Could Hip Impingement Be Causing Your Pain?

As a physical therapist, I’m continuing to see younger patients in the clinic complaining of lateral/anterior (side/front) hip pain. One potential cause is impingement, which essentially means the hip joint is jamming when attempting to move. Most commonly, pain is present with hip flexion activities, such as leg raises, squatting, lunges, and going up the stairs. Patients often complain about pain on the side of the hip, referred to as the “C–sign”.

If this sounds like you, continue reading! This will give you an idea of some of the recommendations I make to patients with this issue. Of course, talk with your health care provider before beginning any new exercise program.

Positions to Avoid

Because certain positions may make the condition worse, I recommend avoiding figure 4 positioning, crossing the legs or sitting with knees together, “hanging on your hips,” and sleeping on the effected side. If a patient is an active person, I might also recommend avoiding high impact activities such as heavy squats, running and intense weight lifting, especially if these cause increased pain (I know you are probably rolling your eyes at me!). Excessive iliotibial band (IT band) and piriformis stretching should also be avoided early in this program.

Figure 4

“Hanging on hips”

Exercises That May Help

Here are some exercises I typically recommend, as well as the progression of those exercises:

Squat Progressions

I may start with a movement such as knee flexion mobilization, which is the first movement in this exercise sheet. This can be done as a stretch or as a set(s) of repetitions and should be progressed to upright squats (the second movement on the  and you should really pay attention to your alignment; hips, knees, and ankles should be in the same plane. Finally, we will progress squats to be single leg squats; continued focus on alignment of the leg and not allowing the opposite pelvis to drop. Below are pictures to compare good and bad form.

Correct form

Incorrect form

Incorrect form

Core Strength

Next, I would likely address the core muscles to some degree. If you have an excessive arch in your low back or your hips feel like they are rotated forward, refer to this exercise sheet for beginning core stabilization.

These exercises (as shown on the exercise sheet), may include:

  • Posterior pelvic tilt
  • Tilt with March
  • Tilt with heel slide
  • Bridge (make sure your pelvis is level)

Once you have these beginner moves down, these exercises can be progressed using an exercise ball.

Dead Butt?

If you have a difficult time activating your glutes (butt muscles) this will need to be addressed. To tell if a patient is having a hard time with this, I ask them to lay on their stomach and lift their leg up. Do they feel the hamstrings or butt muscles fire first? If it’s the hamstrings first, they need a program to strengthen those glutes. Here’s a typical program for that.

Tight hip flexors, often from a fair amount of sitting, should first be stretched by holding the following move on each side for 30 seconds and repeating 3 times.

(Front view)

(Side view)

Retraining the glutes comes next. I’d typically start with bridges, but really focusing on squeezing the butt muscles first. This can be progressed by holding that bridge for up to 5 seconds once a patient is able. When that becomes easy, we can add weight or perform with a single leg. Bridges can be further progressed to a hip thrust, deadlift, single leg deadlift, lateral lunge, and lunge with cross reach. Examples of these are below.

Hip thrust

Lateral lunge

Deadlift

Single leg deadlift

Changing Your Everyday Activities

With hip impingement, you may need to change everyday activities. Here a few tips I generally give patients with this condition:

  • Keep an eye on how you walk. To reduce the force on the hip focus on pushing off the ball of your foot to begin swing phase of your gait and have a slight forward trunk lean.
  • When going up steps, make sure your entire foot is flat on the step, try to avoid ascending on your tiptoes.

Again, always speak with your health care provider before beginning an exercise program. This is just a glimpse into the types of stretches and exercises that may be part of your program if you have hip impingement. You’ll want to work with a provider to create a plan just right for you. Of course, never do any exercises that cause increased pain!

I encourage you to ask questions, share your experience, and leave suggestions for future topics in the comments section below! I will do my best to respond to each as timely as possible.

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Bryon Renwand, PT, DPT, CSCS, works with ProMedica Total Rehab and received his Bachelors of Science in Exercise Science from the University of Toledo, where he also received his Doctorate of Physical Therapy. For his full bio and other articles, please click here.


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