoms, prevent further issues, and get you back to doing what you love without pain. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• P.E.A.C.E and L.O.V.E. protocol. You may be familiar with the advice to rest, ice, compress, and elevate an injury (the R.I.C.E. approach). But the latest thinking is to focus on P.E.A.C.E. (protect, elevate, adjust anti-inflammatories, compression, and educate) and L.O.V.E. (load, optimism, vascularization, and exercise). This new, more comprehensive approach prioritizes movement and exercise — over rest — as a central part of your recovery plan while still protecting and rehabbing your hip.

• Activity modification. Repetitive motions that involve hip flexion, like running or cycling, can increase hip impingement symptoms. It can help to modify some painful activities (but not stop moving altogether) until the worst of your pain passes. Instead of running, try walking or swimming, which involves less hip flexion, or decrease the amount of running you’re doing. If you enjoy cycling, sitting in a more upright position may enable you to continue riding with less pain. Squatting and bending down require a lot of hip flexion and can aggravate symptoms. When you need to pick something up off the floor, lunge forward with the leg of your pain-free hip to avoid flexing the painful hip.

• Adjust your sitting. The less you sit, the less pressure you’ll have on your hips. Unfortunately, sometimes you can’t avoid it, but there are ways to make sitting more comfortable. Raise your seat by placing a pillow or folded blanket on your chair or sit on a stool. This raises your hips above your knees, decreasing how much your hips are bent and easing any pinching or pain. If you sit a lot at work, consider using a standing desk, or propping your computer on a higher shelf or filing cabinet so you can stand while you work on occasion. 

• Exercise therapy. “People with impingement symptoms typically have decreased flexibility and strength in their hip compared to people who are asymptomatic,” says Dr. Kimbrough. “Improving flexibility and strength helps support the hip joint and takes some pressure off the structures that are impinged and pinched.”

In many cases, the symptoms associated with hip impingement can improve with conservative approaches. If the above treatments don’t provide enough relief, your doctor may suggest you consider surgical options.

The above physical therapist-recommended stretches help to open up the hips and can potentially relieve symptoms associated with impingement.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Check in on Your Sitting Posture

First things first: There’s no such thing as perfect posture. But, “when you’re sitting for long periods of time, you may end up in positions that can further aggravate hip impingement pain,” says Dr. Kimbrough. “Changing how you sit can help calm your symptoms.” If you have pain with sitting, try tweaking a few things to see if it makes a difference. Try keeping your back against your chair to maintain a more upright position, as opposed to leaning forward. “Leaning forward increases hip flexion and can put more pressure on the hip joint,” says Dr. Kimbrough. Try uncrossing your legs for short periods of time. Or sit with your feet about hip-width apart and flat on the floor instead of letting your knees roll in toward each other. When legs are parallel and facing straight ahead, it can minimize pressure on your hips.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Mulcahey, M. K. & Thomas Byrd, J.W. (2020, August). Femoroacetabular Impingement. OrthoInfo — American Academy of Orthopedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement/

2. Doyle, S.M. (2023, October 12). Hip Impingement. Hospital for Special Surgery.Retrieved from https://www.hss.edu/condition-list_hip-impingement.asp

3. Hip Impingement. (n.d.). Washington University Orthopedics.Retrieved from https://www.ortho.wustl.edu/content/Patient-Care/3206/Services/Hip-Knee/Adult-Reconstruction-and-Hip-Preservation-Overview/Hip-Impingement.aspx

4. Zhou, J., Melugin, H.P., Hale, R.F., Leland, D.P., Bernard, C.D., Levy, B.A., & Krych, A.J. (2020). The Prevalence of Radiographic Findings of Structural Hip Deformities for Femoroacetabular Impingement in Patients with Hip Pain. American Journal of Sports Medicine, 48(3), 647-653. doi:10.1177/0363546519896355 

5. Frank, J.M., Harris, J.D., Erickson, B.J., Slikker, W. 3rd, Bush-Joseph, C.A., Salata, M.J., and Nho, S.J. (2015, June). Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy, 31(6), 1199-204. doi:10.1016/j.arthro.2014.11.042

6. Mansell, N.S., Rhon, D.I., Meyer, J., Slevin, J.M., and Marchant, B.G. (2018, May). Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. American Journal of Sports Medicine, 46(6), 1306-1314. doi:10.1177/0363546517751912