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Movement

The Hip Impingement Solution

Movement

The Hip Impingement Solution

INTRODUCTION

As we strive to be more active, healthy and mobile, the hips are put under a large amount of stress.  With the increase in functional training, more emphasis is being placed on squatting, lunging, deadlifting and Olympic lifting. Functional exercises are essential in any training program, but for these exercises to be performed correctly, the hips must be able to transfer force from the ground and through the spine. When there is a minor deviation in hip movement, increased friction can occur inside of the joint leading to soreness. Many times after a training session we are experiencing appropriate muscle soreness, which is excellent and needed for increased strength gains. Post exercises soreness should be isolated to muscular tissue in the posterior or lateral hip. If you are experiencing anterior/lateral hip or groin pain the following article should benefit you greatly. Femoral Acetabular Impingement or FAI is becoming a more common pathology identified in the active population due to advancements in diagnostic imaging and clinical assessment. My goal for this article is to educate the reader on the anatomy of the hip, what is FAI, what causes FAI, symptoms of FAI, how to self assess if you are at risk for FAI, and lastly how to address any issues you may be experiencing through a series of corrective exercises.

HIP ANATOMY

Before we go any further, it is important to review the anatomy of the hip to ensure we are all speaking the same language as we move into the causes of FAI. The hip joint is a ball and socket joint consisting of the head of the femur (ball) and the acetabulum (socket). Below are two images of hip boney anatomy. In the figure to the left, we can clearly view the head of the femur and the acetabulum, which are surrounded by various ligaments and joint capsule to encompass the “hip joint”.

Screenshot 2015-03-23 12.34.40

The hip joint is a very complicated joint from a ligament and muscle standpoint secondary to multiple connections from the trunk, shoulder, hip and thigh musculature. For the sake of the topic of this article, we will not dive into all of the ligaments and muscles of the joint, but I would like to point of some key structures which play an important role in this pathology.

Screenshot 2015-03-23 12.34.49

Iliopsoas AKA “hip flexor”:  this muscle attaches from the lumbar spine to the femur (thigh bone) and acts to flex the hip. When this muscle is overly tight, it can cause excessive anterior tilt in the pelvis and lead to abnormal alignment of the hip joint. Picture of muscle seen in with arrow in image to the left.

Gluteals: there are 3 gluteal muscles that attach from the back of the ilium (hip bone) to the femur, which combine to extend/abduct the hip. When these muscles are weak, it can lead to poor knee control during squatting and lunging. Poor knee control can lead to poor mechanics, which encourage hip impingement.

Deep hip external rotators: this muscle group consists of many small muscles that attach from the sacrum (tailbone) to the femur, and act to externally rotate the femur. When these muscles are weak, the knees have a tendency to cave-in (valgus) during a squatting motion.

Screenshot 2015-03-23 12.35.13
CAUSES

The causes of FAI are currently not completely understood, though it is hypothesized that faulty mechanics during daily activities and squatting can cause excessive compression between the neck/head of the femur and the rim of the acetabulum leading to impingement. When excessive contact between these two structures occur, bone growth can form, which leads to a CAM or Pincer type deformity shown below. A CAM lesion is an abnormal formation of bone growth on the neck/head of the femur, which leads to increased contact between the femur and acetabulum causing a pinch when the hip goes into flexion/adduction/internal rotation. A Pincer lesion is an abnormal formation of bone growth on the outer rim of the acetabulum, which also leads to increased contact between these two structures. While CAM lesions are more common in males, and Pincer lesions more common in females some studies suggest 86% of symptomatic people experience a combination of both deformities.

In an attempt to understand what faulty mechanics might possibly cause CAM and Pincer deformities, many studies have identified excessive hip flexion/adduction/internal rotation as the culprit.  The image on the left demonstrates a view of how a lesion may appear while the image on the right dictates the classification for each lesion.

Screenshot 2015-03-23 12.36.55

SYMPTOMS

Symptoms of FAI can vary and for the sake of this article, we will address anterior hip FAI opposed to posterior hip FAI when discussing possible symptoms.  Many individuals who have been diagnosed with FAI have the below complaints:

  • Pain in the upper groin area or from front to lateral hip
  • Deep ache that commonly cannot be palpated
  • Insidious onset
  • Pain with activity (deep squatting or lunging)
  • Difficulty sitting
  • When severe, pain with putting on shoes/socks

It is important to note that though you may be experiencing one or two of these symptoms, you still may not have pathology. Many time symptoms of FAI can be confused and misdiagnosed as a hip flexor or groin strains.  If one side feels different than the other, caution must be taken when training into positions of deep squatting, lunging, twisting and higher impact plyometrics without consulting a physical therapist or orthopedic specialist.

