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What causes hip impingement?

 What causes hip impingement?

Your hips are among the most important joints in your body. However problems with hip joints are common, and as well as causing pain and discomfort these problems can create difficulties with movement, including walking.

According to the NHS, most cases of hip pain in adults that are treated with surgery are caused by osteoarthritis (i). But there can be other causes too including a condition called femoroacetabular impingement (FAI), which is more commonly known as hip impingement.

If you have hip impingement it means there’s a problem with the way your hip joint socket (acetabulum) and the top of your thigh bone (the femoral head) come into contact with each other. The two normally fit together comfortably, but with hip impingement for one reason or another they don’t (impingement means abnormal contact). Think of it as trying to fit a square peg into a round hole.

Because the bones in the hip joint don’t fit together perfectly, they rub against each other when you move. Over time the friction this causes can damage the joint, which in turn causes pain and limited movement.


Who’s affected by hip impingement?

Hip impingement was first described relatively recently in 2005 (ii). However it’s a common condition, with experts suggesting up to 30 per cent of the population have the joint abnormalities that cause it (iii) – though not everyone will have symptoms. Some people are also more likely to have problems with hip impingement than others, with up to 90 per cent of people who play certain sports – football, golf and ice hockey, for example – estimated to be affected (iv).

Indeed, while hip impingement can affect anyone of any age, it’s often diagnosed in active younger people, including those in their 20s and 30s. This may be because active people are more likely to sustain injuries that can lead to hip impingement than the rest of the population. Those who have a highly physical manual job also have a higher risk.

All of these people may be affected because they work their joints more vigorously or more repetitively than the rest of us – though some of those with hip impingement may simply have been born with a defect in their hip joint. Sometimes, however, there’s no obvious reason for why someone has hip impingement.

In fact strictly speaking, because of the way our hip joints work you could say we all have some degree of hip impingement. But people with normal hip joints will only experience pain with extreme movement of the joint, while others with hip impingement will have symptoms with more modest movement.


What are the symptoms?

If you have hip impingement you may experience several symptoms, including different types of pain – though the symptoms tend to vary from one person with the condition to the next. These include:

  • Pain in or around the hip and groin that comes and goes, particularly when you’re involved in certain activities (some types of exercise, for instance, can make the symptoms worse). Pain can also extend through the lower back, the buttocks and down the side of the thigh

  • Sharp pain in the groin when you make movements such as squatting, twisting, sitting down, getting up from sitting, getting into or out of a car and pivoting (especially when you pivot towards the affected side)

  • A dull ache or pain in the hip or groin after sitting for a long time, when bending, crossing your legs or after spending a lot of time walking or exercising

  • Difficulties walking upstairs or uphill

  • Stiffness in the hip joint

  • Limited range of motion in the hip joint, particularly when you rotate your hip inwards or move your leg inwards towards the centre line of your body

  • Difficulty balancing on the affected leg

  • Walking with a limp (this usually only affects moderate to severe cases)

  • Popping, clicking or a catching sensation in the front of the hip joint

These symptoms can start gradually, but they can get worse over time and can often lead to osteoarthritis – by this time, the hip joint will most likely be causing severe pain and disability.

Want to test whether or not you have hip impingement? Try lying on your back and bring each knee in turn up to your chest. At the same time, try to roll your thigh inwards, so that your knee crosses your body slightly. If you have hip impingement this movement should be painful.


How do hip joints work?

The hip joint is a ball-and-socket joint. The ball – or femoral head – is the rounded top of the thighbone (femur), while the socket (acetabulum) is part of the pelvis. The femoral head fits into the socket, with the shape of the joint allowing for a range of movement in the leg (forwards, backwards and side to side).

Both parts of the joint are lined with cartilage. This is a strong, slippery tissue that creates a smooth surface to cushion the joint, help the bones glide against each other during movement with limited friction and allow the femoral head to rotate freely in the socket. A strong but flexible piece of cartilage – called the labrum – also covers the outer edge of the socket, making the socket deeper and gripping the femoral head to create a tight seal around the joint, a bit like a gasket. This makes the joint even more stable.

In hip impingement, abnormalities of either the femoral head or the socket mean they don’t fit together as they should, causing increased friction during movement that can damage the joint:


Cam impingement

This is when there is a problem with the femoral head. This abnormality is usually a small bony thickening, bump or swelling on the femoral neck – the top part of the thigh bone just before the femoral head (the ball of the ball-and-socket joint).

The femoral neck is usually slim to allow the joint to have a good range of motion. But with a cam impingement, the femoral neck is wider and the ball can become more oval in shape than round, so it doesn’t fit in the socket properly. This reduces the range of movement in the hip and can cause damage to the labrum and the rim of the socket, and ultimately to the cartilage in the joint itself.

Cam impingement is considered more common in men than in women (v).


Pincer impingement

In this type of hip impingement – which is more common in women (v) – the front rim of the hip joint socket sticks out too far either in one area or more generally across the whole rim. This means that during movement the femoral neck bumps into the rim of the socket, and over time this can cause damage to the labrum as well as the cartilage within the joint.

