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Pain on movement in the groin or hip area can be caused by hip impingement. This is a condition that affects your hip joint.
The hip joint is formed by a ball-and-socket joint. A hip impingement syndrome, which is also called a femoroacetabular impingement (FAI), describes a condition in which the ball part of the joint (femoral head and neck) does not perfectly match the socket part of the joint (acetabulum).
A hip impingement leads to a pinching (impingement) in the hip, which results in a restriction of movement as the hip joint is flexed and rotated.
There are three main types of hip impingement:
- Cam impingement of the hip is where the femoral head has abnormal bone growth, affecting the smooth movement within the hip socket.
- Pincer impingement of the hip is where the neck of the femur catches on the rim of the hip socket.
- Labral tear, which refers to a tear in the articular cartilage, which surrounds the acetabulum.
A cam impingement of the hip and a pincer impingement of the hip can exist in conjunction with each other, resulting in a combined impingement of the hip.
The hip joint is described as a being a ball-and-socket joint. The top of the thigh bone (femur) features a ball and this ball slots into a cavity (the socket) in the pelvic bone, called the acetabulum bone. In a healthy hip, the ball fits snugly within the cavity.
The hip joint is described as a being a ball-and-socket joint. The top of the thigh bone (femur) features a ball and this ball slots into a cavity (the socket) in the pelvic bone, called the acetabulum bone. In a healthy hip, the ball fits snugly within the cavity.
When the various parts of the hip joint do not perfectly match then this can result in stiffness and/or pain in your thigh, hip, groin, or lower back, as well as a lack of flexibility in extending your hip beyond a right angle. You may find that turning or twisting at your hips exacerbates the pain. In time, this mismatch of the joint can damage the protective cartilage in the joint.
Advances in our understanding of and treatment of hip impingement have come relatively recently. As such, we still do not have any long-term data to support the exact causes of the condition.
However, several possibilities are under investigation: ·
- Genetic shape of the hip joint (morphology) in both men and women
- Participating in sports involving twisting or turning on the hip
- Poor lower limb alignment (biomechanics)
The main hip impingement symptoms are persistent stiffness or pain in the hip muscles or groin, especially during hip movement. Some people may suffer from referred pain radiating into the thigh. You may limp as a result of the pain or be unable to bend at the waist.
Symptoms can occur with activities that involve repeated or prolonged hip flexion especially if combined with an internal rotation or external rotation. This can include:
- Prolonged sitting (a low seat height may be worse)
- Sports involving repeated flexion of the hip such as cycling
- Sports involving repeated twisting and turning on the hip, such as football, rugby or hockey
Hip impingement syndrome occurs as a sharp, stabbing pain or a dull ache, usually in the groin region. Certain movements, such as squatting or twisting, may make the pain worse. Activities, such as running or jumping, may also produce hip pain.
Some people may not experience any symptoms. Hip impingement symptoms usually develop when the condition progresses and there is damage to the hip joint cartilage.
Hip impingement can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination. The main feature on examination is often a pain and reduced range of motion into flexion and rotation.
X-rays and CT scans are usually not required but will be requested if symptoms remain severe enough to consider surgery after appropriate non-surgical management strategies.
Symptoms of hip impingement syndrome can be managed effectively by non-invasive measures. Along with anti-inflammatory medicines for pain management, the most effective treatments are modifications to sitting posture and sporting activities (if applicable).
Modifying your seating position can help to alleviate the pain from hip impingement syndrome. Raising your seat height and slightly reclining the back-rest will open your hip angle and reduce the extent of pinching at the font of the hip joints.
Low-impact hip impingement exercises, such as walking or swimming, can help you to maintain mobility. However, it is usually advised to avoid any activity where there is an impact on your joints, such as running or weightlifting.
Regular hip impingement syndrome exercises can also help maintain flexibility and strength to the affected hip joint, these include:
Bridge from floor
In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week.
Standing quads stretch with posterior tilt
In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week.
Standing hip abduction
In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week. These are suggested exercises only. If you are at all concerned about whether a course of hip impingement syndrome physical therapy is suitable for you or if you experience any pain while doing any exercises, please seek appropriate clinical advice from your doctor or physiotherapist. If your quality of life has been significantly impacted by the condition and non-surgical management strategies have yet to make a noticeable difference, then hip impingement syndrome surgery may be considered.
Hip arthroscopy (keyhole) surgery can be considered for individuals whose hip impingement symptoms are significantly limiting quality of life and sporting activities. An arthroscope is a small, flexible tube about the length and width of a drinking straw. It contains a light source and a digital camera that sends images to a video screen or to your surgeon’s eyepiece.
To qualify for hip impingement surgery you need to:
- have trialled a course of non-surgical management without success
- have clear evidence of the cause of the impingement symptoms on an X-ray or MRI scan ·
- have no significant osteoarthritis of the hip
- have a suitable Body Mass Index (BMI)
You may be asked to complete a questionnaire called an Oxford Hip score. This can help the clinician assess the impact of your symptoms which can be useful in assessing suitability for surgical treatment. Please note that there is no current evidence to indicate that undergoing a hip arthroscopy will reduce the risk of developing hip osteoarthritis in the future.