SELF-ASSESSMENT

In this section we will go over some self assessment techniques to help you determine if your are experiencing symptoms that may be associated with FAI, though these movements are in no way a substitute for a professional clinical examination from an orthopedic specialist, physical therapist, or surgeon. There is a limit to ones ability to perform self-assessment, and an orthopedic specialist will use a variety of special tests and diagnostic testing to ensure an accurate diagnosis.

Screenshot 2015-03-23 12.37.06

Squat test: stand with your feet hip width apart (narrow stance), toes pointing forward and arms overhead. Keep your elbows locked overhead, toes pointing straight forward and your back as neutral as possible, squat down as deep as you comfortably can go. This test is positive if you feel a pinch in the anterior/medial groin. *This is more of a clinical assessment, not a test that has been validated in the research.

Hip flexion test: Lye on your back with both legs straight. Pull one knee to your chest without letting your knee rotate to the outside. Note how high you can flex one hip compared to the other. Test is positive if you feel a pinch in the anterior/medial groin or there is a significant difference in range of motion between the two sides.

*This is a self-assessment of your hip flexion range of motion. Many times hip flexion range of motion is poor with individuals who are experiencing hip FAI. This is more of a clinical assessment, not a test that has been validated in the research.

Screenshot 2015-03-23 12.37.12

FABERS test: Lye on your back with both legs straight. Bring one foot to the opposite knee and let your knee drop to the ground. Note the difference from side to side. Test is positive if there is a significant difference in flexibility from side to side or there is a pinch pain in the medial groin region.

Screenshot 2015-03-23 12.37.16
Thomas Test: Lye off the edge of a table, rock back holding both knees into your chest. Keep your back flat against the table at all times, grab one knee while you let the other knee fall to the ground. Repeat for the opposite leg. Test is positive for iliopsoas (hip flexor) tightness if your thigh does not go flat onto the table, positive for quad tightness if your knee cannot bend >80deg at the bottom of the movement.

*If these tests are positive, it does not mean that you have pathology. These tests will simply identify movements, which cause impingement in the hip. To get an accurate diagnosis of your pain, an orthopedic specialist or surgeon should be consulted.

ACTIVITY MODIFICATION

While no one likes to change what they are doing in their normally daily routine, research has been shown to significantly decrease FAI hip pain with simply changing daily habits that may be contributing to continued irritation. Below is a list of activity modifications that should be performed if you are experiencing above stated signs and symptoms:

  • Sitting: sit with hips in external rotation as opposed to knees together
  • Eliminate sitting with legs crossed
  • Side sleepers: sleep with pillow between your ankles and knees. Avoid excessive hip flexion while sleeping.
  • Sumo squat opposed to squatting with a narrow stance
  • Avoid biking as this causes excessive hip flexion

These activities should be modified until symptoms are completely reduced. Once symptoms are eliminated, caution should be taken when returning to normal activities.

STRETCHING

Stretching and regaining normal range of motion and flexibility is extremely important when addressing deficits related to FAI. I would caution from “over stretching” the hip as this can cause irritation within the joint. Extreme caution must be considered when performing below stretches. Stretching for hip FAI includes the use of an elastic band, as the elastic band will help create slight traction in the joint; therefore, decreasing the risk of impingement and increasing the stretch of the tissue being addressed. Stretching performed prior to a training session should be dynamic and be held no longer than 5 seconds, while stretching post training should be held for duration of 20-60 seconds based on age (longer holds for increased age). All stretches should be performed for 2-3 sets for optimal flexibility gains.

  • Kneeling hip flexor
  • Prone quad
  • Quadruped adductor
  • Quadruped glute
  • Supine hip flexion
Glute

Glute

Hip flexion

Hip flexion

Adductor (left) and hip flexion

Adductor (left) and hip flexor

Quad

Quad

While not all of these stretches will need to be performed daily, areas of tightness are going to need to be addressed to make significant gains. If the Thomas test above was positive, more attention is needed to the quads and hip flexor.

