Hip pain can hold you back from many activities: from your favorite sports, to games with the kids, or even hitting it hard at the gym. Finding the root of your hip pain is the first step to doing something about it.
If you suspect (or know) that your pain stems from hip impingement, introducing hip impingement exercises to your routine may also help you address and treat your pain.
What is hip impingement syndrome?
Also known as femoroacetabular impingement (FAI), hip impingement syndrome is when the contact point of the hip joint (the ball and socket) has abnormal wear and tear. It is technically a mechanical or structural disorder that directly impacts the hip joint.
Usually, this wear on the hip joint occurs on the labrum (or hip joint cartilage) and develops over time due to excess friction on the joint structure. The added friction could be caused by overuse, incorrect form when exercising, tight hip flexor muscles, or an abnormal hip shape. Any of these reasons has been known to cause hip impingement pain.
In a healthy, normally functioning hip, the top of the thigh bone (the femoral head) is rounded to fit perfectly into the hip socket (the acetabular socket). When this is a seamless fit, the femoral head can move without resistance.
There is a thin layer of smooth cartilage that protects these bones at their connection point and a labrum around the rim of the hip socket creating a protective ridge of cartilage for added security during femoral head movement.
Anytime something prevents this smooth, seamless movement between the hip's femoral head and the acetabular socket, hip impingement may occur.
Hip impingement syndrome symptoms can affect anyone at any age - even young adults and children.
Bone shape, tight muscles, and hip impingement pain
When we think about hips and hip injuries, we often assume that everyone's hip is precisely the same. But, just like we all have varying body shapes, our hip bone shapes and hip joints are different, too.
Being aware of your unique hip bone shape can be one of the most effective ways to set realistic expectations for your body, especially if you're an athlete. For example, one person may have an extremely shallow hip socket. Shallow hip sockets will allow for more mobility and flexibility, but they may also create instability and a higher chance of labrum damage, hip labrum tears, and pain from hip impingement.
The human body has a fantastic way of working extra hard to correct injured areas. So as hip impingement sets in for most people, the iliopsoas muscles begin to tighten. These muscles are what you might think of as your hip flexor muscles, and they connect your spine and pelvic bone to the inside of your femur (thigh bone), facilitating movement and giving your body stability.
The iliopsoas muscle is actually made up of two large muscles that sit side-by-side: the iliacus and psoas. These two muscles help stabilize the pelvis and core with every movement you make - whether sitting, standing, bending over to tie your shoe, or stretching out your legs after a long day. They also help protect the hip joint and tendons in your body from taking on too much stress.
But when a damaged hip or hip joint is thrown into the mix, the iliopsoas muscles become fatigued. This may result in tightness in your hip flexors and/or hip pain. And, as your iliopsoas muscles begin to tighten and pull on the bones they connect to, that can cause a pelvic tilt, difficulty fully extending your legs, lower back pain, and a host of other issues. This is what we refer to as a “twisted core.” It’s the result of one or both of your iliopsoas muscles refusing to loosen their grip on your body.
As you can imagine, having tight hip flexors can also make hip impingement symptoms even worse. Having your hips out of alignment can cause problems on its own. Paired with already existing hip impingement syndrome, tight iliopsoas muscles are likely to create even more friction during movement.
In order to ease hip impingement pain, and find the correct hip impingement exercises for your case, it’s important to understand the type of impingement you are dealing with.
Types of hip impingement
The exact type of hip impingement you're experiencing has a lot to do with the shape of your hip joint bones. There are two main types of hip impingement that doctors will often refer to.
- Cam impingement: This occurs when the ball-shaped end of the femur is not perfectly round. Since the femoral head has an abnormal shape, the way it rubs as it moves in the socket adds extra friction to the cartilage and labrum.
- Pincer impingement: This happens when the femoral head is covered too much by the acetabulum or socket. This excess coverage can cause the femur's neck to touch and impinge along the rim of the hip socket. Over time, this causes cartilage and labral damage.
Just because you have one type of impingement in your hip doesn't mean you can't have the other. Plus, there are even more types of impingement than these two. These are simply the most commonly referred to by doctors.
