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Hip Impingement
Dr. Ambrose Yung
Hip impingement is a condition characterised by abnormal contact between the bones of the hip joint, causing pain and restricted movement.
In a healthy hip, the rounded top of the thigh bone (femoral head) glides smoothly within the hip socket. However, with hip impingement, abnormal bone shapes or alignment result in friction within the joint that can gradually damage the surrounding cartilage and joint tissue. Hip impingement often affects athletes and active individuals but can also occur in people with structural differences in the hip.
Symptoms of Hip Impingement
Friction between the hip bones can lead to significant joint tissue damage if untreated, progressively impacting daily activities. The main symptoms include:
- Pain: Pain is commonly felt in the groin area and may be triggered by hip movements that increase bone pressure, such as bending, squatting, or twisting. Pain may also extend to the outer hip or buttocks, particularly after physical activity or prolonged sitting.
- Stiffness: Stiffness in the hip joint can result from the irritation and inflammation caused by bone friction. It can make certain movements difficult, such as bending to tie shoelaces or climbing stairs, as the joint’s flexibility is restricted.
- Reduced Range of Motion: A restricted range of motion occurs when the irregular bone structure of the hip impingement limits how far the hip can rotate or bend. Over time, joint tissue stress makes achieving full movement increasingly difficult and uncomfortable.
Causes and Risk Factors
Hip impingement develops from structural abnormalities in the hip joint that result in improper contact between the femoral head and the hip socket. Contributing factors include:
- Developmental and Genetic Factors - Developmental and genetic factors can contribute to structural differences in the hip that increase the risk of impingement. Some individuals are born with minor irregularities in hip structure, making them more likely to develop impingement over time, especially if physically active.
- Repetitive Hip Movements - Athletes in sports requiring repetitive hip motion, such as football, cycling, or dance, have a higher risk of developing hip impingement. Continuous motion and joint stress can worsen existing abnormalities.
- Age and Lifestyle - Hip impingement often affects younger, physically active adults. Those leading sedentary lifestyles may not experience symptoms until later in life when the cumulative impact of everyday movements causes joint strain.
Types of Hip Impingement
Hip impingement is classified into three main types, which guide treatment based on structural abnormalities:
Cam Impingement
Cam impingement involves a deformity of the femoral head, which is not completely round. The irregular shape causes increased friction within the hip socket, leading to cartilage and labral tissue damage.
Pincer Impingement
Pincer impingement occurs when there is an overgrowth of bone along the rim of the hip socket, known as the acetabulum. This bony overgrowth pinches the femoral head during movement, creating pressure on the joint and contributing to cartilage damage.
Combined Impingement
In some cases, individuals may have both cam and pincer abnormalities, resulting in combined impingement. Combined impingement leads to both forms of friction in the joint, which can increase joint friction, intensify symptoms and accelerate cartilage deterioration.
Diagnosis of Hip Impingement
Hip impingement is diagnosed using a combination of clinical examination, symptom evaluation, and imaging studies. These include:
- Clinical Examination: A doctor typically starts by reviewing the patient’s medical history and performing a physical examination to evaluate hip mobility and pinpoint areas of pain or restriction. The doctor may ask the patient to perform specific movements or exercises that can help identify which part of the hip joint is affected and whether these movements provoke pain, aiding in the localisation of the impingement.
- Imaging Studies: X-rays are often the first imaging tool to identify bone irregularities in the femoral head or acetabulum. An MRI or CT scan may be required for a detailed assessment of cartilage damage, labral tears, or subtle bone deformities. In some cases, an MRI with contrast dye enhances visualisation of the joint tissues and injuries.
Treatment Options for Hip Impingement
Treatment focuses on relieving pain, improving joint function, and preventing further damage to the hip. Options depend on symptom severity, structural abnormalities, and the patient’s activity level.
Non-Surgical Treatment
Non-surgical treatments are typically the first step in managing hip impingement. These may include:
Physical Therapy
A tailored physical therapy programme can strengthen the hip and core muscles, improve joint stability, and increase the range of motion. Specific exercises focus on reducing pressure on the joint during movement, helping to alleviate discomfort.
Activity Modification
Avoiding activities that worsen symptoms, such as deep squats, running, or prolonged sitting, can help reduce joint stress. Modifying physical activities, particularly for athletes, can help manage pain while maintaining some level of fitness.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are often recommended to manage pain and inflammation associated with hip impingement. These medications are usually taken short-term, under medical guidance.
Corticosteroid Injections
In some cases, corticosteroid injections may be used to provide temporary relief from pain and inflammation. These injections are generally used as part of a comprehensive management plan rather than a long-term solution.
Surgical Treatment
Surgery may be required if non-surgical methods fail, particularly to correct structural abnormalities. The type of surgery is determined by the nature and severity of the impingement.
Arthroscopic Surgery
Arthroscopy is a minimally invasive procedure in which a small camera (arthroscope) and specialised instruments are inserted into the hip joint through small incisions. The surgeon can then reshape the femoral head, remove excess bone overgrowth, or repair labrum damage, depending on the specific needs of the joint.
Open Surgery
In more complex cases, open surgery may be necessary to address severe impingement or joint abnormalities. This involves a larger incision to provide greater access to the joint for bone reshaping and tissue repair. Although recovery is longer, open surgery may be more effective for individuals with extensive joint damage.
Preventing Hip Impingement
Prevention of hip impingement focuses on minimising joint stress and maintaining hip flexibility and strength. This includes strengthening the hip and core muscles, avoiding repetitive high-impact activities, practicing proper posture, and incorporating low-impact exercises like swimming or cycling. Monitoring symptoms early and adjusting activities as needed can also help prevent further damage.
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Singapore 258499
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Spire Orthopaedic Physiotherapy & Rehab Centre
101 Irrawaddy Road, #18-03
Singapore 329565
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Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
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Frequently Asked Questions (FAQ)
Can hip impingement cause pain in other parts of the body?
Yes, hip impingement can lead to compensatory pain in areas such as the lower back, knees, or even the opposite hip. This occurs as other parts of the body try to compensate for restricted hip movement and the altered gait that can result from the condition.
Are there long-term complications of untreated hip impingement?
Yes, untreated hip impingement can lead to long-term complications such as osteoarthritis. The persistent friction between the bones can gradually wear down cartilage, leading to degenerative joint changes and increased pain over time.
How long does it take to recover from hip impingement surgery?
Recovery time after hip impingement surgery varies based on the extent of the procedure and the individual’s overall health. Generally, patients can expect to be on crutches for a few weeks, followed by several months of physical therapy. Full recovery may take between 4 to 6 months.