If the hip flexion assessment listed above was significantly different than the non-involved side, pay more attention to the hip flexion stretch. The glute and adductor stretch are great for preparing the hip for the sumo squat position listed below. If any soreness or pain is felt with stretching, be sure to immediately stop that given stretch. Do not try to push through any discomfort with these stretches, and contact your local physical therapist or orthopedic specialist if you are experiencing negative results with the above listed stretches.

CORRECTIVE EXERCISES

Corrective exercises are just that, corrective. These exercises are not huge strengthening exercises, especially in the beginning phases as proper muscle activation needs to be achieved before advancing to more functional positions. These exercises are broken up into 3 phases and are intended to ensure proper muscle activation in phase 1, increased difficulty in phase 2, and muscle hardening in phase 3. All of the exercises listed below or intended to decrease the tendency for the hip to obtain the position of flexion/adduction/internal rotation, which we now understand from research are the compromising positions of hip FAI. Each phase has a purpose and should not be skipped or overlooked. An individual can move on to the next phase when the appropriate sets and reps are met with minimal fatigue, perfect form, appropriate muscle activation, and no pain with any exercise. *For exercises not pictured below, a quick google search will do the trick. Pictured below are the less commonly understood exercises.

PHASE 1 (3x20reps)

  • Sidelying clam
  • Sidelying hip abduction
  • Donkey kick
  • Bridge
Hip abduction

Hip abduction

 

 

Screenshot 2015-03-23 12.38.10

Bridge

 

Screenshot 2015-03-23 12.38.20

Sidelying clams

 

 

PHASE 2 (3x15reps)

 

  • Standing band clams
  • Band walks
  • Single leg RDL
  • Sumo squat w/band around knees
  • Bridge on ball
  • Glute/ham raises

 

Band walk

Band walk

Glute/ham raise

Glute/ham raise

Standing clams

Standing clams

SL RDL

SL RDL

Bridge on ball

Bridge on ball

 PHASE 3 (3×8-10reps)

 

  • Single leg squat (increasing depth)
  • Split squat w/band
  • Single leg RDL w/band (same band position as split squat)
  • Sumo squat w/weight
  • Single leg bridge on ball
  • Glute/ham raises (add weight)

 

Screenshot 2015-03-23 13.18.57
Incorporating these exercises into your daily routine is going to be a huge part of being successful in addressing hip FAI. If performed correctly, these phases can be progressed through in 1-2 week blocks. Once you have completed the final phase, incorporate as many phase 3 lifts as you can into your normal training routine. Review your training with your strength coach to come up with the best possible program. I would also encourage performing phase 1 exercises (1 set) prior to heavy squatting days to ensure your hips are properly activated prior to loading. Stretching can be continued throughout life as staying mobile in your hips will allow for full movement and continued strength gains throughout your training.

I hope the above information has helped open your eyes to an increasing common pathology that has been surfacing in the Olympic lifting and Cross Fit community. As previously discussed, if you are experiencing pain with the above listed stretches or exercises, please stop them immediately. If you continue to experience hip pain you should schedule an appointment with your local physical therapist or orthopedic specialist to undergo a thorough evaluation of your condition.  Hip pain can arise from many different pathologies, and hip FAI should be considered if there is continued anterior hip pinching felt with daily activities or after training Please feel free to contact me with any further questions or concerns you may have.

If you have found the above information helpful, you can also view my Ebook “Body Mechanic” through the Juggernaut online store. Link with description of content is listed below.

