Hip Impingement – Are You Treating The Wrong Hip?
Posted By: Andy Barker
I’m sure you have seen those patients that seem to get better, sometimes quickly, but then just as quickly, they regress.
Sometimes getting rid of their symptoms seems to be the easy part, as no sooner do these symptoms go away, they come back as patients get back in the gym or playing sport.
The hip is also tricky because it can also be easily aggravated with things like sitting, driving and even sleeping, as well as more active movements like squatting, lunging and running.
But there is one thing that can make a big difference to hip pain and not only help you quickly take away a patients hip pain, but also help keep it away.
It’s super simple and really obvious when you know it…
But hardly anyone is doing it!
This blog will make simple sense of the hip, a complex joint in many ways, and show you some easy strategies you can apply with your patients that will help you manage even tricky cases of hip pain.
But first, a big bug bear of mine…
Impingement Is Not A Diagnosis
You might have heard me talk about this before in regards to the shoulder on a previous blog or podcast, or even read about in my FREE downloadable shoulder PDF
We talk about impingement all the time and it is a common diagnosis given to many patients with hip pain.
The most common being FAI – Femoroacetabular Impingement.
But it is not a diagnosis.
It is a mechanism.
It is telling you what is happening at the hip joint.
Impingement means something is being squashed together between the joint.
It is not telling you what structure is being squashed, just something is being squashed.
And that is why it is not diagnostic.
It is also important to remember that it is normal for joints to impinge at their end of range.
Clearly getting pain with movements or positions at the hip is not normal but a pinch or a small level of discomfort could be considered normal when the hip is at end of range.
For the hip we know the joint space is reduced and the joint goes into it’s close packed position when it is flexed, internally rotated and adducted.
There Is More To The Hip Than Just The Ball & Socket
The hip is a ball and socket joint.
You already know that I’m sure.
The socket or acetabulum, forms part of the pelvis.
The other part, the ball is the femoral head and is at the end of the long thigh bone, the femur.
So why is it that we often spend 99% of the time treating and rehabbing all the muscles that influence the femur, like hip flexor stretching, glute exercises and the like…
And almost no time, if any, specifically on the pelvis.
Maybe it is no wonder we are not getting quick and consistent results in the hip…
Because we are only treating half of it!
So your probably thinking…
That sounds logical and sounds like something that makes sense and could help me with hip pain patients…
But how do you do it?
This is a quick and easy test to use with your patients on the treatment bed, which in less than 10 seconds will tell you exactly if they have a pelvis issue contributing towards their hip pain.
If you know this, you can focus exactly on the right problem with your patients rehab and will not make the mistake of treating the wrong thing and get frustrated with hip pain patients that just do not seem to get better.
Here’s how to do it…
Hip Flexion Breathing Test
For some context let’s use a common example that you might see in clinic.
We will keep it simple and say your patient has limited and painful hip flexion.
On the bed you test their range and it is limited to 100 deg and they give you a VAS of 4/10.
Get them to take a breath in, then a big breath out.
This must be a big breath out.
As as they are coming to the end of their breath retest their range.
Sometimes even go away altogether.
In short, when you fully exhale, your ribcage will drop and when this happens your pelvis will posteriorly tilt.
This posterior tilt of the pelvis (think tucking your pelvis under) opens up the hip, giving the ball more room to move in the socket.
Remember you have done nothing at all at the femur (the ball) you have just changed the position of the socket.
If this action improves symptoms it means that the pelvis is having an influence on your patients symptoms and if so, this makes great sense to work on as part of your treatment plan.
Sounds to good to be true…
But it is not.
This is a really effective way to distinguish what is causing your patients hip pain and direct you in your management.
Is it a problem with the femur (the ball) or the pelvis (the socket)?
Unless you test it you will never know.
And if you do not test it, you may just find yourself wasting your time and effort on treatments and rehab exercises that will not work, because you are trying to fix the wrong thing.
Impingement Is Not A Diagnosis: Impingement tells you what is happening at a joint, not what structure is injured.
There Is More To The Hip Than Just The Ball & Socket: The hip is made up of the ball (femoral head) and the socket (acetabulum); do not forget to assess both because either one of these parts of the hip could be causing your patients hip pain.
Hip Flexion Breathing Test: This simple test can help you differentiate between a pelvis or femoral issue and help you direct your rehab and treatment to make sure you treat the right thing.
Hope this helps
PS. If the hip is a joint you struggle with….
I’m not that surprised, because so many therapists, from new grads to experienced physio’s, attack it the wrong way.
Hopefully this post has helped you see how this can easily happen, but therapists are also making many more mistakes when it comes to the hip,
If you would like to learn more about how to simplify your assessments for the hip…
To get the right diagnosis and then learn how to take any patient or athlete through a full rehab programme, from start to finish, confidently and without worry, then get in touch.