Femoroacetabular Impingement (Hip Impingement)

Overview

Femoroacetabular impingement — FAI, or simply hip impingement — describes a hip where the shape of the ball (femoral head) or the socket (acetabulum) means the two pinch together at the limits of movement, particularly when the hip is bent deeply and rotated inwards. A "cam" shape is extra bone on the ball; a "pincer" shape is a socket that covers too much of the ball. Many people have both. Over time the pinching can irritate the labrum (the cartilage rim of the socket) and the joint cartilage.

FAI is typically diagnosed in active people in their twenties and thirties — footballers, hockey players, dancers, martial artists, rowers and gym-goers who squat deep. The classic symptom is a sharp or aching pain in the groin during or after deep squats, sitting in low chairs, driving or getting in and out of a car, often with a click or catch. Many people point to the pain with a "C" shape of their hand cupped around the hip.

Importantly, the bony shapes of FAI are common in people with no symptoms at all, especially athletes. Having the shape does not mean you will have pain, and symptoms often improve substantially with a well-designed physiotherapy programme that changes how the hip is loaded.

Causes and risk factors

• Bony shape of the hip (cam, pincer or both), often developing during adolescence
• Intensive sport during the teenage growth years, particularly football and ice hockey
• Repeated deep hip flexion: deep squats, rowing, cycling, martial arts, ballet
• Weak gluteal muscles and poor pelvic control, which increases pinching
• Stiff lumbar spine or pelvis, forcing more movement through the hip
• A family history of hip shape differences
• Being male (cam-type is more common in men)

How we may be able to help

Our assessment uses impingement tests that reproduce the groin pain, measures your hip range in each direction, checks gluteal and core strength, observes how you squat and move, and examines the lumbar spine and pelvis. If imaging has not been done and the picture suggests FAI with labral involvement, we can arrange an online private GP consultation to discuss X-ray or MRI.

Physiotherapy is the first-line treatment and the evidence supports it. Our physiotherapists work on hip joint mobilisation to ease capsular tightness, then a targeted programme to strengthen the glutes and deep hip stabilisers, improve pelvic control, and modify movement patterns so you avoid the pinching positions during sport and gym work. We will adjust your squat depth, stance and loading rather than stopping you training.

Manual therapy, dry needling and IASTM help with the tight hip flexors, adductors and deep rotators that often guard an impinging hip. Our chiropractor can address lumbar and pelvic stiffness that increases demand on the hip. A 3D posture scan can document pelvic tilt, which directly changes how much room the hip has to move.

What you can do at home

• Avoid deep squatting, low chairs and sitting with knees above hips while symptoms are irritable
• Raise your car seat or use a cushion so hips sit higher than knees
• Strengthen your glutes with bridges, side-lying leg lifts and band walks
• Keep hip movement within a comfortable range — do not force stretches into the pinch
• Modify gym work: box squats to a higher depth, wider stance, avoid deep lunges temporarily
• Keep a note of which activities flare the hip so we can target the plan