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Hip impingement

 

What is it? 

Hip impingement is caused by abnormal contact between the ball and socket of the hip joint. This can be due to changes to the bones or as a result of repetitive and extreme range of motion activities at the hip. For example, the extreme range of motion required for gymnastics, or the repetitive nature of kicking sports. Weakness and tightness of the muscles around the hip can increase the stress at the joint contributing to the symptoms.

Hip joint anatomy

1 Ilium (Pelvis)
2 Acetabulum (Socket)
3 Femoral head (Ball)
4 Greater trochanter
5 Lesser trochanter
6 Femur (thigh bone)

What are the common symptoms?

Symptoms may be felt as a deep, intermittent discomfort in the groin during or after activity. This may be associated with a catching or pinching sensation in the groin. Less common symptoms are buttock pain, pain on the outside of the hip or low back pain.

Sprinting, kicking sports, hill walking and prolonged sitting in a low chair are common activities which can cause pain.

 

How to manage it?

Modify your activity

Reduce activities that aggravate the symptoms. This may mean doing the activity less frequently, changing the activity or simple things such as sitting on a different height chair. Sometimes complete rest, especially from a sporting activity may be required for a short period time to allow symptoms to settle.

Exercises

Strengthening and stretching weak or tight muscles in the leg and around the hip is important to restore the normal control around the hip joint.

Hip Abduction

Standing up and holding on to something if you need to.

Take your leg out to the side and return

Side abduction with resistance band

Stand with an exercise band firmly attached around one ankle and secured to the other side. Hold to something if you need to.

Keep your pelvis still and use your buttock muscles to lift one leg out to the side (away from the midline). Return to the starting position in a controlled manner.

Resistance bands can be purchased online.

Resisted abduction in sitting

Sit on a chair.

Put a rubber exercise band around your knees. Spread knees apart as far as you can.

Slowly bring knees back together.

Hip Extension

Stand straight holding on to a chair.

Bring your leg backwards keeping your knee straight and then return

Do not lean forwards.

Bridge

Lie on your back with legs bent.
Squeeze your buttock muscles and roll your pelvis off the floor.
In a controlled manner, return to the starting position.

Quadriceps (front of the thigh) stretches

Lying face down, take hold of your foot and draw towards your buttocks until you feel tension in your thigh muscle.

Hold still for 30 seconds. Repeat 3 times.

Hip flexor stretch

Stand with one foot in front of the other and take support if needed.

Have you affected hip behind you.

Slightly bend your legs, shift your weight forwards, until you can feel a stretch in front of your affected hip.

Hold for 30 seconds and repeat 3 times.

A mild discomfort during exercise is acceptable but if you get severe pain or increased symptoms stop. Try to return to the exercises again, but at a lower intensity.

If you are having difficulty or need guidance on the right exercises, speak to a physiotherapist.

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing hip pain. Click here to self-refer to a physiotherapist.

How to prevent and manage future flare ups? 

Keep the muscles in your legs and around your hip strong by doing regular strengthening exercises.

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