Hip Injuries

What is hip impingement, and what can I do about it?

Hip impingement, or femoroacetabular impingement, is where the head of the femur pinches up against the acetabulum (hip socket). This is due to the presence of bony growths on either the ball or the socket (or both!). As a result, there may be irritation or damage which occurs tissues around the hip joint, including the labrum and/or cartilage. 

Both surgical and non-surgical options for femoroacetabular hip impingement exist, whether suitability for either management option is dependent on the individual. Conservative care involves a reduction or removal in provocative activities (usually activities requiring deep hip flexion, adduction and internal rotation), medications and exercises targeting hip strength, stability and lumbopelvic control. In the long term, many patients are advised to avoid stretches which push the hip into deep ranges of flexion, internal rotation and flexion. 

For patients with more severe symptoms or that fail conservative management, follow up with an orthopaedic specialist is usually advised.

I often feel sore with side lying, what could it be and what can I do about it?

Many different presentations may result in issues with sidelying. Of patient’s that I see in the clinic, I personally find the most common cause of this is ‘Greater Trochanteric Pain Syndrome’, which may include issues with gluteal tendinopathy. 

Compressive loads on the outside of the hip are typically provocative with this condition, and this compression of sensitive structures may occur from direct pressure, or through the hip adducting.

If I have someone present who typically prefers sidelying, I will often advise them to sleep on the opposite side with a pillow placed between their knees.

Do you recommend any specific exercises for gluteal tendinopathy?

There are many different exercises that are beneficial for gluteal tendinopathy, however, the key is to prescribe the right exercise, at the right dose and time. Furthermore, exercise prescription is only one facet of an effective management plan, and many other considerations should be made, such as load management and activity modification. 

After an assessment, I would particularly look to target any deficits around gluteal strength, lumbopelvic control and single leg stability with exercise. This may include a range of different exercises, possibly side planks, cable hip abductions, wall clams and single leg Romanian deadlifts. 

Should I be worried about clicking hips?

It depends!

It is quite common for asymptomatic joints, including hips, to make clicking sounds. If the clicking is longstand, there is no pain or other symptoms associated with clicking and it is tolerable, I tend to advise patients to continue with their normal activities.

If there is pain, a decrease or increase in range of motion or any other symptoms, then the clicking may be the result of an injury or condition and should be appropriately assessed.