Hip pain due to impingement is a very common complaint in the sportsperson. The most likely positions that cause hip impingement are repetitive flexion, swinging the leg away from and across the midline of the body (i.e. abduction and adduction), and rotation or pivoting.
Sports which increase the likelihood of injury are hockey, tennis and all football codes, but in recent years the increased popularity of high impact sports including running, obstacle races such as “tough mudder” and MMA training in the amateur athlete/office worker have also contributed.
The hip (femoro acetabular joint) like the shoulder joint is a ball and socket joint albeit inherently more stable, possessing a deeper socket (acetabulum) where the femoral head (ball) fits snugly.
Bony impingement of the hip occurs when extra bone grows on the femoral neck or acetabulum or a combination of both, and is called Femoro Acetabular Impingement (FAI).
The labrum of the hip (connective tissue) can get pinched and torn due to FAI, subsequently damaging the joint cartilage causing pain, popping or clicking in the hip.
Clinical diagnosis of FAI can be made with a combination of a person’s history, specific examination findings and plain x-rays if necessary. But it must be realised that structural variations in someone’s anatomy alone do not cause symptoms, with many individuals showing evidence of FAI (as seen on x-ray) with no pain.
Often when someone presents to the Chiropractor’s office with a complaint of hip pain related to impingement, they display many postural and/or muscle imbalances which exacerbate there impingement, regardless of whether FAI is present or not. Below are some examples:
A posture known as the Lower Crossed Syndrome presents with tightness of the back extensors (erector spinae) and hip flexors (iliopsoas and rectus femoris), and weakness of the deep abdominals and gluteus maximus and medius. This leads to a forward tilted pelvis and reduced hip extension (i.e. increased flexion), increasing pressure on the front of the hip joint which is vulnerable to overload and injury.
A leg length difference due to pelvic joint dysfunction and/or muscle imbalance will cause increased weight bearing on the “longer” leg, overloading the hip on the same side. While exercising or playing sport the patient will experience increased hip flexion, internal rotation and adduction, resulting in “functional” hip impingement.
Conservative treatment and Chiropractic Rehabilitation will be successful in alleviating symptoms in the majority of cases so a functional examination is crucial to assess these imbalances. Surgery is rarely needed and a last resort in many cases.