This blog post covers the best exercises and stretches to fix Hip Impingement syndrome.

What is Hip Impingement?

Hip Impingement is a painful condition where the structures which are located at the front of the hip are compressed/pinched/squashed.

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

It can be associated with:

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

In This Blog Post

• Symptoms
• Causes
• Test For Impingement
• Hip Impingement Exercises
• Common Questions

Symptoms

The main symptom associated with Hip Impingement is a pinching sensation at the front of the hip as the:

• Knee is lifted past 90 degrees of flexion and/or
• Torso bends forwards towards the leg.

This can occur with:

causes

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

Femoral Head Anterior Translation

Ideally – the top part of the thigh bone (Femoral Head) should be positioned right in the center of the hip socket (Acetabulum).

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.

Generally speaking – The forward movement of the Femoral head bone is related to the hyper-extended position of the hip and/or the poor control of the hip muscles.

Structural Factors

The size and shape of the bones that make up the hip joint (Femoroacetabular 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.

3. 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

Here a few quick ways to determine if you have Hip Impingement.

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.

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.

(Note: Pain at the front of the hip could also be due to an injury to the Hip Flexor muscles or groin region.)

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Exercises for Hip Impingement

STEP 1: Stop Aggravations
STEP 2: Reduce Inflammation
STEP 3: Releases
STEP 4: Stretches
STEP 5: Joint Mobilizations
STEP 6: Improve Hip Flexion
STEP 7: Reclaim Hip Rotation
STEP 8: Strengthen Hip Flexors
STEP 9: Strengthen Gluteal Muscles
STEP 10: Learn To Hip Hinge
STEP 11: Address Posture
STEP 12: Other Tips

Step 1: Stop All Activities That Cause Pain

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

… 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.

Step 2: Reduce Inflammation

Due to high levels of pain, an excessive amount of inflammation may make it difficult to perform the exercises mentioned on this blog post.

Consider the following options to reduce inflammation in the hip.

Anti-Inflammatory Gel

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

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 symptoms.

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

Cold Therapy

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

(Note: Switch to using heat after 2-3 days following your injury.)

Natural Products

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

Cortisone Injection

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

The aim of this injection is to reduce the level of pain, swelling and inflammation.

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 following tight muscles can help reduce tension in the hip region.

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

Hip Flexors

(Target Muscles: Rectus Femoris, Tensor Fasciae Latae, Sartorius)

Instructions:

• Locate the hip flexor muscles.
• Lie down on the floor.
• Place a foam roller underneath the front of your hip/thigh region.
• Apply an appropriate amount of body weight over the foam roller.
• Make sure to cover the entire muscle.
• Duration: Aim for 2 minutes.

Groin

(Target muscles: Internal Rotators, Adductors)

Instructions:

• Lie down on your stomach.
• 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 any pain, tingling and/or numbness down the leg.)

Gluteal Muscles

Tightness and/or over-activity in the gluteal muscles can push the hips forwards.

This can cause the Femoral head to translate anteriorly and potentially predispose one to hip impingement.

Instructions:

• Sit on the floor.
• 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

Tightness in the muscles at the front of the hip may compress this region.

Performing the following stretches can help decompress the front of the hip.

Hip Flexors

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.

Looking for more hip flexor stretches:

See Post: Hip Flexor Stretches

Groin Stretch

Instructions:

• Lie down on your back.
• Keep the bottom of the feet together.
• Allow your knees to drop towards the floor.
• Relax.
• Aim to feel a stretch in the groin region.
• Hold for 30 seconds.

For more stretches to the groin region:

See Post: Adductor Stretches

Step 5: Hip joint mobilization

The aim of the following exercises is to will help create more space in the hip joint.

If the joint remains tight and compressed, this may allow the impingement in the hip to persist.

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.

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 exercises.

Over time – Increase the amount of movement being performed.

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 moving into any pain.
• Repeat 30 times.

Pelvic Tilts

Instructions:

• Lie down on the floor.
• Keep your knees bent and feet on the floor.
• Tilt your pelvis forwards as far as you comfortably can without causing any pain.
• Perform 30 repetitions.

Step 7: Reclaim Hip rotation

It is important to reclaim as much internal and external rotation of the hip.

This will encourage better mobility within the joint.

Hip Internal Rotation

Recommendation: Aim for >30 degrees of Internal rotation.

If you would like a comprehensive blog post on improving this specific movement:

See Post: Exercises For Hip Internal Rotation

Here are a few exercises to get you started:

Release Posterior Capsule and Gluteals

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.

