Treatment of Hip Impingement

At Sydney Muscle & Joint Physio Penrith presentations of hip pain, pain during hip range of motion, particularly hip internal rotation and provocation during single leg hopping can provide a high suspicion of hip impingement. Hip impingement, also known as femoroacetabular impingement (FAI), can result from subtle abnormalities of the proximal femur (ball) and acetabulum (socket) that can put stress on the hip joint.

 

Certain factors including paediatric hip diseases (hip dysplasia), high-impact athletic activities during growth, and genetic factors have been proposed. Slipped capital femoral epiphysis (SFCE) has been proposed to be a risk factor for development of cam type hip impingement. Recently, there have been reports that athletes with excessive participation in high-impact sports, like soccer, basketball and ice hockey during adolescence when the skeleton matures, have a higher prevalence of femoroacetabular impingement when compared to non-athletes.

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At Sydney Muscle & Joint Physio Penrith our philosophy is to provide evidence based treatment for hip impingement. Generally, the symptoms in individuals with FAI arise from damage to soft-tissues like the labrum and cartilage, with these being aggravated during daily or athletic activities. Therefore, there may be a role for conservative care to reduce hip pain, improve symptoms, and reduce disability by focusing on activity modification, movement pattern retraining, muscle strengthening, and pain management.

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Activity modification

Patient education on joint protection strategies and avoidance of symptom-provoking activities is a fundamental part of the treatment process for hip impingement presentations. At Sydney Muscle & Joint Physio Penrith our joint protection strategies include no stretching of the hip joint, reducing deep squat actions that flex the hip and minimising crossing the affected leg over the other.

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Pain management

Pain management interventions are similarly to any that can be applied to musculoskeletal injuries. Simple analgesic medication can be the first port of call for hip pain from femoroacetabular impingement (FAI)- these can include paracetamol and NSAIDs. Heat and ice can help reduce pain in order to encourage specific therapeutic exercises or movements. Joint mobilisations can be administered to the hip joint to increase range of motion or to help desensitise painful ranges of motion. Our physiotherapists use specific hip mobility techniques to improve pain free hip flexion and internal rotation. Other types of manual therapy for capsular restrictions while avoiding end-range flexion and internal rotation can also be utilised.

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Exercise Therapy

Staged exercise-based physical therapy programs that include therapeutic exercises and activities including strengthening (based on any observed asymmetry in rotation), and cardio-respiratory endurance exercises, and neuromuscular re-education that focuses on multi-joint patterns to improve movement coordination.