What is Impingement of the Hip and how is it managed with Physiotherapy?
“Impingement” of the hip is formally known as Femoroacetabular Impingement Syndrome (FAIS). It is a problem in the hip joint where extra bone growth causes pain during movement and it is one of the more common injuries that present at the clinic.
Pain in the front of the hip and/or groin regions
Possible clicking, locking, popping and/or grinding sensations during hip movement
Symptoms are typically during multidirectional sport, deep squatting, sitting for long periods
Many people cannot regularly participate in multidirectional sport
Most people with this issue are young and active adults, however it is possible for anyone to have this problem particularly with sedentary lifestyles. Typically, this issue begins gradually over time rather than caused by a single specific incident such as an ankle sprain. The pain is usually in the area in front of the hip and/or in the groin region. Some people also describe “clicking”, “locking”, “popping” and/or “grinding” sensations in the hip during movement. The symptoms are usually brought on during multidirectional sports (for example soccer, football and tennis), deep squatting, sitting long periods or other activities where the hip is turning or leg is being flexed towards the trunk. Whilst most people with this issue are able to maintain a level of physical activity with less impact and changes of direction, research shows that only 30% of people are able to maintain regular participation in athletic activities with impact and changes of direction. If this sounds like you so far, it’s very possible that you have Femoroacetabular Impingement Syndrome and we recommend you seek physiotherapy management to help you get back to sport and help get rid of the pain.
Officially, this problem is diagnosed with physiotherapy testing and with x-ray images of the hip. Although in most cases people don’t require any form of scans for their injury, X-ray imaging can be very helpful to confirm the diagnosis of this problem as there are many different issues and injuries which can give similar symptoms to those described above. X-rays are bulk billed under Medicare and Physiotherapists are able to refer patients directly to have it done.
A very important part in the successful management of this condition is the strengthening of the muscles of the hip and trunk so that the hip moves in a more healthy manner during sports and other physical activities. In order for a Physiotherapist to provide a good exercise program that somebody will benefit from, various muscle groups must first be tested to determine which ones need training for a given person.
At Melbourne Sports Physiotherapy, the AXIT testing system is used to determine strength and movement differences between hips. This includes the use of dynamometers and force plates provides great data to help us put together a set of strength and stability exercises to give people the best chance to feel better and get back to their physical activities. We are fortunate to be able to use this equipment to help provide people exercise programs which are tailored to them. At many other clinics where there is no access to such testing equipment, Physiotherapists usually take a guess or simply assume which muscles may need re-training in a patient who may have this issue, and this leads to non-tailored exercise programs which can be very hit or miss in their success.
On top of the above, a functional assessment can also be performed to determine whether stability issues exist during movement. Long before “functional exercise” became a popular form of general exercise (F45, Crossfit, Bodyfit training), functional movement assessments were already performed by good Physiotherapists!
Once specific muscle weaknesses and stability deficits have been identified. The appropriate exercises can then be prescribed. Here are examples of exercises for various muscle groups of the hip:
Single leg bridges for strengthening hip extensors
Crab walk for strengthening hip abductors
Standing banded hip adduction strengthening hip adductors
Twisties for strengthening hip external rotators
WHAT REP RANGE IS GOOD FOR BUILDING STRENGTH?
The 3-10 rep maximum range (mainly the 3-5 range) has been shown to be best for gaining strength - meaning you should be able to achieve close to ‘failure’ within this range, and if you haven’t then increase the weight or resistance for an optimal stimulus for strengthening. However, considerations must be made for training experience, technique, current and previous injuries and total volume (reps x sets x other exercises). I prefer the 8-10 rep range for strengthening so that the resistance isn’t too high to cause potential problems. For reference, the 6-10 rep max range is ideal for muscle hypertrophy and >12 for muscular endurance.
Exercises can be progressed in a variety of ways, but generally speaking an appropriate exercise rehabilitation program considers factors beyond isolated strengthening of basic movements. This includes a combination of functional movements, multi directional and plyometric training to approximate movements which may happen during sport.
A good exercise program should be progressive and systematic, with considerations to:
Muscle activation in basic positions
Single leg stability
Impact loading: jumping and landing drills
Multidirectional movements relevant to sport
Training: individual and team
The stage that will be appropriate will depend on baseline strength, progress with exercise program and symptoms. At any given time, rehabilitation will include exercises in multiple categories.
How long it takes to get well again depends on various factors:
How greatly the injury has affected performance to begin with
Quality and performance of exercise rehabilitation
Patient goals, for example management will likely take longer to prepare for sporting activities as opposed to simply being pain-free in regular life activities
Generally speaking, an appropriate and thorough exercise program which considers strength, single leg stability, plyometrics and multidirectional movements should go at least 12 weeks.
Occasionally, despite best efforts with rehabilitation. Injection therapies and surgical management may be required. In any case, a good rehabilitation will still need to be followed as exercise is the only way to improve the muscular control of the hip during movement.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!