In the absence of both cam and pincer impingement, hip impingement caused by hypermobility or a shallow hip socket is also possible.
To understand if you have hip impingement and could benefit from hip impingement exercises, let's take a look at some of the symptoms of this syndrome.
Hip impingement symptoms
Hip impingement symptoms often fly under the radar for years. Some people won't even feel pain until the hip damage worsens with time. The most common symptom is pain in the groin area. However, pain may not be existent at all in the early stages of hip impingement, or you may associate it with other issues.
Hip impingement pain will usually be more noticeable when walking, running, or performing an exercise that flexes the hip.
Other than hip pain, you may experience some decreased range of motion and tightness in the iliopsoas muscles.
When hip impingement symptoms first occur, you may only feel resistance, pain, or decreased range of motion when engaging in stretching, running, jumping, or other activities that put stress on the hip joint.
So, if you're an athlete that often pushes the limits of your body, you may notice hip impingement pain much earlier than someone that works in an office setting and goes on leisurely walks each evening.
No matter the hip engagement, if the syndrome worsens with time and day-to-day hip use, even the most simple activities could become painful. Doing things like walking up stairs or standing up from sitting after driving to the market are likely to produce pain in the groin area.
Something that hip impingement patients need to realize is that if gone unchecked, hip impingement can lead to osteoarthritis.
If you are having pain at night as you are lying in bed, or even when walking slowly on flat ground, this could mean that a lack of cartilage is allowing contact of the bones as you move. As the cartilage breaks down, other symptoms could arise, and osteoarthritis is not out of the question.
Now that you are aware of the symptoms, it’s time to explore some hip impingement exercises to properly stabilize your hip joints and prevent hip pain.
Top 5 hip impingement exercises
Luckily, surgery is not the first or only option to treat hip impingement. While some patients may require surgery due to severe damage to the labrum or joint structure, we believe it should be a last resort.
Instead, we focus on helping you create and practice hip impingement exercises that strengthen the muscles around your hip joint and promote balance and alignment.
Here are the top five hip impingement exercises to try before resorting to surgery.
When entering into physical therapy for hip impingement of any kind, it is essential to note that strength training and stretching are equally important. If you try to rely solely on stretching, it is possible to overstretch your hip muscles - especially the iliopsoas.
Since hip impingement can be caused by hyper flexibility, overstretching your hip flexor muscles could exacerbate the problem entirely. Still, if part of your hip's misalignment is from overly tight muscles, then some hip stretching could be beneficial.
Knowing the cause and type of your hip impingement can help your physical therapist design hip impingement exercises that will not be harmful to your joint.
Some commonly used stretches that a physical therapist may have you do include:
- Hip flexor stretches like lunges
- Piriformis stretches to stretch the back hip
- Groin stretches like a gentle butterfly stretch
Be sure to listen to your body as you engage with these hip impingement exercises. Happy muscles shouldn't hurt. Tightness and pain are both indicators that you could be stretching your muscles too far.
Besides stretching the iliopsoas muscles, strength training will often be used to further stabilize the hip structure and keep it in proper alignment. Hip strengthening may seem normal in this situation, but what about core strengthening as part of your hip impingement exercises?
Your iliopsoas muscles are a part of your core and play a large role in the stability of not just your hips, but your whole body. So, by balancing out the muscle strength in and around your hips, you add more stability to the hip joint itself.
Core strengthening exercises ideal for hip impingement patients:
- Leg raises
- Pelvic tilt
- Pelvic clock
Just as with stretching exercises, if core strengthening exercises cause you pain at any time, STOP. Be sure to report these instances back to your physical therapist so they can restructure hip impingement exercises that better fit your needs.
Since your hip area is the source of your pain, it’s important to strengthen your hip region. Of course, finding hip-strengthening exercises that don't hurt may take some trial and error. You may also need to work with your therapist to release your muscles and promote the correct hip joint alignment before engaging in any strengthening movements or exercises.
One way to do this is with a tool like the Hip Hook, the only muscle release tool designed to release both the psoas and the hard-to-reach iliacus muscle. The iliacus is half of your iliopsoas, and it is too often overlooked in addressing hip pain and impingement. Its location along the inner side of your pelvic muscle can make it very difficult to reach and release without a specific tool or a skilled therapist.
