Best Physical Therapy Exercises for Hip Impingement and What To Avoid
Updated: Apr 25
Our hip joints bear most of the bodyweight and allow us to move, run, walk and jump. It generally is a very flexible joint, but it loses the ability to perform these functions because of trauma or repetitive movements.
This condition is called femoral acetabular impingement (FAI) or hip impingement, causing stiffness, pain, and early hip osteoarthritis.
The pain and stiffness worsen with bending the hip or waist during seemingly simple activities like riding a bike, bending to tie the shoes, or sitting for a long time.
One of the best ways to manage this condition is doing hip impingement exercises. In this article, we'll review the recommended exercises as well as hip impingement exercises to avoid.
Exercise as Treatment for FAI
The first thing anyone with hip pain or stiffness should do is visit a doctor and a physical therapist to get diagnosed and start hip impingement physical therapy. Check the differences between physiotherapy and physical therapy here.
They will create an individual treatment and recovery plan and offer different treatments to manage the symptoms. These treatments may include heat therapy, electrical stimulation, various hands-on modalities, and, almost always - physical exercises. Studies have shown that passive treatments are much less effective than exercise, so movement will be your primary tool for recovery.
Proper and regular exercises will help manage pain and may even prevent future problems.
The hip impingement exercises will focus on improving your overall mobilities as well as hip flexibility, mobility, balance, and strength.
Hip Flexor Stretch
Most people with hip impingement experience stiffness and tightness in the iliopsoas muscle group, which is located at the front of the hips and helps to bend the hip. As many daily activities include bending (e.g., sitting, tying shoes, picking things up), patients experience tightness and sometimes pinching quite often.
To help relieve these sensations in discomfort, it's essential to include hip flexor stretches in your hip impingement exercise program.
Here's an exercise you can try:
Get on one knee on the floor (the one with the hip flexor you want to stretch, but you can do this on both sides), keep your other foot flat on the floor in front of you.
Keep your back straight and slowly lunge your body forward with chest high. Draw the tailbone down toward the floor and lift your pubic bone toward your navel.
Draw your belly button in towards and tighten your buttocks muscles.
Lunge as deep as you feel comfortable (find that edge), but don't overdo it, especially if you're just starting.
Hold for 20-30 seconds and repeat 3 times. Switch the sides.
The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. It stabilizes the hip joint and lifts and rotates the thigh away from the body, so stretching it out is essential for hip impingement physical therapy.
Try this exercise:
Lie on your back with your feet flat and knees bent.
Place one of the ankles to rest above your bent knee, grab the thigh of the leg that's on the floor and pull towards your chest. Go as deep as you feel comfortable.
Hold the stretch for 20-30 seconds and repeat three times. Repeat on the other side.
One of the FAI symptoms is tightness in the groin and inner thigh, so stretching those groin muscles should be in your hip impingement exercise program.
Seated butterfly is an easy and helpful exercise you can do to help stretch the muscles out.
Sit on the floor with your back straight and with the soles of your feet pressing into each other.
Root down into your seat. Tuck your chin, inhale, and on an exhale, allow your knees to fall towards the ground. If it feels too tight, push your feet forward and if you want a deeper stretch, get them close to your body.
Feel the stretch and hold the pose for 20-30 seconds. Release and repeat 3-4 times or as many as feels comfortable.
Besides the stretches, your physical therapist will teach you some FAI exercises for hip strengthening. It's crucial to strengthen weak muscles of the hip to increase flexibility and reduce pain.
Among these exercises, you might find bridges, straight leg raises, isometric hip raises, hip hikes, and clamshells.
Here's how you do a bridge exercise:
Lie on your back, keep your feet on the floor with your knees bent. Tighten your abdominal muscles.
Raise your hips off the floor and align with your knees and shoulders.
Hold for three deep breaths, put your hips down and repeat 5-10 times.
Your hip health is also closely connected to your core health; that's why you should also strengthen it.
Among these exercises is the pelvic tilt, straight leg raises, bridge, squats.
Here's how you do a simple pelvic tilt:
Lie with your back on the floor with your legs bent and toes facing forward.
Pull your belly button toward your spine, tighten your buttocks and hip muscles, tilt your pelvis forward and hold for 5 seconds.
Repeat for 10-20 times or more.
Hip Impingement Exercises to Avoid
While there are many exercises that will help with FAI, it's important to remember that there are also hip impingement exercises to avoid. Yes, not all exercise is good exercise.
Avoid exercises involving significant hip flexion with internal or external rotation as they aggravate the condition. Deep lunges, squats, high jumps, high knees, rowing. leg press, squat-jacks should be avoided.
When treating hip impingement and managing its symptoms, a combination of various physical therapy modalities are used, but exercises are the most important part of it. Is physical therapy painful? Find out here.
The physical therapist creates a special exercise program for each patient after a thorough evaluation. However, you will usually be taught hip flexor stretches, piriformis stretches, groin stretches, and hip strengthening and core strengthening exercises.
And while these exercises are highly beneficial, you will also receive a list of exercises to avoid as they could worsen your condition and its management.