Hip impingement: understanding your pain and getting back to your activity

What is hip impingement?

Femoroacetabular impingement anatomy

Hip impingement, or femoroacetabular impingement, is an abnormal contact between the head of the femur and the rim of the socket that receives it (the acetabulum), during certain hip flexion and rotation movements. It’s linked to a particular bone shape (extra bone on the femoral neck or the acetabular rim), present in many athletes without necessarily causing symptoms.[1]

Why does this impingement become painful?

Pain appears when repeated hip flexion and rotation movements, particularly in a deep squat position or during extreme movements, cause repeated painful contact between the bony structures. Sports with a large hip range of motion (football, dance, martial arts) particularly expose athletes to this type of impingement.

The 3 types of femoroacetabular impingement

• Cam type: extra bone on the femoral neck, the most common in young athletes
• Pincer type: excess bony coverage on the acetabular rim
• Mixed type: a combination of both, the most common form in practice

Symptoms and diagnosis of hip impingement

Typical pain and its triggers

The pain is located in the groin crease, sometimes described with the “C sign” (the hand forms a C on the side of the hip to point to it). It’s classically triggered by prolonged sitting, deep flexion (a squat position), or sporting movements at an extreme hip range of motion.

How symptoms progress without treatment

Without treatment, stiffness and pain can progress, with the hip’s available range of motion gradually decreasing. A symptomatic impingement neglected for many years is also considered a risk factor for early hip osteoarthritis.[4]

Differential diagnosis

Several hip conditions can look like hip impingement :

• Adductor tendinopathy or psoas tendinopathy, with pain more linked to muscle contraction
• An isolated labral tear, without an associated bony impingement
• Early hip osteoarthritis, particularly in older athletes

Causes and risk factors

Hip impingement is primarily linked to a particular bone shape, but not every athlete with this shape develops symptoms.

Biomechanical and personal factors

• Bone shape (Cam, Pincer or mixed type)
• Intensive sporting activity before the end of growth, which can influence bone remodelling
• A lack of motor control of the pelvis and hip at extreme ranges of motion
• Associated stiffness in the posterior chain or adductors

Which sports contribute to symptomatic hip impingement?

All sports with a large range of hip flexion and rotation are particularly concerned:

• Football (kicking, changes of direction)
• Ice hockey
• Dance
• Martial arts
• Climbing
• Weight training with deep squats

Why do some athletes develop a symptomatic impingement and others don’t?

Bone shape alone doesn’t explain the pain : many athletes have an impingement visible on imaging without any symptoms. It’s often the combination of this bone shape with a high training volume at extreme hip ranges of motion that tips a silent impingement into a painful one.

Treating hip impingement in rehab with a sports physio

The goal of treatment is to optimise the hip’s available mobility and strengthen the stabilising muscles to limit the repeated strain causing the pain.

1. 1Reducing pain and managing load
2. 2Recovering available mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Hip proprioceptive work
6. 6Closed-chain strengthening (weight-bearing)
7. 7Optimising the sporting movement
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“Hip impingement is managed by optimising the available mobility, not by trying to force the limited range of motion.”

Strengthening and available mobility, the cornerstones of treatment

The work focuses on optimising the hip’s genuinely available mobility, without forcing the range limited by the bony impingement, combined with strengthening the stabilisers to reduce repeated strain on the joint.

In brief

• Optimising available mobility
• Strengthening the stabilising muscles
• Correcting sporting technique if needed
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary. It’s better to temporarily adapt the deep flexion and rotation movements that clearly reproduce the pain, while starting rehab as soon as possible.

When should you see a specialist for hip impingement?

If pain persists for more than four to six weeks despite rehab, or if mechanical locking is very marked, a medical opinion is recommended to precisely assess the bone shape and discuss further options.

What progress can you expect with a suitable programme?

The bone shape doesn’t change with rehab: what improves is the pain and function. Most athletes notice a clear improvement within 6 to 12 weeks of working on available mobility and strengthening, with better tolerance of everyday and sporting movements.[5]

Factors that influence this progress

Slowing the progression

A well-managed symptomatic impingement helps avoid worsening joint wear over the long term.

The 10% progression rule

Not increasing your training volume by more than 10% a week limits repeated strain on the impingement area.

Avoiding repeated extreme ranges of motion

Limiting repeated very deep hip flexion positions in training (beyond what your sport actually requires) reduces how often the bony structures make painful contact, without having to give up your sport.

The HOPP care programmes to treat your hip impingement and get back to sport

This impingement requires suitably managed mobility and load. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your hip is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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