Once you’ve used the Hip Hook and felt a release, you can then move to some of these hip impingement exercises that may help strengthen the hips:
- Bridges (single and double leg)
- Lateral band walking
- Isometric hip raise
- Hip hikes
Remember, releasing muscle tension needs to happen before you can strengthen. Otherwise, you will cause your already-tight muscle to contract even more or may not be able to achieve a full range of motion.
Many balance exercises may feel a bit like strength training and will engage your leg muscles, hip muscles, glutes, and core. Working on balance is a way to target small muscle groups around the hip joint to improve the joint's stability. As your balance improves, you will gain more control of your pelvic and lower extremities, and take some pressure off of the hip joint itself.
Keep in mind that when performing balance exercises, you will have to push yourself just a little. If it’s easy to balance, try to move to the next level of a movement, or shift the position of your eyes. Feeling wobbly is normal!
Balance exercises to try include:
- Using a Bosu ball
- Standing on a balance board
- Single leg squats
When attempting these hip impingement exercises, be sure to have something nearby (such as a wall or chair) to help you with stability as needed. Work to find a balance of challenging yourself just enough to pursue a better balance, without putting yourself in danger of injury.
And, if you are unsure of any movement, always ask your therapist. They will be there to supervise your form and provide alternatives if your current level of hip mobility doesn’t allow you to safely do an exercise.
Working on form and functional training
Something as simple as the way you step as you walk can impact your hips. Body awareness is important for managing and treating hip joint pain.
Functional training will teach your body how to move correctly as you go about day-to-day activities. This can also be targeted to your needs. For instance, if you're an athlete, you may need functional training to strengthen your hip joint enough for sprinting or kicking. If that's the case, a physical therapist would need to structure your hip impingement exercises around your form and overall awareness of movement.
And when doing any of the above hip impingement exercises, you should always prioritize form over trying to go deeper into a stretch or completing an exercise more quickly. In many ways, you are re-teaching your body and hips to move in a different way while doing familiar exercises. If you’ve been suffering from hip impingement for some time, your body may have acquired muscle memory around improper form. This may be as a result of certain muscles compensating for others in your hip region or because your hip joint structure wouldn’t allow for a full range of motion.
So, be gentle with yourself! Slow down and listen to your body.
Other hip impingement treatment options
Though these solutions may help, remember that hip impingement exercises aren’t everything. While physical therapy is the ideal option for treating hip impingement, some other options are available. Things like rest, pressure release of muscles, injections, and surgery could all be a part of the healing process.
Choosing the right types of treatment or hip impingement exercises for your body is easiest with the help of a medical professional. However, if your doctor breezes over the iliopsoas muscle when discussing possible treatments, ask them if tight hip flexors could be causing more pain than the hip impingement itself.
Many physical therapists are well aware of the role the iliopsoas muscle plays in hip pain, so they may opt to perform some pressure release of the muscles during sessions together. Luckily for you, Aletha Health now has a way for you to release your iliopsoas by yourself with the Hip Hook. This provides a regular and controlled manner for you to get all the benefits of an iliopsoas release at home.
Hip pain is not something you simply need to live with. With the help of a medical professional, regular iliopsoas muscle releasing, and tailored hip impingement exercises, you will be well on your way to recovery from your hip impingement pain.
FAQs on hip impingement
Does stretching help hip impingement?
Having supple, flexible muscles surrounding the hip joint allows the hip to move as freely as it can within the socket. While the hip impingement may be related to bone structure, the surrounding muscles can help or hinder movement and can reduce pain. Muscle release along with stretching will provide the best results.
Can you fix hip impingement without surgery?
Nonsurgical options address the muscles surrounding the hip joint. While this does not address the structural cause of hip impingement, stretching and strengthening these muscles may provide enough pain-free mobility to avoid surgery.
Does hip impingement go away?
While the structural causes of hip impingement won’t go away on their own, the symptoms of hip impingement (pain, pinching, decreased mobility) can be greatly reduced by addressing the surrounding hip muscles.