While one type of impingement is more common in men and another in women, studies suggest that around 85 per cent of people with hip impingement have both types (vi).

Other factors may also play a part in hip impingement, since some people with the deformities that cause it don’t experience any symptoms. Nobody really knows what these may be, but weak hip muscles may be an issue.


Getting a hip impingement diagnosis

Getting a diagnosis of hip impingement can take time, especially if you also have low back, buttock or pelvic pain (these can also be signs of other conditions). However if your GP suspects you have hip impingement they may refer you to a hospital specialist who will first establish whether or not the pain is coming from the hip joint and then rule out any factors that may make you susceptible to the condition. They may also examine you and manipulate your hip joint to see if specific movements – such as the knee-to-chest movement outlined above – cause pain.

Other tests you may have include x-rays of your hip to look for signs of arthritis or any other cause of hip pain as well as the deformities that are associated with hip impingement. You may also have an MRI scan of your hip to look at the joint in more detail (this type of scan can detect whether the labrum is torn or if there’s any sign of damage to the joint’s cartilage). Some people may also need a CT scan to look at the joint in even more detail.


Hip impingement treatment

Scientists are still trying to decide which is the best approach to managing hip impingement. However several treatments are available, both surgical and non-surgical.

  1. Non-surgical treatments – also known as conservative management – are usually recommended in the first instance:

    • You may be advised to take over-the-counter anti-inflammatory medicines such as ibuprofen to reduce any pain and inflammation – often you have to take these just before you do any activities that bring on your hip pain.

    • People with hip impingement are also often advised to stop or modify any activities that make their symptoms worse, such as playing certain sports.

    • Physiotherapy may also be helpful as it can help strengthen the muscles around the joint and improve the range of movement. For instance, a physiotherapist could show you how to do postural balance exercises and hip and lower limb strengthening exercises, as well as exercises that help improve your core muscles. Experts also suggest that strengthening the hip muscles could help reduce inflammation in the hip joint (vii). See Exercises for your hips, below, for examples of exercises that could be beneficial.

    • If taking anti-inflammatories and doing hip-strengthening exercises don’t provide sufficient pain relief, some specialists may advise injecting medication directly into the hip joint. By far the most common type of injection used is one that contains corticosteroids, which help relieve inflammation. Other substances sometimes used in injections for hip impingement include platelet-rich plasma – this contains blood cells called platelets taken from your own blood – and stem cells that may actually help damaged cartilage to regrow and heal (though research is still ongoing into the latter).

  2. Surgery can be carried out to repair any damage in the cartilage and labrum in the hip joint and also to remove any excess bone that’s stopping the joint moving smoothly (removing bone from the femoral head-neck junction is called a femoral-osteochondroplasty, while trimming and reshaping the rim of the socket is called a rim-trim). These procedures can use an open incision or they may be performed using keyhole surgery (arthroscopy). Sometimes, if the cartilage in the joint is significantly damaged, a complete hip replacement operation (arthroplasty) may be necessary.

    • If you have the symptoms of hip impingement it’s important to get a medical assessment, since the longer your symptoms are left untreated, the more damage can be done to your hip joint.


Exercises for your hips

If you have hip impingement your GP or hospital specialist may have already recommended resting, avoiding activities that cause pain and taking anti-inflammatory medicines. There are also several stretches and exercises you could do that may be helpful, including the following:


The bridge

  1. Lie on your back with your knees bent and feet flat on the floor under your knees, keeping your hands relaxed at your sides.

  2. Push your lower back into the ground and at the same time tighten your abdominal and buttock muscles.

  3. Slowly push through your heels and raise your hips off the ground – it should form a straight line from your knees to your shoulders. Keep your abdominal and buttock muscles engaged throughout. Avoid pushing using your arms or hands

  4. Hold for 10 seconds at first, and gradually increase to holding for 30 seconds before slowly lowering your hips and returning to the starting position.

  5. Repeat the exercise until you have done three sets of 10.


Hip abduction

  1. Stand up straight, feet shoulder width apart. Gently hold onto the back of a chair with one hand at your side.

  2. Squeeze your abdominal muscles – imagine you’re trying to make your belly button touch your spine.

  3. Slowly move the leg furthest from the chair out to the side of your body, keeping your knee straight and your toes pointed. Keep your upper body and back straight.

  4. Slowly lower your leg to the starting position.

  5. Repeat until you have done three sets of 10, then do the same using your other leg.


Hip flexor stretch

  1. Kneel on the floor (use a small pillow to kneel on if that feels more comfortable).

  2. Raise one leg and place the foot flat on the floor in front of you (the further away you put your foot, the more intense the stretch).

  3. Slowly move your upper body forwards, hingeing from the hips, while keeping your back straight and your chest high. Keep your abdominals and buttocks squeezed throughout, and feel the stretch in the front of your hip (it’s normal to feel a little discomfort but stop if the stretch is very painful).

