Hip Impingement: What It Is and How to Keep Training

Quick answer: Hip impingement is extra bone growth on the hip socket, on the neck of the femur, or on both, and it can create pain at the front of the hip or into the groin when the hip bends deeply. It does not automatically mean you have to stop lifting. Most people can keep training by assessing their squat technique, adjusting their programming and intensity, using the warm up to create more comfortable range, and changing modifiable parts of the lift like stance width, depth, and torso angle.

Introduction

You set up for your squat, start to descend, and somewhere around parallel you feel it. A pinch right at the front of your hip. It is not the kind of pain that makes you drop the bar. But it is enough that you cut the set short. Or you may notice you start shaving a little range of motion off from your squat than you’re used to.

Then you start to notice it outside the gym. Getting out of the car. Sitting through a long meeting. Pulling your knee toward your chest to tie your shoe.

If that sounds like your hip, hip impingement is one of the things you may have heard thrown around. It sounds like a scary diagnosis, but it’s a lot more common (and a lot more manageable) than it gets credit for. It is not a reason to stop lifting. But it is a reason to get more specific about how you lift.

What is Hip Impingement?

Your hip is a ball and socket joint, which is part of what makes it so mobile. It’s built to move through flexion, extension, rotation, and everything in between, whether that’s performing a deep squat, sprinting, or just tying your shoes.

Hip impingement (the medical term is femoroacetabular impingement, or FAI) happens when there’s extra bone growth on either side of that joint that changes how much room the ball and socket actually have to move together. Depending on where the extra bone shows up, it gets one of three names:

Three Types of Hip Impingement

Pincer lesion: the overgrowth is on the hip socket itself, the acetabulum.

Cam lesion: the overgrowth is on the neck of the femur, the bone that sits inside the socket.

Combined lesion: both are happening at the same time, which is actually the most common version.

None of these mean your hip is broken, you’ll be in pain forever or that something is fundamentally wrong with your hip. It just means the joint has a little less clearance in certain positions, which can create pinching or pain when you ask it to move into deep flexion, especially under load.

Signs You Might Have Hip Impingement

There is a fairly recognizable pattern to hip impingement symptoms. However, none of these things can confirm hip impingement on their own. Plenty of other things can create hip pain. Treat this as a reason to get assessed or look into things further, not as a self diagnosis. 

• Pain in the front of the hip. It often sits right in that crease, and it sometimes travels into the groin.
• Pain when the hip bends deeply. Bringing your knee toward your chest is the position that tends to reproduce it. That is why sitting, driving, getting in and out of a car, and deep squats are the usual complaints.
• Stiffness and loss of range. The hip can feel generally stiff, and internal rotation is often the range that goes first.

Maybe you have noticed you’ve stopped squatting quite as deep, or you avoid long drives. Or maybe you have noticed that one hip just does not rotate like the other one. These patterns are worth looking into and taking to someone who can actually assess it. At Rise Performance and Physical Therapy we can assess, diagnose and treat hip impingement and get you back to your favorite activities faster with less down time.

How to Manage Hip Impingement While You Keep Lifting

Here is the approach I take as a Doctor of Physical Therapy, and it is probably simpler than you are expecting.

When somebody comes in with hip pain during squats, I am not immediately handing them ten to fifteen corrective exercises. Real adaptation comes from training and loading, not from a pile of corrective exercises you do in your living room.

So the first thing you want to try are easy adjustments to things like your form, technique and even your exercise program. A lot of the time, looking at these things can address most of the pain.

At minimum they make enough of a difference that we know what we are working with. Only after that does it make sense to add more.

Start with your technique

If your hip hurts during squats, the squat itself is the first thing you want to look at. Sometimes this is genuinely just a matter of making a few adjustments. A small change in setup or bracing can shift how much room your hip has to move into flexion and can change how the lift feels. 

To create more space in the hip when squatting you can try two things: 1) widening your stance in your squat just a bit and 2) turning your feet slightly outward. 

These two things may help to create enough space within the hip to prevent pinching or pain in the front of the hip when performing movements like squats. 

Look at your programming before you add exercises

The second question is whether your hip is actually reacting to the squat, or reacting to how much squatting it’s been asked to do lately.

Someone can have pain with squats when squats themselves are not the problem. It might be that the volume is not being managed well, or that the load is increasing faster than the body is adapting or able to handle the increased load.

It could also be that the program is not organized in a way that lets you recover between hard lifting sessions.

These are all fixable, and none of them require you to stop training.

So the real question becomes: where can we make some changes to your programming?

Using RPE to set your everyday intensity

Using RPE is a way to help manage intensity in your workouts. Meaning how close you are training to failure and how often you are doing it.

RPE stands for rate of perceived exertion. It is a scale of 1 to 10 for how difficult a set was for you.

The majority of your training should sit around an RPE of 7 to 8.5 for your main compound lifts. 

These lifts are taxing on your nervous system, and they ask a lot of stabilizing muscles and joints to complete.

Performing every compound lift with an RPE of 9 or 10 when training is not necessary to see results. Save the 9 to 10 RPE work for your isolation exercises. There is less fatigue involved in using these smaller muscle groups.

Use your warm up to create a window

The warm up is where the hip-specific work belongs and these movements just get mixed into what you’re already doing.

