Hip impingement
Hip impingement pain is something that has been coming into clinic a lot lately, so we just wanted to break it down a little bit.
Hip impingement is when the ball joint of the femur (leg bone) “pinches” against the socket joint of the acetabulum (pelvis bone). This can happen for a few reasons. Anatomically, there are a few variations of shape of the ball or the socket joint that can predispose people to increased pinching in the hips. We call these abnormalities cam or pincer or mixed impingement types and they can be easily diagnosed on xray or MRI scan. They can be due to hip issues at birth, previous injuries or altered biomechanics of the hip over time.
However, if it is not genetic, it is acquired, meaning that the extra bone formation is produced over time as you learnt to walk and loaded that hip joint. If it is acquired and you believe in epigenetics, then movement patterns and movement quality are of utmost importance to address.
A hip becomes compressed for a number of reasons. Tightness through the hip flexors or the hip capsule can cause hip compression. It can also occur due to tightness through the ‘short hip external rotators’ (we usually blame the piriformis but there are actually 6 different muscles here that could all be contributing). These short hip external rotators run from the pelvis to the thigh bone and cup it like a hammock. Therefore, when they are tight they wedge the thighbone up into its socket, causing a compressed, impinged hip. Both of these are tightened up with prolonged sitting, which is why sitting is like smoking for your hip health.
They may also be overworking if other muscles aren’t doing their job properly. Very often, we find that either the lower abdominals or the gluteus maximus will be inhibited. If the lower abdominals are inhibited, then the hip is not able to move freely, as it does not have a stable pelvis to move on, and so the low back becomes unstable whilst the hip tightens up even further. This is why, in so many patients with low back pain, their hips also need to be addressed. Clinically, this presents as a lack of core stability of the lower abdominals with extremely tight hip flexors and quads, also known as ‘quad dominance’.
If the gluteus maximus is underactive, then the short hip external rotators or hamstrings will try and take over to produce hip extension and become extremely tight. Ever done a glute bridge and cramped in the hamstring? Yeah, your hamstring is doing the work for two people because your gluteus maximus isn’t doing enough! This is why so many people with hip issues have extremely tight hamstrings and piriformis muscles. And as said before, tightening through the hip rotators only compounds the issue as it compresses the hip even further into the socket.
There is LOADS we can do to decompress that hip without needing surgery. Even big scary labral tears and bony impingements do NOT always need to be treated surgically. There’s a reason why hip replacements and knee replacements STILL need to be replaced after a few years: they rarely fix the underlying issue. They are a band-aid solution to give some relief for a few years. Even if the joint is never completely repaired on imaging, that doesn’t mean that it has to be painful. Studies have shown that nearly ¾ of the population will have hip conditions on imaging and yet have ZERO pain.
We believe function is MUCH more important than structure. The ability to differentiate hip movement from pelvis and low back movement is extremely difficult but crucial to rehabilitating anyone with hip impingement.
At Kinetic Healthcare, our Chiropractors from our CBD and Narellan practice may also look at how your shoulders are functioning. This is because the opposite shoulder may also be driving your hip issue. A tight pec on the left will mess up your hips on the right, as the oblique sling (the muscle chain connecting one hip to the opposite shoulder) loses its ability to lengthen through the abdominals, and the shoulder and hip are pulled towards one another. This is why so often patients will have a sore right hip and left shoulder or vice versa AT THE SAME TIME. Fixing your shoulder first may be crucial to fixing your hip.
You do NOT have to live with hip pain. Don’t wait. Come get assessed. Fix it before it leads to a low back issue, a knee issue, a foot issue or a shoulder issue. Figure out what needs to be done and then stick to the plan. Our team of Chiropractors from our CBD and Narellan office are only too happy to help
Feel better. Move better. Perform.
Mike