ANTERIOR HIP IMPINGEMENT
Anterior hip impingement is a condition in which there is a muscle/joint imbalance at the
hip joint causing the femoral head to shear anteriorly in the acetabulum. This causes the
anterior hip joint to sustain compression forces with movements of hip flexion, internal
rotation and adduction (either separately or in combination). The compression forces
cause a chronic synovitis and over time lead to articular surface breakdown i.e.
osteoarthritis. So if we can catch the impingement early and make changes to the
perpetuating compressive forces, we can prevent or at the very least delay, the
development of the structural arthritic changes in the hip.
The patient with anterior impingement will complain of an ache in the groin area perhaps
spreading into the anterior thigh and maybe even some lateral hip pain. The pain may be
intermittent at first but will likely develop into a steady ache. Certain movements, like
putting on socks, crossing the legs, squatting to read a putt, getting in and out of the car
or even just getting up from sitting, often cause a jab of sharp pain. There is usually no
trauma. The pain is usually helped with anti-inflammatory medication. Hopefully at this
stage there are no findings on an x-ray.
Assessment of the patient presenting with this hip pain and dysfunction would include
assessment of the lumbar spine, sacroiliac joint and the lower extremity looking for
imbalances that would cause the mechanics of the hip to change. These imbalances could
be tight muscles, tight joints, facilitated nerve roots, weak muscles, a leg length
discrepancy, or even poor posture or poor body mechanics. This presentation will focus
on the focused articular assessment of the hip joint itself and a technique to stretch the
joint capsule.
To assess the hip movements, I have the patient lie supine (demonstrated) and I passively
take the hip into full available flexion, into full available internal rotation and full
available adduction. (I do test the other movements but have not demonstrated them since
they are usually not affected in this condition). At least one of these movements is
usually limited with a hard capsular end feel and pain. Or, in the early stages, the
movement may be painful at the end range of the movements. These movements can also
be tested in a quadrant position which combines the 3 movements (flexion, adduction and
internal rotation) into one test. (Demonstrated).
If the capsule is tight posteriorly, I include a capsular stretch in the treatment program.
Because the joint is deep it is difficult to reach the joint with my hands to glide the joint,
so I prefer to use a belt technique. With the patient lying supine, I belt around the
patient’s proximal thigh and my trunk. I use the belt to distract the joint and I apply a
firm posterior glide mobilization to the joint. (Demonstrated)
If the hip flexors of the gluts are tight I use soft tissue techniques to relax the muscles. I
prefer not to give the patient home muscle stretches to follow until the joint biomechanics
allow them to do the stretches without causing a shear at the joint.
Hopefully this little bit of insight into anterior hip impingement helps you to recognize
the complaint before it continues on to structural degenerative changes. In the early stage
there is a chance that those degenerative changes can be averted, but it does require a
complete physical evaluation and an individualized treatment program that is directed at
the perpetuating factors found for that patient.
If you have any questions or comments, please feel free to call me at the clinic. Trevor
Christie 2330419. Or you can email to dougchristiephysio@mts.net