Hip Impingement Explained: Causes and Treatment

Hip impingement, or femoroacetabular impingement (FAI), is linked to an abnormally shaped ball-and-socket joint. It’s common in active sportspeople and even more common in elite athletes. So what does impingement of the hip mean, and how should it be managed?

What is hip impingement?

Femoroacetabular impingement occurs when an abnormal joint shape restricts movement and causes pain. Bony spurs form around the joint, so the ball of the hip (the top of the femur) pinches against the socket (acetabulum) in certain positions. This pinching causes pain and restricted movement.

Symptoms of hip impingement

People typically report pain during activity, especially in sports that involve sudden changes of direction. The pain is usually at the front of the hip or groin, sometimes felt in the buttock or lower back, often with a weak feeling and restricted movement.

We confirm the joint shape with a plain X-ray, and MRI reveals any cartilage or labral damage. One caution: imaging changes don’t always mean pain. Around half of elite athletes show impingement changes on X-ray, yet most have no pain, so a thorough clinical assessment must come before, and guide, any scan.

Does impingement of the hip lead to early arthritis?

Hip impingement is a risk factor for early hip arthritis, particularly with a CAM-type spur between the head and neck of the femur, and the larger the CAM, the higher the risk. But not everyone with a CAM develops arthritis; genetics and conditions such as diabetes and obesity matter too.

The bottom line: a bony spur doesn’t inevitably cause arthritis. So surgery to remove the bump should be done to relieve pain, not to prevent arthritis — we don’t know that it prevents arthritis at all.

How do we manage hip impingement?

Conservative treatment and physiotherapy always come first. Pain relief and return to sport are often possible without removing the spur or fixing a labral tear.

Rehab aims to improve hip and lower-back range of motion and strength while reducing pain. Exercise is the primary treatment, and may include:

Hip stretching and mobility work

Strengthening the glutes, hip flexors, and adductors

Balance exercises

Abdominal strengthening

Pilates and yoga often help achieve these goals. Neuromuscular training — performing exercises with correct alignment of the back, hips, and legs — also reduces stress on the joint.

How effective is physiotherapy for hip impingement?

Better than we once thought. In a study of young athletes with FAI, 75% chose rehab over surgery — most of the exercise group improved, and only a small minority (14%) needed a hip joint injection. After the injection, only half of that 14% went on to surgery. Overall, about 80% avoided surgery, and all three approaches (rehab, injection, surgery) reshowed similar responses

How long should you try conservative treatment?

Expect improvement in pain, strength, and range of motion by about eight weeks. Aim to return to sport within 3–6 months, and continue independent rehab for at least six months. If therapy doesn’t help, discuss other options with your doctor.

Hip impingement cortisone injection

A cortisone injection into the hip joint can reduce pain and let you continue therapy, and can also clarify the diagnosis. We always perform hip injections under ultrasound for accuracy. Usefully, the response also predicts surgery: improvement after an ultrasound-guided hip injection indicates successful hip arthroscopy, so if the injection works, surgery is more likely to succeed.

PRP injection for a hip labral tear: does it work?

PRP concentrates the growth factors from your own blood. While PRP improves hip arthritis, its effect on labral tears remains unclear. It’s an option instead of cortisone for a hip labral tear, but the evidence isn’t settled.

When is surgery considered?

Hip arthroscopy (keyhole surgery) can remove the spurs and repair the labrum. It improves symptoms such as pain, but not everyone benefits, and about 5% feel worse. Don’t expect a full return to all activities — and only 50% of athletes return to their sport, with just 14% returning to their previous level. So surgery is for severe symptoms, not for chasing the same level of competition.

Should arthroscopy be done to “preserve” the joint and prevent arthritis? The evidence is controversial. A study comparing arthroscopy with physiotherapy found worse joint metabolism in the surgical group at 12 months. So at present, keyhole surgery should not be done to prevent arthritis — only to improve symptoms. That said, some people benefit from earlier surgery, especially young men with a labral tear after a pivot or twist.

Frequently asked questions about hip impingement.t

Can hip impingement be treated without surgery?

Usually, yes. Around 80% of people avoid surgery with a structured rehab programme, sometimes helped by a hip joint injection. Surgery is reserved for those who don’t respond.

Is hip impingement the same as a hip labral tear?

They’re related but not identical. The abnormal joint shape of impingement often causes a labral tear over time. Many people have both, and the treatment — rehab first — is largely the same.

Should I stop sports if I have hip impingement?

Not necessarily. Modify the movements that pinch the joint (deep squats, extreme rotation), keep up your rehab, and most people continue sports. Pain that persists despite this warrants assessment.

Bottom line on hip impingement

Hip impingement can cause pain and restriction that limits sports. It’s a risk factor for arthritis, but only a minority with bony spurs develop it. Treatment is always conservative first; a cortisone injection can help if pain continues; and keyhole surgery is a final option, done for symptoms — not to prevent arthritis.

To book a one-stop hip assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.