Hip Impingement and the Pelvic Floor
by Alex Wiley and Karlyn Driedger.
What is Hip Impingement?
Hip impingement or femoral-acetabular impingement (FAI) is a common injury affecting the alignment of the bones that make up your hip. There are two main categories of hip impingement.
- Structural: This type of impingement is directly related to the shape of the two bones. The hip joint is considered a ball and socket joint where a sphere-like end of the femur sits into a bowl/ socket shape in the the pelvis. Bone spurs or growths can develop over time based on how the joint has been stressed, either on the ball or socket part of the joint. These bony changes can also be secondary to other injuries such as labral tears, large collisions, and repetitive movements over time. Individuals who participated in a lot of dance, hockey, and activities with twisting and pivoting motions are more susceptible to structural hip impingements.
- Functional: There are lots of different muscle groups that surround the hip joint. One group of muscles are your deep hip rotators. These muscles play a similar role to the rotator cuff muscles of your shoulder. They work collectively to center the ball in the socket. If these muscles are weak or not functioning optimally, the ball can sit more forward in the socket and cause symptoms. These muscles need to be working throughout the entire range of hip movements. Additionally, imbalances in the larger muscle groups can shift how the ball sits in the socket and the function of the deep hip rotators. For example, overactive hip flexor muscles or weak gluteus and hamstring muscles can create an imbalance.
- A Combination: Some individuals can also experience hip impingement as a result of structural and functional changes. Functional changes, that go unaddressed, could lead to structural changes to the joint over time. For this reason, addressing signs and symptoms of hip impingement early is really important!
What does Hip Impingement have to do with the Pelvic Floor?
The deep hip rotators work very closely with your pelvic floor muscles. Overuse or overload of the pelvic floor muscles (which may appear as incontinence, painful sex or bladder urgency) can be linked to FAI. If the deep hip rotators are weak, it can cause an increased demand on the pelvic floor and lead to pelvic floor symptoms along with hip impingement symptoms.
What are the symptoms of hip impingement?
Hip impingement often feels like a discomfort in the front part of your hip and thigh. It can be a deep, aching pain in the groin or buttocks that is often aggravated with prolonged sitting, deep squats, and impact such as running and jumping. The most aggravating positions are often flexion and internal rotation of the hip. Some individuals will also experience clicking and catching in the joint. Range of motion can also be impacted – primarily in flexion (bringing your knee to your chest).
How can a Physiotherapist help?
The physiotherapy assessment is where we start! It is important to understand the underlying factors that are unique to each client. Based on the assessment and the outcomes the client wants to achieve, we develop a treatment plan.
Physiotherapy treatment is very effective in treating FAI. A treatment plan often involves manual therapy, stretching, hip strengthening, and balance work. A large focus is placed on releasing tension in the area and training the deep hip rotators. The deep hip rotators need to be working in all ranges of motion and movements to ensure adequate alignment of the joint.
In some cases, surgery is indicated. A surgery will address the structural components of the impingement but not the functional components. As previously mentioned, many structural impingements also have functional components. Post-op physiotherapy is imperative for regaining hip strength, stability and full range of motion, to prevent symptoms from returning.
The pelvic health team at Foundation is specialized in addressing core strength, deep hip strength, and the connection between pelvic floor muscles and hip muscles. Book an appointment with our team to finally get rid of that nagging hip pain!