Your hip is designed for a wide range of motion. The top of the femur, or thigh bone, is shaped like a ball, and it fits into the hip socket like a glove. These bones are lined with cartilage that cushions them as they move against each other. In a healthy hip, this anatomy is what allows you to move your legs in various directions without pain.
Sometimes, though, one or both of the bones in the hip joint can be misshaped, and when they move against each other, they cause pain. This condition is known as hip impingement.
We spoke to UNC Health orthopedic surgeon Chad Parkes, MD, about hip impingement and its treatment.
Hip Impingement Explained
Hip impingement occurs when one or both of the bones of the hip are misshaped. When the top of the femur, typically shaped like a ball, has extra bone and isn’t perfectly round, it’s a cam impingement; when there is extra bone on the hip socket, it’s a pincer impingement. Some people can have a combination of both of these deformities.
Hip impingement often occurs in conjunction with a labral tear. The labrum is cartilage that surrounds the hip joint, and when the bones don’t fit perfectly in place and start to rub against each other, the labrum can become damaged.
Dr. Parkes says that 40 percent of the population may have an incorrectly shaped hip joint, but not everyone will experience symptoms as a result. It’s commonly diagnosed in young athletes.
“It’s hard to know exactly what leads to the development of hip impingement, but we do tend to see it more in active, young people whose bones are still growing, because their growth plates are open,” Dr. Parkes says. “When a young person does high-impact activities, their growth plates may form extra bone around the hip joint, resulting in hip impingement.”
Symptoms and Diagnosis of Hip Impingement
The primary symptom of hip impingement is pain in the hip. The pain may be more pronounced during hip flexion—when you move your leg straight in front of you—or when you sit or squat, as those movements put the two bones of the hip joint in contact. You may also feel pain in the groin.
“Historically, young athletes were often told to stretch through groin pain,” Dr. Parkes says. “Stretching won’t improve pain or lack of motion caused by hip impingement, and forcing a stretch through pain, especially deep flexion or internal rotation, could damage the hip more over time.”
In addition to the pain, you may experience decreased ability to move or rotate your hip.
Hip impingement is diagnosed with a physical exam and an X-ray, which may show the formation of extra bone.
“There are a lot of structures around the hip that cause pain, so if you have pain in the hip and groin that gradually gets worse, it’s important to get evaluated,” Dr. Parkes says.
Hip Impingement Treatment
Hip impingement doesn’t necessarily require immediate treatment.
“If we see impingement morphology [shape and structure] on X-rays, but the patient is not experiencing pain, we do not necessarily need to treat the impingement, but rather watch it closely over time,” Dr. Parkes says. “A lot of people will also find out they have a labral tear and think they need immediate surgery, but not all tears require surgical treatment.”
When you are in pain, there are a few nonsurgical options.
“Many patients experience pain relief through physical therapy—strengthening the muscles around the hip and core—and anti-inflammatories,” Dr. Parkes says. “If those options don’t work, we might consider a corticosteroid injection into the hip.”
If pain continues, you may need surgery to prevent continued damage to the cartilage, which could cause arthritis. Hip impingement typically is treated with hip arthroscopy, or scope, a minimally invasive procedure.
“During a hip scope, we can repair the labrum and shave down the excess bone to reshape the hip,” Dr. Parkes says. “Following the surgery, a patient is typically on crutches for four weeks, working with physical therapy to progress their strength and mobility during the rehabilitation.”
While the goal of the surgery is for you to return to all normal activities, you may not be able to engage in sports activities for at least four to six months to ensure your hip heals properly.
If you’re experiencing joint pain, discuss it with your doctor. Need a doctor? Find one near you.