Hip Impingement Exercises

What is Hip Impingement?

Hip Impingement is a condition where the front (anterior) of the hip is compressed/pinched.

(This generally occurs when the hip is flexed past 90 degrees.)

It can lead to issues such as:

• Labral tears
• Cartilage wear
• Arthritis

It is also referred to as Femoroacetabular Impingement (FAI).

What causes Hip Impingement?

The following factors increase the likelihood of the front of the hip getting compressed.

a) Femoral head anterior translation

Ideally – the Femoral Head (highest part of the thigh bone) should sit right in the center of the Acetabulum (hip socket).

This is to allow for the normal movements to occur within the hip joint.

With femoral head anterior translation –  the femoral head is pushed forwards relative to the acetabulum. This can disrupt normal joint movement and lead to a hip impingement.

This is generally related to the hyper-extended positions of the hip and/or the poor control of the gluteal muscles.

b) Structural factors

The size and shape of the bones that make up the hip joint can predispose the hip to  impingement.

Types of lesions:

(Use Google search to see an image of the different types of lesions)

• Cam lesion: The femoral neck has a thickened appearance.
• Pincer lesion: The rim of the hip socket is more pronounced and is protruding.
• Mixed lesion: Presence of both a Cam and Pincer lesion.

c) Posture

The following postures may predispose you to developing a hip impingement as they directly affect the position of the hip joint:

• Sway Back Posture
• Anterior Pelvic Tilt
• Rotated Pelvis

Hip Impingement Test

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1. Forward hinge

Instructions:

• Sit up straight on the edge of a chair.
• Keep your knees together and feet shoulder-width apart.
• Keep your lower back completely arched and pelvis tilted forwards.
• Moving from the hips, hinge all the way forwards.
• Lean towards the side where you experience pain.

2. Knee lift

Instructions:

• Sit up straight on the edge of a chair.
• Tilt your pelvis forwards and arch your lower back.
• Lift your knee up without losing the arch in your lower back or leaning backwards.

3. You may also experience pain with:

• Prolonged sitting
• Walking uphill and/or on stairs
• Touching your toes from standing position
• Pivoting on the leg (especially towards the painful side)
• Getting out of a low chair

Note: Pain at the front of the hip could also be due to an injury to the Hip Flexor muscles!

Exercises for Hip Impingement

The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. For more information: Medical disclaimer.

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Step 1: Stop All Activities That Cause Pain

Stop, Modify or Reduce exposure to any activity that makes your symptoms worse.

… How can you expect your Hip Impingement to improve if you keep exposing it the activities that irritate even more?

The goal here is to remain as active as possible without exceeding the capacity of what the hip can comfortably tolerate.

I can’t stress this enough: Failure to comply with Step 1 will make it very difficult to perform the Hip Impingement exercises.

Step 2: Reduce Inflammation

Due to pain, an excessive amount of inflammation may make it difficult to perform the Hip Impingement exercises.

a) Anti-inflammatory gel

Apply an anti-inflammatory gel to the area of pain for 2-3 times per day.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the Hip Impingement.

(Note: Please consult your medical doctor before taking any medication.)

c) Cold therapy

Apply an ice pack to your hip for at least 10-15 minutes, 3-5/day.

(Note: You can switch to a heat pack if your hip pain is not acute in nature.)

d) Natural products

You can try taking turmeric, ginger, chia seeds and/or fish oil capsules which are apparently natural ways to help reduce inflammation.

e) Cortisone injection

The cortisone injection consists of a strong anti-inflammatory steroid (cortisone) and an analgesic substance.

The only issue I have with the cortisone injection is that it does not address the underlying cause of the Hip Impingement.

More often than not – the injection may provide some short term relief, but only to have the pain come back at a later date.

Step 3: Releases

Releases to the hip muscle will help reduce tension in the area.

(Use Google to find the exact location of these muscles.)

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a) Flexors

Instructions:

• Locate the target muscles:
  • Rectus Femoris
  • Tensor Fasciae Latae
  • Sartorius
• Place a foam roller underneath the target muscles.
• Apply an appropriate amount of body weight over the foam roller.
• Make sure to cover the entire muscle.
• Duration: Aim for 1 minute.

b) Adductors

Instructions:

• Place a foam roller directly underneath the Adductors (inner thigh).
• Apply the weight of your leg on top of the foam roller.
• Make sure to cover the entire length of the muscle.
• Duration: Aim for 1 minute.

c) Internal rotators

Instructions:

• Place a foam roller at the front/inside of your hip region. (see above)
• Whilst applying your body weight, perform a rolling motion over the foam roller.
• Duration: Aim for 1 minute.
• (Note: Be gentle! There are nerves and arteries that run through this area! Stop the exercise if you get tingling and/or numbness down the leg.)

d) Glutes

Instructions:

• Place a massage ball underneath your buttock region. (see above)
• Whilst applying your body weight, perform gentle circular motions over the ball.
• Duration: Aim for 1 minute.

