Hip Pain - Impingement ?
Hip pain caused by impingement is initially felt in the front of the hip as either a pinching or tight feeling. The pain is most commonly felt while the hip and knee are bent up towards the chest i.e. while stretching or performing yoga poses such as the ‘pigeon’. The pain can then spread to a more generalized hip pain. Pain can also be felt in the front of the hip or groin with movements such as crossing the legs, running or walking. Individuals will often feel like they want to keep stretching the front of the hip, which in fact will exacerbate the pain. Furthermore, continuing to move the hip into the painful motion will continue to aggravate the pain and will not ‘stretch out’. Associated with the hip impingement are a variety of other diagnoses such as; hip flexor strain, hip tendinitis, iliopsoas bursitis, and groin ‘pull', labral tears and early osteoarthritis.
The most common finding is excessive muscle tension in the gluteal and rotator muscles at the back of the hip. The hip joint is designed for the ball part of the hip to ‘spin’ in the socket. Excessive tension and compression through the muscles in the back of the hip will push ball forwards in the socket during movement and/or at rest. The hip pain is caused by the front part of the ball pinching against the soft tissue in the front of the hip socket. The soft tissues in the front of the hip can be very tender to touch.
A thorough examination and history taking is required by a manual physical therapist to determine if you have hip impingement and how best to manage it. There are many causes of hip pain that should be examined to allow for the correct diagnosis. The physical examination involves looking at posture, movement patterns, strength and mobility of the hip, pelvis and lower back. These three areas function together and any loss of mobility or muscle imbalance will place greater strain on the other regions. The examination will also identify daily habits that are contributing to the pain i.e. sitting posture, standing posture, sleep position, etc.
Manual physical therapy treatment that will use a combination of manipulation, mobilization, IMS dry needling, soft tissue work, and stretching will help restore normal mechanics. One of the best manual therapy techniques to restore hip mobility was invented by New Zealand physiotherapist Brian Mulligan and is termed a mobilization with movement
A specific therapeutic exercise program will be taught to reinforce correct posture and movement patterns, and improve range of motion and strength.