Related Articles

[Strong360] A New Approach To Mobility

The Best Damn Squat Mobility Article, Period

Healthy Hips, Healthy You

REFERENCES

  • Austin, A.B., Souza, R.B., Meyer, J.L., & Powers, C.M. (2008). Identification of abnormal hip motion associate with acetabular labral pathology. Journal of Orthopaedic & Sports Physical Therapy, 38(9): 558-565.
  • Bandy, W.D., Irion, J.M (1994). The Effect of Time on Static Stretch on the Flexibility of the Hamstring Muscles. Journal of the American Physical Therapy Association, 74:845-850.
  • Cook et al. (2009). Conservative Management of a Young Adult With Hip Arthrosis. J Orthop Sports Phys Ther. 39(12):858-866.
  • Lewis, C.L. & Sahrmann, S.A. (2006). Acetabular labral tears. Physical Therapy, 86, 1:110-121.
  • Magee, David J. (2008) Orthopedic Physical Assessment, Fifth Edition. St. Louis, Missouri: Saunders Elsevier.
  • Makofsky et al. (2007).  Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study. J Man Manip Ther. 15(2): 103-110.
  • Martin, R.L., Enseki, K.R., Draovitch, P., Trapuzzano, T., & Philippon, M.J. (2006). Acetabular labral tears of the hip: Examination and diagnostic challenges. Journal of Orthopaedic & Sports Physical Therapy, 36(7): 503-515.
  • McCroy, P., Brukner, P., et al. Hip joint pathology: Clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sports Med. 2003;(13):152-156
  • Selkowitz, et al. (2013). Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata?  Journal of Orthop Sports Phys Ther, 43(2): 54-64. 
  • Yazbek, P.M., Ovanessian, V., Martin, R.L., Fukuda, T.Y. (2011). Nonsurgical treatment of acetabular labrum tears: a case series. Journal of Orthopaedic & Sports Physical Therapy, May;41(5): 346-353.

32 Responses to “The Hip Impingement Solution”

August 16, 2015 at 7:43 pm, Rosemary Squillace said:

Hey I just wanted to let you know this article has been a lifesaver! I’ve been having this issue for the past few months and did so much research and tried so many different exercises without any success. I’ve been doing the suggested exercises for the past two weeks and can already tell a huge difference in my hip and am so excited to start being able to squat again. Thank you so much! 🙂

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March 23, 2016 at 8:05 am, Jessica Metz said:

I totally agree! I found this on Google.com and aboslutely love the article!

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July 17, 2017 at 8:45 pm, Caroline Monterubio Skaar said:

Hi Dan! Thanksfor this informative article. I feel pinch pain in the knee to chest hugger and cannot squat well without turning feet out. Does this growth of bone mean that i can never do this knee to chest yoga pose or get a full pancake, front and side splits? I am a dancer and felt the hip psin after injuries on both hips a few years back. I am trying to gain flexibility and am doing a programme called focused flexibility and it is improving my splits and bridge. But is this irreversible. Will the bones always be like this and will it make it impossible for me to to do pancake tilt over my hips and all tge stretches i mentioned? Thank you for your help. Regards, caroline

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April 11, 2016 at 3:30 pm, Dan MacLean said:

Rosemary and Jess,
Thank you guys for the post. I am very glad that the information above has been helpful in getting you back to doing what you love to do. If this information was beneficial you can also checkout my Ebook just re-released through Amazon.com centered around correcting deviations that may be present in the all important overhead squat position. Thanks again for your posts.

Ebook “body mechanic” can be found here:
http://www.amazon.com/gp/aw/d/B01E4BL60S?ref=aw_sitb_end_act_to_dtl

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October 01, 2015 at 5:08 am, Guymelef said:

I am 3 months after a hip arthroscopy that was performed in order to treat a cam impingement. My labrum was stitched up and the peeling cartilage on my femur was smoothed out as much as possible. I am still in significant pain and feeling very disheartened after my surgeon just told me that any deep flexion or heavy impact moves should be avoided indefinitely in order to exacerbating any further degradation (i.e. Squatting, deadlifts, running, etc). After reading this article, I feel that i may be able to get back to some level of squatting once my pain has subsided.

I would recommend anyone to put off FAI surgery if at all possible and have it as a last resort only. In retrospect, I looked to it as a panacea that I thought would cure me of my pain when it has turned out to be less successful than I had hoped.

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December 24, 2015 at 10:41 pm, Dan said:

Hey, I had one arthroscopy done on my left. I have symmetric cam impingement in my right hip also.
Don’t lose hope! My surgeon told me right off the bat that 6 months recovery can be expected, and he was right. I went through a decent amount of PT after about 3 months, mostly proprioceptive. However, because my right hip still suffers from cam impingement, when I squat deep now my pelvis tilts to avoid it, leading to risk of back injury. I’m waiting to get a second surgery on my right hip while strengthening my posterior chain as best as I can.

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October 06, 2015 at 2:01 pm, Tom said:

I have anterior hip pinch in bottom of squats only when belted. Just closing up a 12 week 5×5 program (enhanced), (have been working with compound exercises for a couple years now). Squat sets at 5x7x300lbs, trying to use a 4″ belt and get a sharp searing pain in hip crease at the bottom, can squat 300 without belt with no pain, full range of motion. Low bar, mid width stance, neutral back, good knee stability.
Wondering if the abdominal pressure is exposing an issue that doesn’t normally show?
47yr old, 215bw.