Step 4: Stretches

What stretches you focus on really depends on what specific muscle is tight. Stretch the muscles which are tight for you.

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a) Hip Flexor

Instructions:

• Assume the lunge position as above.
• Perform a posterior pelvic tilt
  • “Tuck your tail bone underneath you” 
  • Keep your glutes contracted.
• Lean your torso away from the side you are stretching.
• Aim to feel a pulling sensation at the front of your hip.
• Hold for 30 seconds.
• Repeat 2-3 times.

(For see more hip flexor stretches, check out this post: Hip Flexor Stretches.)

Step 5: Hip joint mobilization

These exercises will help create more space in the hip joint.

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a) Band distraction (Hip Neutral)

Instructions:

• Anchor a thick resistance band to a stationary object at ground height.
• Wrap the other end of the band around the ankle. (see above)
• Move your body away from the anchor point until there is a firm amount of tension on the band.
• Lie down.
• Relax your entire body and allow the band pull on to your hip joint.
• Aim to feel a pulling sensation around your hip.
• Hold this position for 1-2 minutes.
• Progression: Move further away from the anchor point.

b) Band distraction (Hip flexion)

Instructions:

• Anchor a thick resistance band to a stationary object.
• Loop the other end of the resistance band as close to the hip crease as possible.
• Move your whole body further away from the anchor point to create a firm tension on the band.
• Flex and hold your hip to ~90 degrees.
  • Hold onto the back of your knee with your hands.
• Keep the hip completely relaxed.
• Hold this position for 1-2 minutes.
• Progression: If able – start to pull your hip into more flexion.

Step 6: Pain free Hip flexion

Keeping your hip moving is important! Do not push into any pain as you perform the following exercise.

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a) 4 point kneel rock back

Instructions

• Assume the 4 point kneel position.
• Maintain a neutral pelvis and lower back throughout this exercise.
• Slowly move your pelvis backwards.
  • Stop before hitting any pain.
• Repeat 30 times.

Step 7: Reclaim Hip rotation

It is important to reclaim as much internal and external rotation of the hip as to allow for better mobility of the joint.

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A. Internal rotation

Aim for at least 30-40 degrees of Internal rotation.

(Note: If you would like a comprehensive blog post on improving the mobility of you hips, check out this post: Exercises for Hip Internal Rotation.)

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a) Release posterior capsule and glutes

Instructions:

• Place your gluteal region on a massage ball.
• Apply an appropriate amount of body weight.
• Perform circular motions over the ball.
• Make sure to cover the whole area.
• Duration: 2 minutes.

b) Stretch

Instructions:

• Sit down on the edge of a chair.
• Place your ankle on the top of the knee of the other leg.
• Sit as tall as possible as to create an arch in your lower back.
• Whilst maintaining this arch, pull your knee towards the opposite shoulder.
• Aim to feel a stretch in the back of your hip.
• Hold for 60 seconds.

c) Strengthening

Instructions:

• Lie down on your side with your knees slightly bent.
• Keep your knees together throughout the exercise.
• Lift up your ankle off the other ankle.
• Make sure that you do not move your pelvis.
  • Don’t cheat! Only the leg should be moving.
• Aim to feel a contraction in the side of your hip.
• Hold for 3 seconds.
• Repeat 20 times.

b. External rotation

Aim for at least ~45 degrees of External rotation.

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a) Releases

Instructions:

• Place a foam roller at the front/inside of your hip region. (see above)
• Whilst applying your body weight, perform a rolling motion over the foam roller.
• Duration: Aim for 1 minute.
• (Note: Be gentle! There are nerves and arteries that run through this area!)

b) Stretch

Instructions:

• Sit on the floor with your back against a wall.
• Assume the position as shown above.
• Sit up at tall as possible.
  • Try to create an arch in your lower back.
• Slowly push your knees down towards the ground.
• Aim to feel a stretch in the groin.
• Hold for 30 seconds.
• Repeat 2-3 times.

c) Strengthening

Instructions:

• Lie on your side with your knees bent at 90 degrees.
• Whilst keeping your ankles together, lift up your upper knee as high as possible
• Make sure that you do not move your pelvis.
  • Don’t cheat! Only the leg should be moving.
• Aim to feel your glutes activating.
• Hold for 3 seconds at end range.
• Repeat 20 times.

Step 8: Hip flexor strengthening

Do not move into pain! Only move as far as you can comfortably move without causing pain.

In the initial stages – you can perform the following exercises with the knee pointing outwards. As you progress, aim to keep your knee pointing straight ahead.

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a) Knee lift (Standing)

Instructions:

• Whilst standing, lift your knee as high as possible without causing any pain.
• Aim to feel a contraction in the front of your hip.
• Hold for 5 seconds.
• Repeat 30 times.
• If you find it difficult to lift the weight of your leg, you can use your hands to help.
• Progression: Wrap a resistance band between your ankles.

b) Knee lift (sitting)

Instructions:

• Sit up right on the edge of a chair.
• Lift your knee as high as possible without causing any pain.
• Do not lean backwards.
• Aim to feel a contraction in the front of the hips
• Hold for 5 seconds.
• Repeat 30 times.
• If you find it difficult to lift the weight of your leg, you can use your hands to help.
• Progression: Wrap a resistance band between your ankles.

c) Supine leg lift

Instructions:

• Lie down on the floor.
• Lock your leg straight.
• Lift your leg to ~30 degrees.
• Aim to feel the contraction at the front of your hip and thigh.
• Hold for 5 seconds.
• Repeat 20 times.
• Progression: Add an ankle weight.

