Hip labrum impingement may occur when the ball and socket joint is unable to move smoothly within the joint. It is more frequently known as Femoral acetabular impingement (FAI). The ball and socket joint are lined with a layer of cartilage that assists in cushioning the femur bone into the socket, which allows free movement no grinding or rubbing within the joint, resulting in no pain. It is also lined with a ridge of cartilage called the labrum, this will keep the femoral head in its place inside the hip socket enabling extra stability.

Anatomy

The hip is a synovial joint more so known as a ball and socket joint. The ball of the joint is the femoral head (the upper part of the femur) more commonly known as the thigh bone. Within the socket is the acetabulum which is surrounded by the pelvis, this makes up the joint.

The surface of the ball and socket is protected by articular cartilage. This enables the bones in and around the joint to glide easily when performing everyday movements such as walking. The cartilage also helps prevent any friction around the surface of the joint avoiding any sort of impingement. Another feature around the joint is the hip labrum. This fibrocartilage labrum is found within the acetabulum, this enables stability to the joint as the hip has a large range of motion in movements such as flexion, extension, abduction, adduction and rotation.

Causes

Common causes of hip impingement are triggered by the femoral head being covered too much by the hip socket. Repetitive grinding at this joint leads to cartilage and labral damage, causing the feeling of impingement.

Other factors that may affect an individual to suffer with labrum impingement could be that individual may have been born with a structurally abnormal ball and socket joint. Also, movements that involve repetition of the leg moving into excessive range of motion may aid in the injury of hip labrum impingement.

Symptoms

Some common Hip Labrum impingement symptoms are as follows:

• Stiffness in the hip or groin region
• Reduced flexibility
• Pain when performing exercise such as running, jumping movements and walking
• Groin area pain, especially after the hip is placed into flexion
• Pain in surrounding areas such as lower back and the groin
• Pain in the hip even when resting

Causes

When you go to visit your doctor/ health care professional about hip complications they may talk about two main types of hip impingement:

• Cam impingement
• Pincer impingement

Cam impingement “occurs because the ball-shaped end of the femur (femoral head) is not perfectly rounded. This interferes with the femoral head’s ability to move smoothly within the hip socket”. 

Pincer impingement “involves excessive coverage of the femoral head by the acetabulum. With hip flexion motion, the neck of the femur bone “bumps” or impinges on the rim of the deep socket. This results in cartilage and labral damage”.

Unfortunately, both these two types can happen at the same time, more so known as combined impingement. Which may cause an individual to experience a lot of pain and discomfort.

Diagnosis

The diagnosis of hip impingement will be given by a doctor based on how you describe your symptoms and after performing a physical examination of the hip.

A passive motion special test that is commonly used for hip impingement is called the FADIR (flexion, adduction and internal rotation). This is where the patient will lie in supine position (on their back) with the legs relaxed, then the doctor will carry out the test:

1. The affected leg will be raised so that the knee and hip are at a 90-degree angle
2. The doctor will support the knee and ankle and gently push the entire leg across the midline portion of the patient’s body moving into adduction 
3. Then whilst keeping the knee in position, the doctor would move the foot and lower calf away from the body into abduction 

People who are suffering with hip impingement would feel pain during stage 3 of the test, however it may be hard to differentiate between each injury as someone not suffering with impingement may still feel pain, so it is always important to test the unfaceted side for a comparison.

Some imagining tests may also be performed such as: 

• X-Ray – The X-Ray screening may show an irregular shape of the femur bone at the top of the thigh or too much bone around the rim of the hip socket, thus causing the impingement
• MRI Scans – This may pick up wear and tear of the cartilage which runs along the hip labrum 
• CT scans may also be performed

Treatment

Non-Surgical Management

Activity Modification: 

Advise the patient to avoid activities that exacerbate symptoms, such as deep squats, prolonged sitting, or high-impact sports.

Physical Therapy:

• Stretching Exercises: Focus on stretching the hip flexors, hamstrings, and quadriceps to improve flexibility.
• Strengthening Exercises: Emphasise strengthening the gluteal muscles, core, and hip stabilisers to support joint function and reduce stress on the hip.
• Manual Therapy: Incorporate techniques such as joint mobilizations and soft tissue massage to reduce pain and improve range of motion. A deep tissue massage or sports massage may be a good option.