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February 19, 2016 at 12:43 pm, GWhite said:

I am experiencing the exact same issue, were you ever able to figure out what was going on? Thanks!!

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December 07, 2015 at 2:57 pm, Grammar dude with FAI said:

CSB, but it’s ‘lie’

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February 13, 2016 at 7:18 pm, Nate Huyser said:

Dan, thanks for the article on hip impingement. You have some great figures and great background information on FAI. I have struggled with hip-related problems for at least eight years… and I am only 22. As a result, I have obtained a passion for movement and will be attending physical therapy school next year. This past fall I was formally diagnosed with FAI in both hips and told I needed surgery by the orthopedic surgeon I saw. My experiences with trying to fix my hips on own suggested that I could make great improvements without surgery. I am in the process of fixing my FAI without surgery and have started my own blog about FAI (www.solvefai.com). I hope to add to the literature supporting the conservative/non-invasive treatment of FAI.

While there may be certain situations where surgery is needed, my experiences have shown that since FAI is a relatively new diagnosis, physical therapists have not learned the most effective ways to treat it. I hope that someday all physical therapists/personal trainers/CSCS etc. can learn efficient ways to troubleshoot this hip problem. Hopefully this will decrease the number of FAI surgeries performed (as the research behind the efficacy of the surgeries, as well as patient’s personal testimonies, have been thoroughly disappointing).

Thanks again for the article Dan. The more information out there about Femoral Acetabular Impingement, the better.

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April 11, 2016 at 3:23 pm, Dan MacLean said:

Nate, thanks for your post. As you know FAI can be a very debilitating condition for many people of all levels. Unfortunately FAI symptoms get confused with post workout soreness therefore the athlete usually does no seek treatment until the condition has worsened. I am glad you are a proponent for getting more info about hip FAI out there to the general public and it seems you have the important qualities that make a great Physical Therapist. Good luck to you!

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March 23, 2016 at 8:05 am, Jessica Metz said:

If you have a stiff, tight or painful hip then http://www.HipFlexors.info will unlock your hip flexors and restore movement the way it should be. Unlocking your hip flexors instantly breathes new life, energy, and strength into your body! I experienced immediate results. I’ve been able to loosen up my hips, decrease back tightness, and even workout harder. With so many people suffering with hip pain out there, this program is a great tool for anybody that wants to reduce pain while improving strength, performance, and overall health. Hip flexibility, mobility and strength is one of the most important things you can do to keep your overall body healthy. The video presentation and visuals in the exercise program give me confidence that I am doing the exercises correctly which for me is key with no personal trainer. The website is very complete in listing the possible causes of tight hip flexors and other factors that can lead to the issue. It has detailed, descriptive information regarding the anatomy of the hip, causes of such injuries, and a very progressive and well explained exercise and stretching schedule that will assist to re-balance the hip and pelvic region, safely stretch and strengthen the muscle group. Best of luck to you! 🙂

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April 04, 2016 at 7:35 pm, Martin said:

Are all stretches and corrective exercises intended to be done on the side where “pinch” is felt in the anterior/medial groin?

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April 11, 2016 at 3:25 pm, Dan MacLean said:

Hey Martin,
Thanks for your post. The exercises should Defintely be performed on the symptomatic or painful side. Although since the one hip can directly effect the opposite hip, it is important the strength wing exercises be done bilaterally to ensure proper alignment and decrease the risk for future asymmetries from side to side. Thanks and let me know if you have any further questions or comments.

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April 11, 2016 at 3:19 pm, Dan MacLean said:

Body Mechanic Ebook can now be found on Amazon.com by following the link below:
http://www.amazon.com/gp/aw/d/B01E4BL60S?ref=aw_sitb_end_act_to_dtl

Reply

July 09, 2016 at 3:34 pm, salvo said:

What is a good substitute for the glute ham raise I don’t have equipment to do this

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December 02, 2016 at 3:22 am, Dan MacLean said:

A good substitute would be to perform a back extension type movement over a physio ball, making sure to not hyper extend your spine as you come up. Keep your abs and glutes tight during the entire movement.

