Hip Impingement Explained: Cam, Pincer, Symptoms and Rehab

You're listening to the Restoring Human Movement Podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host. Hey everyone, it's your co-host Sebastian with the Restoring Human Movement Podcast. Today we are going to cover the topic of hip impingement. I'm going to cover some of the basics of it. I'm actually drafting a YouTube video, a little script that I'll probably follow in one of the videos to come here. So make sure that you go to the link in the description to watch the images part of this as well. Now, if you're an athletic individual, such as a runner who's been dealing with hip or groin pain, this is a podcast you're going to want to listen to.

Unfortunately, this is something that a lot of people just overlook for many years and assume that it's not going to get better because of the bad information out there about hip impingement. I'll tell you right now that, yes, there is a bony component to it that will probably not change, but that does not need to change. As I discussed in some of the other podcasts about hip impingement, that there's a biomechanical factor to it, which is why a lot of times people succeed in doing things like rehabilitation and exercise for it. So who gets hip impingement? Actually, what is it first? It's actually a condition where there's pinching on structures of the hip.

Typically, it's from two different types, but there can be mixed. It's called a pincer type, which is a bony overgrowth of part of the pelvis called the acetabulum. This is the reason why you should look at the YouTube channel for this because it may provide some more insight. Or it's an abnormality, or let's just, I don't want to call it an abnormality. Let's call it a different from the generally accepted normal of femur head shape, which is where we get the idea of what we call the cam. The cam of a hip impingement is an oblong shape femoral head or a bony growth that goes into the neck of the femur, which is the thigh bone, which then can obstruct a little bit as you go through range of motion too.

But again, there's mechanical aspects to it, and there's a lot of them. Ones who get it are typically athletic individuals such as soccer players, hockey, dancers. Repetitive hip movements tend to be a common thing associated to it, but we've seen it in people like runners, hurdlers, baseball players, golfers, and even people who just like to work out as a hobby. Normally, it affects people into their 20s to 50s or so, I'd say the sweet spot is probably around the late 30s. But the bony overgrowth tends to happen when you are developing. So when you're a teenager or prepubescent, there are some factors that are associated to family history, such as your parents have had it, so you may too.

But actually, most of it goes along with how active you were as an adolescent. So let's not just go all out and blame genetics on this one, because there are lifestyle factors too. Previous hip injuries can be a predisposing factor for it. And a lot of the pain associated to the past hip injury oftentimes goes away, and then later on, we tend to find that there's actually hip impingement that follows years later. I've found in clinical practice, with a lot of our telehealth and our in-person people, when we actually assess, oftentimes we find that people have an old injury on the other side of the body, which puts excessive load on the symptomatic side of the hip, which can oftentimes create hip impingement as well.

Normally, how it feels is there is pain into the hip or the groin, which is the front crease of the hip, especially with things like squatting, sitting, and twisting. I know a lot of people that I've met, swinging the leg up into their car is actually one of the most painful things, and they have to lower their leg down, which is actually painful too. Many of them will demonstrate lifting the leg or the knee up to the chest in a standing position is painful, as well as they report that a lot of exercises like dead bugs or hip flexor ones tend to really bother the problem as well. There tends to be stiffness or an odd feeling in the front or side of the hip as well.

I've had many people describe it's not pain really, it just feels abnormal or not like my other side. There can be clicking into the joint, which is oftentimes not painful, but when you have painful clicking, popping, locking in place, that's more of a possible labral issue. When there's a grinding, that's going to be more of an arthritic type of condition. There tends to be, we don't notice like a skipping that you can oftentimes hear from even feet away, which tend to be more arthritic based. Symptoms always tend to get worse with prolonged sitting, but a lot of times even low back conditions and knee conditions get worse with prolonged sitting.

Stagnant time is really hard on a lot of people's problems, which is why we tend to advise that you get as active as you possibly can, as long as you don't provoke the area as soon as possible. And yes, it is generally okay to be physically active while having some sort of pain. It's not a good idea to fight through pain and completely ignore the signs of pain ramping up as you're going through more activity. But I think if we're smart about it and we have a good arsenal of exercises that we can swap in to a workout program, or if we can be smart about talking to our coaches or teachers about, hey, I can't do this one movement today in soccer or dance, but I can do these ones instead.

