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One in Five People are Predisposed to Hip Impingement - How Serious is It?

Generally speaking, when there is abnormal contact between your thighbone and your hip, this is called hip impingement. More specifically, we are referring to femoroacetabular impingement (FAI).

FAI is important as it can lead to a pain syndrome that can sideline runners and workers, and up to half of all hip osteoarthritis cases may stem from a long-standing case of FAI.(1) What’s more, one in five people have their thigh or hip bones shaped in a way thought to cause FAI syndrome (FAIS).(2)  Fortunately, for some people, pain caused by hip impingement might not be as bad as it sounds.

What is Hip Impingement?

Hip impingement is typically experienced as pain near the groin that may be more intense when moving the near its limits, after long sitting, or walking uphill. In more severe cases, pain may be felt at night or during walking on flat ground. The usual definition of hip impingement (femoroacetabular impingement) is one or more specific deformities of the hip and/or thigh bone. One in four people with bones shaped these ways develop pain and/or osteoarthritis.(3) However, this popular definition deserves some scrutiny. Impingement refers to something being trapped or compressed. Why, for this particular impingement, do we define it as a deformity of bones? Can’t other structures such as muscles, tendons, and ligaments affect the mechanics of joints and cause impingements?

Does Hip Impingement Require Surgery?

Janice Loudon and Michael Reiman of Duke University in North Carolina offer a definition of hip impingement (FAI) that only refers to the fact that there is abnormal contact (regardless of whether it’s caused by the shape of the bones or something else).(4) They point out different ways slight changes in muscle length and joint play could predispose people to hip impingement.

What’s more, the evidence suggests that good physiotherapy can create pain relief on par with surgery.(5,6) Physiotherapy, of course, does not change the shape of bones. It does change how muscles, ligaments, fascia and other soft tissues work. The efficacy of physiotherapy could be evidence that the causes of hip impingement are not limited to deformed bones.

What Can I Do to Protect Myself from Hip Impingement Syndrome and Osteoarthritis?

Physiotherapy is less expensive and less invasive than surgery, so it is often recommended as the first treatment. A significant portion of people who start with physiotherapy still go on to surgery as well, which is followed by more physiotherapy. It may be a good idea to receive an assessment by a credentialed physiotherapist at the first sign of pain that occurs when the hip is near its limits of movement. FAIS is caused by gradual wearing of the joint over years. Theoretically, early intervention with physiotherapy or surgery may prevent future joint damage and lessen the risk of needing a total hip replacement.

⦁ Clohisy JC, Dobson MA, Robison JF, Warth LC, Zheng J, Liu SS, Yehyawi TM, Callaghan JJ. Radiographic structural abnormalities associated with premature, natural hip-joint failure. JBJS. 2011 May 4;93(Supplement_2):3-9.
⦁ Frank JM, Harris JD, Erickson BJ, Slikker III W, Bush-Joseph CA, Salata MJ, Nho SJ. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015 Jun 1;31(6):1199-204.
⦁ Khanna V, Caragianis A, DiPrimio G, Rakhra K, Beaulé PE. Incidence of hip pain in a prospective cohort of asymptomatic volunteers: is the cam deformity a risk factor for hip pain?. The American Journal of Sports Medicine. 2014 Apr;42(4):793-7.
⦁ Loudon JK, Reiman MP. Conservative management of femoroacetabular impingement (FAI) in the long distance runner. Physical Therapy in Sport. 2014 May 1;15(2):82-90.
⦁ Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. The American Journal of Sports Medicine. 2018 May;46(6):1306-14. 
⦁ Griffin DR, Dickenson EJ, Wall PD, Achana F, Donovan JL, Griffin J, Hobson R, Hutchinson CE, Jepson M, Parsons NR, Petrou S. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. The Lancet. 2018 Jun 2;391(10136):2225-35.

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