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August 17, 2016 at 10:21 am, Todd said:

Hey there,

I was diagnosed with FAI in early 2015 after years of increasing lower back pain – originally thought to be herniation. It took a specific type of high resolution X-Ray to actually diagnose my mixed FAI. A condition the Sports Meds said was something I was mostly born with.

Before that I was doing years of PT for an assumed lumbar herniation (there wasn’t one). This PT included lots and lots of hip mobility work. After years of lower back pain with the new hip mobility regime suddenly I started having groin pain. Which is ironic because for twenty five years I was kickboxer, thai boxer, and trained in BJJ – all concentrate heavily on hip mobility (I also did yoga for years). IOW. I was doing hip mobility work for 25 years.

And therein lies the problem.

You can’t stretch bone. Hip mobility and stretching can make FAI worse, not better. Often what you are doing is grinning bone again bone in a vain attempt to stretch soft tissues.

The sports med docs were stunned at my hip mobility. I’m 52 years old I could kick over their heads. I could do splits. despite what X-rays told them and despite the appalling lack of internal rotation on my left hip. But. This of course would cause me course of pain.

But since I had been kicking thai pad and 200lb heavy bags (not to mention back squats, deadlifts, etc) for twenty years my hips had taken a beating and the cartridge was now worn down.

The first lower back diagnosis with the regime of hip mobility an stability exercise had exacerbated the FAI making matter much worse. So we then opted to halt all PT for three months and do steroidal injections to reduce the inflammation. It was like a miracle. Hip, groin and lower back pain gone instantly.

Then slowly we re-introduced stability work like the list above. BUT: No more back squats. No more deep squats – three quarter squats with light loads ONLY. Lots of single leg work. No more heavy deadlifts.

At first it sucked to see my legs become licorice whips, though my core now is far stronger in the applied and functional strength sense. The trade off of no longer having ripped quads is there being no pain. Being able to do activities I love like hiking and skiing (and walking) is better trade off. Frankly, heavy deep back squatting past 40 is a fools game anyway.

Anyway. Let this be a warning. Get diagnosed by a sports doc. Not a PT guy or a chiropractor. And remember stretching can make things way worse if you DO have FAI.

—Todd

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September 17, 2016 at 1:37 am, Melissa Clements said:

Dear Dan,

I have FAI on both hips, a labral tear on my left hip, and had a CAM labral repair on my right hip two years ago. I have undergone significant physical therapy, but every time I start to run again, I get significant pain in both hips, sometimes for over a week, making it painful both at rest, and especially to walk. I also get pain with walking over 30′, even with modified, short strides. I hate swimming. It looks like biking is also inadvisable, due to hip flexion. What cardio can I do? I am desperate to find something, especially after having my second child (9 months ago).

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December 02, 2016 at 3:27 am, Dan MacLean said:

Hey Melissa,
Thank you for the post and sorry to hear about your extended troubles. Typically if walking forward causes symptoms I would advise walking backwards for a while (no im not joking). Backwards or retro walking can be beneficial as it will help activate your posterior chain (glutes/hamstrings and stretch your hip flexor sat the same time. I would begin with slow walking for 10-15 mins and build up to 30mins by adding 5 mins every week along with increasing speed. Once you get to 30mins, then attempt forward walking again and see if there is any difference.

Another form of cardio would be elliptical as this avoids the “impingement zone”. You can also attempt “super setting” strengthening exercises or performing your exercises in a circuit to get more of a cardiovascular effect!

I hope this info helps and please let me know how your progress is going!

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April 19, 2017 at 7:31 am, JRT6 said:

My daughter has to walk backwards after a workout in track so while training with her the other day I gave it a try and man I did not want to stop walking backwards. I felt normal in my hip for the first time in a long time and it was euphoric.

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September 18, 2016 at 8:34 am, jseliger said:

Sitting: sit with hips in external rotation as opposed to knees together

What exactly does this mean, beyond keeping one’s knees apart?

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December 02, 2016 at 3:32 am, Dan MacLean said:

Hey jseliger,
Sitting in hip external rotation means sitting with your knees apart and your knees and feet pointing in the same direction.

This position avoids the painful and irritation that internal rotation/sitting with your knees together will bring.

Try sitting with your knees touching on a physioball, and then rotate your knees far away from each other to move into hip external rotation. This new position should feel much better while sitting.

I hope this recommendation helps!