Step 9: Glute strengthening Exercises for Hip Impingement

The purpose of the glute muscles (your butt) is to keep the femoral head in the center of the hip socket. (especially during hip flexion)

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a) Glute activation (Standing)

Instructions:

• Loop a resistance band around your foot.
• Place this foot onto the floor.
• Pull the resistance band upwards with your hands as to create a firm amount of tension.
• Slowly raise your leg being careful to not allow the band to pull your leg up too quickly.
• Aim to feel a contraction in your glute muscles.
• Allow your leg to be lifted as high as possible.
  • Do not move into any pain.
• Repeat 30 times.

b) Glute activation (Supine)

Instructions:

• Lie on the floor with your foot onto a wall. (see above)
• Place your knee in a position where you just start to feel a pinch in the hip.
• Drive your heel into the wall for 10 seconds as hard as you can.
• Aim to feel your glutes contract as you do this.
  • Drive through your heel.
• Relax.
• If able – try to move closer to the wall as to increase the amount of hip flexion.
• Repeat 5 cycles.

c) Bridge

Instructions:

• Lie down on your back with your knees bent.
• Rest your feet on an elevated block.
• By pushing through your heels, lift your buttocks off the floor.
• Lift as high as you can without arching your lower back.
• Make sure you can feel the contraction in the glute muscles.
• Hold for 5 seconds.
• Repeat 15 times.
• Progression: Hold onto a weight at the front of your hips.

d) Deep lunge

Instructions:

• Assume the lunge position.
• Hinge your torso forwards.
• Drop your body down as low as possible.
• Make sure to feel your glute activation
  • Drive through the heel of the front leg.
• Perform 20 repetitions.
• Progression: Hold onto a weight.

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Step 10: Address postural factors

Although you may see significant improvements with these Hip Impingement exercises, it is important to check if you have the following postures that may also be contributing to the hip issue.

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1. Sway Back Posture

In this posture, the leg bone (femoral head) is not centered in the hip socket as it is pushed forwards.

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2. Anterior Pelvic Tilt

When the pelvis is tilted forwards, the hip joints are already placed in a position of hip flexion.

What this means is that the hip is more likely to be jammed in end range flexion making it more likely to impinge the front of the hip.

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3. Rotated Pelvis

A Rotated Pelvis can influence the position of the hip joints.

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Step 11: Other tips

a) Increase height of the chair

This will reduce the amount of hip flexion required to sit and thus reduce the chance of impinging your hip.

You can also consider using a kneeling chair which allows you to sit with a wider hip angle.

b) Don’t sit like this!

It is important to maintain a neutral position of your pelvis as this can influence the position of the hip joint.

c) Push your knees out

When you need to sit, squat or bending forwards, have your knees in a slightly “pushed out” position. (see above)

This will encourage more hip external rotation which helps create more space in front of the hip joint.

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Step 11: Common questions

a) How long does Hip Impingement take to heal?

I recommend persisting with these hip impingement exercises for at least 3-6 months.

If there has been minimal to nil improvements, it might be an idea to consider surgical interventions

b) Should I do surgery for Hip Impingement?

Please note: Surgery does not always fix the problem! It should only be used as a last resort!

The 2 main surgeries:

1. Hip replacement: The damaged bones which are directly involved with the hip impingement are completely removed and replaced with prosthetic components.
2. Hip arthroscope: Using a small camera to see inside your hip, tears to the labrum and/or cartilage can be trimmed. Irregular-shaped bones which may be contributing to the hip impingement can also be shaven down.

c) What are the exercises to avoid with Hip Impingement?

Any exercise which requires deep flexion of the hip should be avoided (or modified).

This might include exercises such as:

• Deadlift
• High knees
• Deep squats/lunges
• Good mornings
• Reverse crunch
• Leg press

d) Can I squat?

Yes – but only to a depth which does not reproduce the pinching sensation at the front of the hip.

Consider doing lean back squats. (see below)

Instructions:

• Hold onto a stationary object that is in front of you.
• Keep your feet shoulder-width apart.
• Lean backwards so that your entire body weight is relying on your arms.
• Drive your hips backwards as you squat down.
  • Most of your body weight should be resting on your heels.
• Perform 20 repetitions.
• Progression: Gradually squat deeper as comfortably tolerated.

e) Is cycling good for Hip Impingement?

Cycling is fine.

You will need to make sure that the seat is not set up too low as this may encourage excessive flexion at the hip.

Remember – Any movement that does not cause your symptoms is only going to help your hip get better!