Are you okay with me participating? Because sometimes what we find is that, especially younger athletes, is they just say, I'm hurting. And they say, I can't do anything, which is not really correct. They may be limited from sprinting. They may be limited from change of direction drills, deep squatting in the gym. Like all these things may be limited. But what they could do is probably jog a little bit. They could do footwork drills. They could do some dance movements. And they can certainly do in the gym, upper body movements, usually deadlifting or hip hinging is okay. So there's a lot of things that they can oftentimes do.

But if they just say, oh, I can't do anything. And it's poor communication to the coach. Then sometimes they won't get the modifications that they actually need to get better either. There are some x-ray findings that you can use to identify hip impingement. One of the main ones is called crossover sign. It's found in a basic x-ray of the pelvis or in the hip. And you're going to find that there's overlapping lines of the front and back part of the hip socket from the pelvis. Normally, this isn't the case. It's going to be, they're not going to cross over quite as much. Hence, what we call crossover sign.

But I've met many people with this that don't actually have symptoms associated to it. They're incidental finding. So I wouldn't hang my hat on. That's going to be painful all the time. Nor do you need to have a hip surgery to repair that. But usually, the presence of crossover sign can help identify diagnosing hip impingement or also known as FAI. I don't think I mentioned that earlier. Femoral acetabular impingement. By assessing the severity of the acetabular overcoverage. MRI can find soft tissue injuries in the area, but it's usually not going to be the best at assessing for hip impingement.

But you can certainly find edema and swelling in the areas. I know a lot of people have been misdiagnosed as well. They believe they don't have hip impingement, and they think they have a TFL strain or rectus femoris tendinopathy or a hip flexor tendinopathy. And these, most of the time, are fairly incorrect, in my opinion. I know you may find conflicting information. I saw a few videos on YouTube where they said actually the opposite. I would disagree. I would say that most people that at least we see in our office, and maybe it's because of the information we put out and the self-screening process that people do, but most people do not actually have tendinopathies in those areas.

Or, sorry, they are not the symptom generators. So they tend to actually have the symptom generator being the actual impingement. And that comes down to having a good, thorough examination to figure out what actually is the symptom generator. In one of the other podcasts I recently did, I talked about self-assessment and active and passive assessment on your healthcare provider's part. And this can all be done on telehealth. Normally, passive range of motion, such as bringing the knee to the chest. In a seated position is fair. Laying on the back actually works really well, too. You bring the knee to the chest by using all the power of the arms to do so.

And you bring it up to the chest and across the body a little bit. This simulates a test, what we call Fadir's test or scour's test. It's like a self-scour, self-fadir's test. F-A-D-I-R test. And these are ways to make the impingement basically increase. And so you're trying to approximate two bony structures. And this is usually painful passively on people with hip impingement. But it tends to be not painful on those with their tendinopathies because the tendinopathy requires the active structure, the tendon and muscle complex to be contracting to challenge the symptomatic tissue. If you do it with your arms passively or your healthcare provider does it for you or directs you through it telehealth wise.

If that is not painful, but active is, it still could be active tissues. It could be your tendinopathies. But if both are painful, active and passive, it can still be hip impingement. And I know it's hard to decipher exactly what it is on your own. That's why people like myself exist. We are liaisons and guides to help you figure out what to do for it. It's not in your best judgment to figure out complex problems like this, but giving a little bit of insight of what we're looking for, I think is a good starting point. But as I tell everybody, most people do solve some of the, they do solve a lot of their problems on their own, whether it be because they actually treat it correctly, self-wise, or if they take away a trigger, they just stop their sport, which is not usually the best thing to do because they actually like their sport.

