Hip impingement

What it is

Femoroacetabular impingement is abnormal contact between the femoral head-neck junction and the rim of the socket. It comes in two shapes: a cam type where extra bone on the femoral neck jams into the socket, and a pincer type where the socket over-covers the head. Many people have both.

The bone shape is extremely common - present in a large proportion of athletic people with no symptoms - so the shape alone is not the diagnosis. Symptoms arise from the combination of that shape with the depth and volume of hip flexion loading, and they involve irritation of the labrum and the cartilage behind it.

What it feels like

• Deep pain in the groin, often indicated by cupping the hip with a C-shaped hand
• Worst with deep squatting, sitting in a low chair and getting out of a car
• Pinching at the front of the hip at the end of a deep bend
• Clicking or catching in the joint
• Stiffness after sitting, and reduced hip rotation

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Cam morphology

Extra bone at the junction of the femoral head and neck jams into the socket during deep flexion and rotation, shearing the cartilage. It develops during adolescence and is much more common in people who played high-impact sport during growth.

Pincer morphology

The socket covers too much of the head, so the neck contacts the rim earlier in the range. It compresses the labrum directly and is more common in women.

Deep flexion loading volume

The shape only produces symptoms when it is loaded repeatedly in deep flexion. Squatting sports, hockey, football, dance and martial arts are the common settings.

Labral irritation and tearing

The cartilage rim is compressed and sheared by the abnormal contact. Labral tears are the usual finding on imaging, though they are also common in people without symptoms.

Adolescent sport during growth

Cam morphology develops during the growth spurt in people doing high-impact sport, which is why it is so much more common in athletes and in men.

Reduced hip internal rotation

Both a sign and a contributor. Loss of rotation means the joint reaches its bony limit sooner and the compensation is taken elsewhere.

Deep hip flexor and rotator overactivity

The deep muscles work harder to control a joint that is irritable, and they become tight and tender - which is often what is felt rather than the joint itself.

Weak glutes

Poor gluteal control allows more femoral internal rotation and adduction during loading, which brings the impinging surfaces together more often.

Being told it means surgery

Not a cause, but a common outcome of an imaging finding. Conservative management works well for many people, and the bone shape is present in many pain-free hips.

Who tends to get it

• Athletic men, in whom cam morphology is much more common
• Anyone who played high-impact or squatting sport through adolescence
• Hockey, football, dance and martial arts participants
• Anyone with reduced hip internal rotation
• People with weak glutes and poor pelvic control

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineHip Relief & Rotation

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Groin pain with locking or giving way; night pain; a limp in a young person

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Structured physiotherapy improves symptoms in a substantial proportion of people over three to six months, and it is a reasonable first treatment for most. Arthroscopic surgery outperforms physiotherapy in some trials for athletes with clear cam morphology and persistent symptoms, so it is a genuine option rather than a last resort - but it is a decision to make after a proper conservative trial, not on the basis of a scan alone.

Prevalence basis: Hip imaging cohorts

Others the same routine covers

These share the Hip Relief & Rotation routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.