Posterior Hip 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.
• Lean your torso slightly forwards.
• Aim to feel a stretch in the back of your hip.
• Hold for 60 seconds.

For more stretches: Back of Hip Stretch

Internal Rotation 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.

Hip External Rotation

Recommendation: Aim for at least >45 degrees of External Rotation.

If you would like a comprehensive blog post on improving this specific movement:

See Post: Exercises For Hip External Rotation

Groin 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!)

Groin 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.

Hip External Rotation 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.
• Aim to feel your glutes activating.
• Hold for 3 seconds at end range.
• Repeat 20 times.

Step 8: Hip flexor strengthening

It is important to strengthen the muscles at the front of the hip as this area tends to get weaker with Hip Impingement.

These muscles are called the” Hip Flexors” and are involved with raising of the leg.

When performing the exercises, move your leg as far as you can comfortably move without causing any pain.

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.

Knee Lift (Standing)

Instructions:

• Stand up right.
• Hold onto something for balance.
• 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.

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.

Step 9: Glute strengthening Exercises

One of the roles of the gluteal muscles (also known as your “butt muscles”) is to keep the femoral head in the center of the hip socket (especially during hip flexion).

This can help reduce the amount of impingement occurring in the front of the hip.

Glute Activation (Standing)

Instructions:

• Loop a resistance band around your foot.
• Place this foot onto the floor.
• Lean your back against a wall for support.
• 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.
• Allow your leg to be lifted as high as possible.
  • Do not move into any pain.
• Aim to feel a contraction in your gluteal muscles.
• Perform 30 repetitions.

Glute Activation (Supine)

Instructions:

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

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 gluteal muscles.
• Hold for 5 seconds.
• Repeat 15 times.
• Progression:
  • Hold onto a weight at the front of your hips.

Deep Lunge

Instructions:

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

If you are having difficulty engaging your glute muscles:

See Post: Glute Strengthening Exercises

Step 10: Learn to Hip hinge

The hip hinge is a movement which involves bending forwards at the hip whilst keeping the spine in a neutral position.

To restore the normal movement of the hip, it is important to learn how to perform this movement without causing any pain in the front of the hip.

Staggered Leg Hinge

Instructions:

• Place your feet in a staggered position.
  • The front leg will be the side targeted.
• Bend the front knee slightly.
• Shift most of your body weight onto the front leg.
• Keep a neutral spine and pelvis throughout this exercise.
• Push your hips backwards as you hinge forwards from the hips.
• Lower your torso as far as you can without causing any pinching pain at the front of the hips.
• Perform 30 repetitions.
• Progression:
  • Hold onto an appropriate amount of weight.

If you are experiencing the pinching sensation very early into the movement, you may need to hold off on this exercise for now until your body is ready for it.

Looking for other ways to perform this hip movement?

See Post: Hip Hinge Exercises

Step 11: Address postural factors

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

Sway Back Posture

As part of a Sway Back Posture presentation, the hips are pushed in front of the base of support.

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

For a detailed guide on how to fix this posture:

See Post: Sway Back Posture

Anterior Pelvic Tilt

Anterior Pelvic Tilt is where the pelvis is tipped forwards.

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.

For a detailed guide on how to fix this posture:

See Post: Anterior Pelvic Tilt

Rotated Pelvis

A Rotated Pelvis is where the pelvis is twisted towards one side.

This pelvis position can influence the position of the hip joints.

For a detailed guide on how to fix this posture:

See Post: Rotated Pelvis

Step 12: Other tips

Try out the following tips to see if it helps manages your symptoms.

Increase Height Of The Chair

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

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

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.

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 can help to create more space in front of the hip joint.

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Common Questions

Have any other questions? Feel free to ask me in the comment section.

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 a review with a specialist.

Should I do surgery for Hip Impingement?

Note: Surgery does not always fix this problem! It should only be used as a last resort. Please give the exercises mentioned on this blog post a chance to work.

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.

Are there any exercises that I need to avoid?

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

This might include exercises such as:

As your hip pain improves, it is a good idea to re-introduce these exercises to promote strength and resilience in the hip.

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.

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!

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Conclusion

Hip Impingement (Anterior Femoroacetabular Impingement) is a condition where the structures in the front of the hip are compressed during hip flexion.

Perform the suggested exercises and stretches in this blog post to fix this issue.

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Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purpose only. Use of the content is at your sole risk. Seek guidance from a health care professional before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.