And so if you like your sport, taking that sport away is not always the best thing. But if you want to keep your sport and treat it right, that's why your healthcare provider exists who has experience in this to basically become a cheat code. They accelerate the timeline and make it so you don't have as many mistakes and so much risk. Now, typical treatments are very conservative care. Physiotherapy, exercise, rehabilitation, whether it be performed by a physical therapist, physiotherapist, sports chiropractor, personal trainer. These are all things that are interchangeable. I know that the degrees are basically what makes it, so you call it physical therapy or personal training or anywhere in between.

But there are general guidelines that we all follow or the good coaches. I'll call all that category coaches. Good coaches will follow general guidelines of accepted causes. Like we know there's a posterior anterior tilt aspect to the problem. We know there's a core problem oftentimes. And we know there's an issue with lateral stability. And we know that generally hip flexion like deep squat bothers it. So there's ways to scale these things. And we usually use something called the regional interdependence model. And this is where we try to improve hip mobility by improving stability in other locations.

And that may be up and down what we call a kinetic chain, which is all the way from all the way down the foot. But it could be core issues. I've actually seen people, strangely, who have had a hip impingement start because of an old shoulder injury or an old toe injury. And so if you have someone to properly assess your movements and any deficiencies of range of motion or stability in the areas where you should have it, then you are beating the odds. In my opinion, giving exercises as rehabilitation, hard ones, is the cornerstone to making it so you improve quicker. I believe we do a good job here of accelerating people's timelines.

They say a standard care for this is about 12 weeks to have a reduction of pain. I would not agree, but I do feel that that's actually commonplace. People have to do about three weeks of physical therapy, but oftentimes before they're candidates for things like imaging and so on. So they want to see that you're failing care. And I tend to find that people's reduction of symptoms for most people is around three to four weeks with the system that we use, which is curating the right exercises, making them hard enough to create an adaptation and reduce pain at the same time, but also identifying triggers and removing triggers in people's lives.

So it's a little bit of forming a recipe, but usually conservative care with a skilled provider is advised first. Many people use anti-inflammatory medications. And with my degree, I'm not allowed to suggest those, but I have observed that it is commonplace to do so. And I have known people who have had hip impingement surgery. I think it would take a lot to get there to make that suggestion, at least for me. When people do have labral injuries or hip arthritis, I would make that judgment call a little bit quicker because those are big physical internal obstructions, which are really hard to get around.

And impingement, though, is dynamic. Again, there's a mechanical aspect to it. We can reduce it at will just by changing positions. Those other conditions aren't quite as willing to change with just simple coaching. Usually acute cases, again, they resolve within a couple of weeks, but chronic cases can last months to years. I've seen decades for some people, and eventually it can turn into something like hip arthritis or labral tears, non-traumatic labral tears. And unfortunately, a lot of these, I think, are associated to either neglect, they're just denial that they want to deal with it, or sometimes they don't really get the right care for them.

But I'd say as a general rule, most people, if they get the right care, three to four weeks is pretty good for a pain management aspect. And then when we start to get into function, getting a stronger hip, which usually helps out with femoral acetabular impingement. So getting the glute max to work better, getting it stronger, getting better hip extension, correcting some of the anterior posterior tilt aspects, getting better core stability, getting a stronger leg. Like these take time, but these can happen concurrently. They can happen while you're actually resolving some of the pain for a lot of people.

But then it's also the long game. I tend to notice, at least prognosis-wise, people fare super well, and especially if diagnosed and treated early, I'd say within a few months is usually the standard window. Most people just assume their problems are going to go away when they first get them, which is why most of the time we don't see people, you know, after when they're a day or a week old. But I definitely think within the months, like under a year window, under the six-month window is certainly the best time to get a good head start on it. So if you guys are looking for help, we do have telehealth sessions and we're licensed in different states and we excel at working with people with hip impingement as well as lower body injuries.

So we're lower extremity experts. Knees, heels, hip impingement, sports hernias, low backs, and so on. I believe that we get the timeline accelerated for a lot of people because we have a good system of dealing with things like this. And we make really targeted suggestions rather than picking 15 different exercises for the glutes when you really only need probably two. So if you guys are looking for help, reach out to us, subscribe to the podcast, and certainly look at the YouTube video that I made surrounding this topic. See you guys next time.