Hip Impingement – Treating it Conservatively

Matt_SilvaggioDo you play tennis or hockey, ride horses or perform various types of dance including ballet? After sitting for a period of time do you find your hip stiff when you first go to stand up and then find it takes a few steps or a few minutes to loosen up with walking? Do you have groin pain with or after activity and pain in your sacroiliac joint region that has gone misdiagnosed for years? If so, you could be experiencing impingement of your hip, or femoral acetabular impingement (FAI).

Typically symptoms come on slowly and people tend to wait it out to see if they will resolve on their own. They may try anti-inflammatory medicine, which will resolve symptoms initially but one’s sport will surely aggravate the hip again. If you sense this scenario is developing with your one or both of your hips, don’t wait to start conservative management. Starting physical therapy early in the symptom presentation can improve the success of treatment and get you back on the track sooner.
When working through the differential diagnosis of one’s hip condition, it is important to consider extra-articular (outside of the hip joint capsule) and intra-articular (structures within the hip joint and involving the hip capsule) pathology of the hip as well as dysfunction of the lumbar spine and pelvis. Often the pelvis (sacroiliac joint) corresponding with the painful hip will become limited in mobility due to compensations for the hip pain during walking, running, or while playing sports. This cascade of dysfunction and pain can work its way into the lumbar spine as well. This is part of the reason why correct diagnosis of hip impingement can be misleading because one’s pain presentation can cover an assortment of areas of the body. Once the diagnosis is made that hip impingement is a driving component of one’s pain and problems, a plan of care is established and discussed with the patient.

Typically, physical therapy treatment for this condition involves functional manual therapy to improve the efficiency of the hip joint and its respective soft tissues, which intricately involves the pelvis (sacroiliac joint) and lumbar spine as well. Neuromuscular re-education techniques will be utilized to improve the imbalance of muscular strength and stability around the hip joint including the hip flexors, abductors and extensors and make sure that they are working in unison with the core stability of the trunk. This is reinforced by providing a patient specific home exercise program in weight bearing and non-weight bearing to further strengthen and develop the necessary endurance to return to your recreational activity.

If further consultation is needed at the end of this rehabilitation process, we would refer the patient to a specialist that has particular experience in diagnosing hip pathology.

Matt Silvaggio, MSPT has been practicing across a broad scope of physical therapy settings since graduating from Nazareth College of Rochester, NY in 2003. His experience has been shaped by working in acute rehabilitation, home health, orthopedic private practice as well as sports medicine settings.
Elite Health Services, located in Old Greenwich, (and now Westport!) CT is a world-class provider of certified functional manual physical therapy, personal fitness, golf & triathlon performance training, massage therapy and wellness related services. Our team of highly skilled and dedicated professionals take a no-excuses approach to providing exceptional care and delivering exceptional results. To learn more visit www.EliteHealthServices.

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