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January 14, 2017 at 6:42 am, Grégoire Dein said:

Hey Dean, thank you for this article which is very good I think. I put a link to this one on my blog (www.conflitdehanche.blogspot.com) if you don’t mind. If you want me to suppress it, feel free to ask. Thank you very much.

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February 02, 2017 at 6:30 pm, enys5000 said:

Im having a hard painful time lifting my knee/leg up to my chest – especially if I play hockey . Most likely the culprit . Is this the same thing your explaining here ? – It hurts now and I’m not even playing sports lately . It has hampered my life . Would these exercises help – My Doctor just says I’m old 47 – Where else can I seek help ? Thanks

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June 26, 2017 at 11:41 am, Dan MacLean, PT said:

Hey enys5000,

You may be experiencing symptoms of hip impingement which is very common in hockey players do the the multi directional movements involoved. I would suggest visiting with your local sports physical therapist to evaluate your hip as well as the movement patterns involved in hockey to see if there are any movement deviations that are contributing to your symptoms.

Thanks for your response and sorry for the late reply!

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April 01, 2017 at 8:34 am, Matt C said:

Dan,

I’ve been fighting impingement in my left hip for some time. I am on phase 1 of the corrective excercises. The articles says to move on once I can complete all movements with good form and relative ease.

I am very weak at the ‘Sidelying hip abduction’ movement! Ive squatted 500 lbs, but could barely do 20 the first day for a single set.

It’s improving, but I am curious if there is any additional work I can do for that area.

Also, what is the difference in the muscles used for the Sidelying hip abduction compared to the “bad girl machine” or banded abductor work while in a squat position? Is it just the leverage difference, or does the hip flexion drastically change the muscles involved in the movement? I have done those moves in the past and felt mischief stronger.

Thanks for this article, by the way. It is really making a difference. My pain and tightness was not only making lifting impossible, but it was impacting my day to day life. A little more than a week in, I am feeling much better.

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June 26, 2017 at 11:39 am, Dan MacLean said:

Matt,

Sorry for the late reply but I hope I can still help. Thank you for your comments and to your point you may already be doing movements that challenge your “glute medius” which is the target muscle in the side lying hip abduction exercise. You are also activating this muscle during a banded squat but we are relatively isolating it as much as we can while in the sidelying position which is why that exercise feels much harder.

Another great exercise for the glute medius is a side plank and once you are able, perform a hip abduction movement while in the side plank position. The side plank is the number one exercise for glute medius activation.

The glute medius is a frontal plane (side to side) muscle more than a saggital palne (front to back) muscle which is why performing squats and deadlifts tend to not activate this muscle. The problem becomes when your quads and hip flexors become “dominant” the glute medius does not work as well which causes an adductor/internal rotation force in the hip leading to this impingement.

Hope this info continues to help you and again sorry for the late reply!!!

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May 19, 2017 at 4:09 pm, Leigh Egger said:

Great article guys… nice and simple but quality!

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June 23, 2017 at 1:16 pm, Tarissa said:

Hi Dan!

Wow- what an informative article. Thank you for the fine balance between the technical terms and everyday language used.

I would like to take you up on your offer to ‘contact you with a further concern’ I have…

I am a very active person, but I have always struggled with my flexibility. About 2 and a half weeks ago, I started experiencing a very sharp pain, in what feels like my right hip flexor. That day I had done some slightly heavier than normal squatting.

There is a sharp pain in my anterior hip whenever I bend at the hip. (Even doing something like picking up a pen from the floor hurts) I rested it completely for these two weeks, but with little to no improvement.

My question is- do I continue to rest it and wait it out, or is it worth seeing a doctor? If so, would you recommend a physio, chiro or GP? Will they just tell me to keep resting?

Thank you, and I appreciate your time!

Tarissa, South Africa

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June 25, 2017 at 4:09 pm, Dan MacLean said:

Hello Tarissa,

Thank you for your reply! I am sorry you are experiencing the anterior hip pain. I would suggest going to see a sports physio to help you with your current movement issues. If you have rested for two weeks and are still experiencing pain it is time to seek additional help.

The cause of anterior hip pain can be multiple and the physio should be able to give you an idea on what is causing your pain as well as some specific corrective exercises to address and deviations you may have!

Hope this helps and good luck on your journey!

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July 14, 2017 at 10:00 am, gill m said:

absolute farce I cannot even get up from squat atall I have to be pulled up, and if I tried to and succeeded in doing the other exercises I would think I was just fine

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