The goal of a warm up is to decrease some sensitivity and give the hip a little more room to move. That creates a window where you can go train and load the hip with less irritation or pain. 

A few things that tend to help:

• Lateral and posterior hip mobilizations: including a posterior hip capsule stretch and superband work helps create a little more space inside the joint.
• Deep squat breathing: to spend time in the position under low demand.
• Hip flexor isometrics: which can create a small window of decreased pain that you then use to train. Three sets of 30 to 45 second holds works well, and you can also break those into smaller pieces. Usually around two minutes of total work before a training session is enough.
• Copenhagen planks: use these to build capacity through the inner thighs or adductor muscles and hip.
• Supported hip airplanes: Here the pelvis moves on the femur rather than the other way around. That gives you more control. You end up using your hip rotators to find ranges that feel more comfortable.

One caution here: hammering hip mobility can make things worse. More stretching is not automatically better, especially in a joint that is already getting compressed at end range. Use the warm up to create the window, then go spend your energy training.

Change the modifiable parts of the lift

If your hip is still not feeling great, there are a lot of variables inside a squat, lunge or deadlift variation you can adjust. Most of these are small, and most of them you can test in a single session.

• Stance width: Where your feet sit changes how your hip is positioned in the socket. A stance width of hip distance or slightly wider apart typically feels a little more comfortable on the hip.
• Degree of toe out: A small rotation can allow the femur bone to sit a bit more comfortably inside the hip socket especially in deeper ranges of motion.
• Range of motion: Temporarily avoiding deeper ranges of motion is a reasonable adjustment to let symptoms calm down. Remember this is not permanent.
• Tempo: Slowing a movement down can be helpful when a tendon is irritated. It forces more full body tension and offloads the more sensitive areas.
• Load: Sometimes the bar, dumbbell or load you’re using really is just heavier than what your hip is currently able to handle. In this case, temporarily adjusting the load can allow you to still have a meaningful training session without aggravating the hip
• Shin angle: This is how far your knee travels over your toes. The more positive the shin angle (or the more your knees travel over your toes), the less hip flexion you end up in. Front squats create a more positive shin angle, so the hip doesn’t have to work quite as hard.
• Bilateral versus unilateral: Split stance and single leg work change the demand at the hip entirely. For some movements double leg variations may feel more comfortable for others single leg work may give you the added challenge without adding more weight, reps or range of motion that may aggravate the hip. 
• Torso angle: The more forward lean you have in a squat, the more hip flexion you create. That can bring on more symptoms if your hip is sensitive to that position.

You do not need to change all eight. Usually one or two of these cab be the difference between a set that pinches the hip and a set that does not.

Accessory Hip Impingement Exercises to Manage Pain Long Term 

Everything discussed above so far is about adjusting what you are already doing. This part is about building the hip so that it needs fewer adjustments over time.

This is also where the difference between correctives and accessory work matters. A pile of low-load correctives on the floor is not the same thing as loaded accessory work. Everything discussed below involves real training, and it belongs in your session alongside your main lifts.

Build strength around the hip

• Hip flexor strengthening through different ranges. The hip flexors sit right at the front of the hip, which is where these symptoms usually show up. Training the hip flexors at multiple different joint angles can help provide more stability and control in the hip and helps build strength in the positions the hip currently wants to avoid. 
• Adductor strengthening through different ranges. Your adductors run along the inner thigh and do a lot of work controlling the hip at the bottom of a squat and in any split stance position. That is also the region where groin symptoms show up with hip impingement pathology. Copenhagen planks are a good entry point, and the same principle applies, train them in multiple positions, not just where they feel strongest.

Train the range and control the pelvis

• Train rotation by adding it to movements like split squats and lunges. Internal rotation is often the first range to go. Adding a rotation to a split squat or lunge trains that range with your foot planted and weight through the leg, which is how your hip is actually working when you squat. That tends to carry over better than rotating your leg while lying on the floor.
• Direct core strengthening, with attention to the obliques. Your obliques attach into the pelvis and help control how it sits over the femur. When the pelvis can hold its position under load, the hip doesn’t have to work quite as hard. 

None of this replaces the adjustments in the last section. It is what makes them temporary. You change the lift so you can keep training now, and you build the hip so you need fewer of those adjustments six months from now.

When It’s Worth Getting Your Hip Impingement Pain Looked At

You can take the advice above and do a lot of it on your own. But it is worth bringing in someone who can assess you when the pain is

• Not responding to any of the changes you have made
• Your range of motion is getting worse
• You are finding yourself constantly avoiding certain movement patterns or positions
• Your pain has been consistent for more than 3 months 
• Your pain is getting worse 

How Rise Performance and Physical Therapy Can Help Address Your Hip Impingement Symptoms 

If you’ve read through this article and are still wondering which of these changes would move the needle forward most for you, that is the part I can help guide you through. At Rise Performance and Physical Therapy, we work out of two locations in Denver and Wheat Ridge, Colorado with real gym equipment on site.

I will assess how your hip actually moves, watch you squat, and build a plan around what your hip can handle right now, then we adjust your program as your capacity changes and evolves over time. 

The best part is you get to keep training while we do it. Request an in person appointment here.

Not local to Denver, CO? No worries, we can perform the same movement assessment on screen together, discuss your training and health history and build you a plan that incorporates your strength and rehab goals completely remote. Check out our remote rehab coaching and support options here.