When All Is Right—-Think Left!
A Look at Hip impingement Mechanics and Prevention of FAI
Jason Masek, MA, PT, ATC, CSCS, PRC
The hips play a major role in our ability to walk, bend, jump, dance and kick. Your hip is a ball-and-socket joint, where the rounded femoral head of your thigh bone, or the “ball,” sits inside the acetabulum, or “socket” area of your pelvic bone. In a healthy hip joint, these two pieces fit together perfectly so the ball can move both smoothly and securely within the socket.
If your pelvis is misaligned, it can change how the femoral head (ball) moves inside the socket, this may narrow joint space, increase mechanical stress, and create or aggravate hip impingement. Hip impingement,—also known as femoroacetabular impingement (FAI),is a condition where there is abnormal contact between the femoral head (ball of the hip) pinches up against the acetabulum (cup of the hip). ) which can lead to pain, restricted movement, and eventually arthritis. A typical early symptom of hip impingement is nagging pain in the groin crease; you may also feel your hip getting stiff or locking up. Because they don’t fit together perfectly, the bones rub against each other during movement, which can cause pain and limit motion. Over time, this can damage the joint potentially leading to arthritis.
Muscle imbalances and hip impingement are often interconnected, and understanding this relationship is crucial for both managing your symptoms and preventing further dysfunction. When certain muscles are too tight, too weak, or not activating properly, it alters the mechanics of the hip joint, increasing the likelihood of impingement.
Muscles surrounding the pelvis act as guide wires, controlling position and stability. Just like guide wires stabilize a tall telephone pole, your muscles, stabilize your bones especially in weight-bearing joints like the hip. If the tension in those “wires” is asymmetrical or pulling unevenly the pole (pelvis) starts to lean, rotate, or becomes unstable potentially leading to hip impingement. A rotated or tilted pelvis can change hip socket orientation, leading to earlier contact between femoral head and acetabulum.
Muscle imbalances act like dysfunctional guide wires. These imbalances pull bones and joints out of optimal alignment which can lead to or worsen issues like pelvic asymmetry and hip impingement. Asymmetry can contribute to the development or worsening of hip impingement by disrupting natural hip joint mechanics. Restoring balance to the “wire tension/muscles” restores optimal position, function and reduction of pain. Addressing imbalances through physical therapy and movement correction is often key in both preventing and managing hip impingement.
With regards to left and right hip impingement, different muscles need to be recruited where others need to be inhibited. Let’s take a look at right hip impingement. Muscles attaching to the pelvis directly affect the position of the pelvis which can ultimately affect the position of the thigh bone. We can influence the position of our pelvis by strengthening certain muscles. If your right hip hasn’t improved in spite of the stretches, exercises, and therapies, perhaps it’s time to look at the left side. A common misconception is that there are one or two muscles on the right side that can be identified as being tight, and that it is the result of these tight muscles that are causing one’s right hip pain. From a clinical standpoint, right hip pain does not necessarily mean that you have a right sided issue, and therefore does not mean continuing to treat the right hip is the correct thing to do.
Pincer impingement occurs when the acetabulum covers or encloses the femoral head more than it should. This so-called “over-coverage” of the femoral head usually develops along the front-top rim of the socket, causing the neck of the femur to bump into the socket whenever you flex your hip joint by bending forward at the hip or drawing your knee toward your chest.
Pelvic positioning acts similarly to a telephone pole being held up by guide wires. Acknowledging that we all have asymmetrical tendencies that will affect how we sit, stand, walk, run, squat, etc. over time these tendencies will bring about postural changes and change the resting length of muscles. Over time some muscles shorten and tighten, while others lengthen and become loose. The result is a muscle imbalance. For example, habitually standing on one’s right leg will shift one’s center of mass to the right causing the increased strain on the right hip. The right adductor will be short and tight and the left adductor will be long and loose.
Right “Pincer” hip impingement. Over-coverage of right socket on right ball of hip. Tight right adductor with a loose left adductor.
In order to direct your pelvis to a more balanced state you have two options to either push from the right side or to pull from the left. With respect to muscles, you would facilitate the right glute max to push you to the left and the left adductor to pull you to the left. With respect to right hip impingement, simply decreasing the activity on the right side would decrease one’s pain. In spite of stretching a tight right hip or groin, one would still need to tighten a muscle on the opposite side to maintain the length that you gained from stretching.
PRI Right Sidelying Respiratory Scissor Slide (used with permission from Postural Restoration Institute)
Sidelying Scissor Slide Skeletal Dynamics
Sidelying Scissor Slide Muscle Dynamics (Adductors)
The next time you encounter right hip impingement, please take into account it may not truly be a right sided issue. You may want to tighten your left guide wire to decrease the demands on the right side!
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