Medications:

• NSAIDs: Prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and alleviate pain.
• Pain Relievers: Recommend acetaminophen for additional pain management if needed.

Injections:

• Corticosteroid Injections: Administer corticosteroid injections into the hip joint to reduce inflammation and provide temporary pain relief.

Surgical Interventions

• Indications for Surgery:Consider surgery if the patient experiences persistent pain and functional limitations despite exhaustive non-surgical treatments.

• Arthroscopic Surgery:
  • Debridement: Remove bone spurs, damaged cartilage, or any other impinging structures to alleviate pain and improve hip function.
  • Labral Repair: Repair any torn labrum to restore joint stability and function.

• Post-Surgical Rehabilitation:
  • Early Mobilisation: Initiate gentle range-of-motion exercises soon after surgery to prevent stiffness.
  • Progressive Strengthening: Gradually introduce strengthening exercises as healing progresses, focusing on restoring hip strength and stability.
  • Functional Training: Incorporate functional and sport-specific training to facilitate a return to normal activities and athletic pursuits.

Exercises

• • 1. Hip Flexor Stretches

    • Purpose: Stretch the muscles at the front of the hip to reduce tightness and relieve pressure on the hip joint, which can help alleviate impingement symptoms.
    • How to Perform:
      • Kneel on one knee with the other foot in front, forming a 90-degree angle at both knees.
      • Gently push your hips forward while keeping your back straight until you feel a stretch in the front of your hip.
      • Hold for 20-30 seconds and switch sides.

    2. Piriformis Stretches

    • Purpose: The piriformis muscle, located in the buttocks, can become tight and exacerbate hip issues. Stretching it helps improve flexibility and reduce pressure on the hip joint.
    • How to Perform:
      • Lie on your back with knees bent.
      • Cross one ankle over the opposite knee.
      • Pull the uncrossed thigh toward your chest until you feel a stretch in the buttock of the crossed leg.
      • Hold for 20-30 seconds and switch sides.

    3. Isometric Hip Raises in Abduction

    • Purpose: Strengthen the hip muscles, particularly the abductors, without moving the joint, which is beneficial when movement causes pain.
    • How to Perform:
      • Lie on your back with your knees bent and feet flat on the ground.
      • Place a resistance band around your thighs just above the knees.
      • Gently push your knees apart against the band without lifting your hips.
      • Hold the tension for 10-15 seconds, relax, and repeat.

    4. Glute Bridge

    • Purpose: Strengthens the gluteal muscles and stabilizes the hip, which can reduce stress on the hip joint and support recovery from impingement.
    • How to Perform:
      • Lie on your back with knees bent and feet flat on the floor, hip-width apart.
      • Press your feet into the ground and lift your hips toward the ceiling, squeezing your glutes.
      • Hold at the top for a few seconds before slowly lowering back down.

    5. Single Leg Bridge

    • Purpose: This variation of the glute bridge further challenges the glute and core muscles, improving stability and strength on one side of the body at a time.
    • How to Perform:
      • Begin in the same position as the glute bridge.
      • Lift one leg off the ground, keeping it straight, and then lift your hips using the strength of the supporting leg.
      • Hold at the top, then lower and repeat before switching legs.

    6. Straight Leg Raises (Can Also Use Resistance Band)

    • Purpose: Strengthen the quadriceps and hip flexors without putting undue stress on the hip joint, helping to maintain stability and reduce symptoms.
    • How to Perform:
      • Lie on your back with one leg straight and the other bent.
      • Keeping the straight leg’s foot flexed, slowly lift it toward the ceiling to about a 45-degree angle.
      • Lower the leg slowly and repeat. You can add a resistance band around your ankles for added difficulty.

    Prevention

• • • When exercising avoid placing full body weight onto your hip when the legs are positioned in excessive range of motion
    • Do daily stretches morning and night
    • Always rest when needed
    • Perform rehabilitation exercises given by a physiotherapist

If you feel you may have this condition / injury and would like it assessed by a professional our team of sports therapists and physiotherapists can help. Alternatively you can speak to your doctor. Either way please contact us for further information alternatively please make a booking directly online.