  4. Hold the stretch for 10 seconds at first, gradually increasing to 30 seconds. Repeat two more times, then switch to the other side.


Piriformis stretch

  1. Lie on your back, knees bent and feet flat on the floor.

  2. Raise one leg and cross it over the other leg – the ankle should rest just above the opposite knee.

  3. Keeping your upper body on the floor, stretch your arms forward and grab the thigh of the leg that’s making contact with the floor. Pull that thigh gently towards your chest and feel the stretch in your buttocks and at the back of your hips.

  4. Hold the stretch for 10 seconds at first, gradually increasing to 30 seconds. Repeat two more times, then switch to the other side.

* Please note, if you have hip impingement always check with your doctor, specialist or physiotherapist before doing any new exercises. If any exercise or activity makes your pain worse, it should be avoided.

Meanwhile, if sitting for long periods triggers pain in your hip or groin, it may be a good idea to try changing your sitting position. Try opening up the angle of your hips more so there’s less pinching at the front of your hip joints by making your seat a little higher and reclining your back rest slightly.


Natural support and pain relief for hip impingement

Certain nutritional supplements could offer you some extra support if you have hip impingement, such as those that may reduce inflammation. These can be helpful as they are often more gentle than some conventional anti-inflammatory medicines:


High-strength fish oils

The omega-3 fatty acids found in oily fish are widely thought to help reduce inflammation in the body. Indeed experts have found these fatty acids affect the body’s production of substances called prostaglandins, which play a key role in inflammation (viii). They may also be useful for people who cannot tolerate conventional anti-inflammatory drugs, as studies suggest they have similar benefits but without the associated side effects (ix). Another study has also found taking fish oil supplements may help relieve pain and improve joint function (x).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3 (this is sourced from marine algae rather than from fish).


Turmeric

This well-known curry spice grows in India and Indonesia. It contains an active ingredient called curcumin, which is thought to have several health benefits including reducing pain, inflammation (xi) and joint stiffness. There is even some evidence it has an anti-inflammatory action because it blocks several substances that promote inflammation in the body, including tumor necrosis factor (TNF), prostaglandins, interleukin-12, cyclooxygenase 2, collagenase, elastast and thromboxane (xii).

Studies elsewhere suggest curcumin may help protect joint cartilage and relieve cartilage degeneration (xiii). A review of 15 studies has also found curcumin could be a potential treatment for osteoarthritis, which can develop as a result of hip impingement (xiv). And like omega-3 fatty acids, turmeric may be a safer option for people who cannot tolerate conventional anti-inflammatory drugs because it doesn’t come with their side effects (xv).


Glucosamine and chondroitin

Glucosamine and chondroitin are thought to help build and repair cartilage, which may reduce the progression of osteoarthritis. Both are found naturally in the body, though supplements are often sourced from shrimp or crab shell.

There are mixed results from studies into using both substances for osteoarthritis symptoms, though one review of studies suggests glucosamine may have an effect on joint stiffness and chondroitin may be more effective than a placebo (dummy pill) on relieving pain and improving mobility (xvi). Researchers elsewhere have found taking both glucosamine and chondroitin together may be beneficial compared with taking just one or the other (xvii).


Devil’s claw

Devil’s claw is a herbal remedy originating from South Africa that’s used for the relief of rheumatic pain as well as general aches and pains in the joints, based on traditional use only. Most of the scientific evidence for devil’s claw comes from studies into arthritis – one, for instance, suggests it may relieve pain significantly better than a placebo (xviii), while another has found that, while it seems to be effective as a treatment for hip and knee arthritis, it’s also safe and has a low risk of side effects (xix).


Vitamin D

Vitamin D is widely accepted as important for bone health as it helps your body to absorb calcium from food. However it may be important for joint health too, especially in older people. One study, for instance, has found that older men with low levels of vitamin D have an increased risk of develop osteoarthritis in their hip (xx).

Getting enough vitamin D in your diet is a problem for many people, especially during the autumn and winter months (that’s because our main source of this vitamin is sunlight). Indeed the UK government recommends everyone should take a supplement containing 10mgc of vitamin D every day between October and early March.

Some people may need a vitamin D supplement all year round, however, especially those who are housebound or people who usually wear clothes that cover up most of their skin whenever they go outside. People with dark skin may also make enough vitamin D from sunlight, says the NHS (xxi).

If you want to take a vitamin D supplement the recommended form is vitamin D3 (cholecalciferol), as this is the natural form of vitamin D our bodies make when we’re exposed to sunlight. You can get these in tablet form as well as in veggie-friendly drops. Most vitamin D3 supplements aren’t suitable for vegans, however, since they’re made from the fat of lamb’s wool. But the good news is you can get vegan vitamin D3 supplements available these days that are sourced from lichen.

Hip impingement can be painful and make day-to-day life difficult. But as this guide shows there are treatments available, as well as self-help measures you can take to make things easier for yourself. To find out more about a wide range of health conditions and what you can do about them, visit our health library

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 
 
Our Author - Christine Morgan

Christine

Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.

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