Hip impingement(fai)

Here’s what’s going on:

Hip impingement—more formally called femoroacetabular impingement (FAI)—happens when the bones of the hip joint rub together abnormally, causing irritation, pain, and sometimes damage to the cartilage or labrum.

Common causes/ risk factors

1. Bone shape abnormalities

Cam impingement – The femoral head (ball) is not perfectly round and has an extra bony bump that grinds against the socket during movement.

Pincer impingement – The acetabulum (socket) has excessive coverage over the femoral head, pinching the labrum and cartilage.

Mixed impingement – A combination of both cam and pincer changes (most common).

2. Repetitive hip motion

Sports or activities with deep hip flexion, rotation, or pivoting (soccer, hockey, dance, martial arts, weightlifting) can cause repetitive stress and speed up joint wear.

3. Developmental factors

Subtle bone overgrowths may develop during adolescence, often in active athletes.

Hip dysplasia or other childhood hip disorders (e.g., slipped capital femoral epiphysis, Legg–Calvé–Perthes disease) can change hip joint shape.

4. Joint injury or overuse

Trauma to the hip (falls, collisions) can worsen impingement or cause labral tears that increase friction.
Overtraining without adequate rest may encourage bone spur formation.

5. Genetic predisposition

Some people inherit a natural variation in hip joint shape that makes them more prone to impingement even without major injury.

6. Age-related changes

Bone spurs and cartilage wear can develop over time, narrowing the joint space and creating impingement-like symptoms.

Primary Muscle Groups That Help Reduce Impingement Risk

1. Deep Hip Rotators – "The rotator cuff of the hip"

Muscles: Piriformis, gemellus superior/inferior, obturator internus/externus, quadratus femoris
Function: Keep the femoral head centered during motion, preventing it from gliding forward or upward into the socket edge.
Why it matters: Weakness here allows uncontrolled rotation and translation, increasing labrum stress.

2. Gluteal Muscles – Power + stability

Gluteus medius & minimus
- Stabilize pelvis in single-leg stance
- Reduce dynamic valgus and hip adduction (which can close space in the front of the hip)
Gluteus maximus
- Controls hip extension & external rotation
- Helps pull femoral head backward during deep flexion, keeping it from jamming forward.

3. Core & Pelvic Stabilizers

Transverse abdominis, multifidus, obliques
Function: Maintain neutral pelvis, prevent excessive anterior tilt (which can close the front of the hip joint)

4. Hip Flexors (Balanced, Not Tight)

Iliopsoas, rectus femoris, sartorius
Strong and flexible hip flexors help with controlled hip lifting without pulling the femoral head too far forward.
Over-tightness can worsen impingement, so mobility work is key.

5. Adductors (with good length)

Adductor longus, brevis, magnus, gracilis, pectineus
Provide medial hip stability during cutting, pivoting, and rotation
Need balance between strength and flexibility to avoid restricting hip clearance.

Muscle Geek Treatment

MAT, Chiropractic and Physical Therapy Principles along with Class IV laser therapy and shockwave therapy to treat hip impingement that’s primarily caused or aggravated by muscle imbalances, while also addressing pain, inflammation, and movement restrictions.

Step 1 – Understand the Muscle Imbalance Component

When hip impingement is functional (muscle-related) rather than purely structural, common patterns include:

Overactive/tight muscles: hip flexors (iliopsoas, rectus femoris), TFL, adductors
Underactive/weak muscles: deep hip rotators, gluteus medius/minimus, gluteus maximus
This imbalance shifts the femoral head forward/superior in the socket during movement, increasing labral stress.

Treatment:

1. Utilize Muscle Activation Techniques

2. Soft tissue mobs via manual or mechanical devices

3. Joint Mobilizations

STEP 2 – Class 4 Laser Therapy

GOAL: Reduce inflammation, improve circulation, accelerate soft tissue recovery, and improve neuromuscular activation.

Target areas

Anterior hip / hip flexor region – iliopsoas, rectus femoris tendon, TFL attachment
Lateral hip – gluteus medius/minimus tendon insertions
Deep rotator region (posterior hip) – piriformis, quadratus femoris
Labral irritation area – along the anterior joint line (avoid direct bony point heating)

Treatment Plan:2–3×/week initially, taper as symptoms improve

Laser Benefits for Hip Impingement

Decreases inflammation in irritated labrum/tendons
Reduces anterior hip capsule tightness
Improves microcirculation to promote healing of strained stabilizers

Step 3 – Shockwave Therapy Protocol

GOAL: Break up adhesions, release myofascial trigger points, improve muscle length, and stimulate regeneration.

Target muscles for imbalance-related impingement:

Iliopsoas tendon & muscle belly – reduce anterior pull
TFL & proximal IT band – release lateral tightness that tilts the pelvis
Adductors – restore balanced hip motion
Glute medius/minimus tendon – stimulate tendon healing and improve recruitment
Piriformis / deep rotators – improve external rotation capacity

Treatment Plan: 1×/week for 3–5 weeks

Shockwave Benefits for Hip Impingement

1. Releases soft tissue restrictions pulling the femoral head forward

2. Improves flexibility and ROM

3. Stimulates metabolic activity in weak or degenerated tendons

Step 4 – Integration with Rehab Exercises

Immediately after therapy, the tissues are more pliable and receptive to activation work.

Post-treatment strengthening: glute max, glute medius, deep hip rotators
Post-treatment mobility: hip flexor stretches, 90/90 hip rotations, adductor rock backs
Neuromuscular control: single-leg stance, lateral band walks, hip hinge patterns

IF LEFT UNTREATED, HIP IMPINGEMENT CAN LEAD TO MORE SEVERE CONDITIONS LIKE LABRAL TEARS OR OSTEOARTHRITIS

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