Conditions
Hip impingement is also known as femoro-acetabular impingement (FAI). This condition results in abnormal contact between the head or neck of the femur on the acetabulum (socket) of the pelvis and can cause hip pain. There are 3 types of FAI.
CAM Lesion – when there is extra bony growth on the neck of the femur which comes into contact with the socket when the hip joint is flexed, resulting in pain.
Pincer Lesion – when there is extra bony growth on the edge of the socket that comes into contact with the femur when the hip is flexed, resulting in pain.
Combination – the presence of both CAM and Pincer lesions resulting in pain on hip flexion.
On assessment FAI is quite easy to diagnose. X-ray can be done to confirm the presence of the altered shape of the hip joint. MRI may be chosen to view the impingement and any other associated structural issue such as a labral (ring of cartilage around the socket) tear that can co-exist.
Management
FAI is managed in 2 ways. First is conservatively, where activity and biomechanical modifications aim to reduce the impingement in the hip. A thorough assessment of the pelvis and lower limb biomechanics is performed to identify all involved structures. Stretching tight or stiff structures and specific strength / control exercises of the small muscles in the back of the hip joint as well as some of the major muscle groups in the lower limb are likely required. The pain, and slightly altered movement within the hip joint, often causes the athlete to develop poor muscle recruitment patterns that need to be corrected.
The second option is surgery to reshape the hip joint and remove the excess bone. This is followed by a comprehensive rehabilitation program that has all the same aims as the conservative approach. It is vital to correct the biomechanics and muscle recruitment patterns around the hip and pelvis. Generally, the surgical approach is only taken if conservative management fails to relieve the symptoms and allow full return to sporting activity. The physiotherapists at Premium Physiotherapy can recommend an affiliated hip surgeon if symptoms do persist.