Hip Impingement

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapist office in Vancouver. And we're talking hip impingement. How are you doing Wil? 

Wil: I'm doing great. Thanks Mark. Basically it's when the head of your femur or your femur bone basically pinches up against that part of the socket of your pelvis, which is called your acetabulum. So what they normally refer to it as FAI. Which is femoroacetabular impingement. And there's a few different causes to that. 

There's definitely, you know, like sort of structural genetic component where if you're pelvis and your hips are aligned in a certain way and the neck of your femur is not proportioned, or if it's shorter then you have an increased risk of having this type of impingement happening. 

So aside from looking at sort of the congenital factors, we're looking at more of the other secondary issues of like, imbalances that you develop from sport and activity, to specific injuries. Then you can run the gamut of like, you know, having issues that are caused by like the sacred iliac joint that shifts the alignment of the whole pelvis, which then causes a movement issue in the actual hip. So that's huge because I see that quite a bit too. To where you have like, in your hip, you have cartilage that's called your labral. And so you can sometimes experience sort of an injury into there. And then if you have sort of that kind of stuff going on and that can definitely give you changes in terms of the actual motion and movement of the whole hip. 

So when it comes down to the true FAI, there are a lot of different causes to this. And I think you really want to address what are the biomechanical factors.

So biomechanical factor being like, you know, what are the things that are affecting the way that this joint is moving. Assuming that you account for all the structural issues and that, all that stuff is normal. And you don't have that aspect with regards to that getting in the way. And then you're looking at muscle imbalances. So you have like your lower back joints maybe, your spinal joints maybe contributing to all that. 

Mark: So how would I know? How does this show up when somebody comes into your office, what are they complaining about? 

Wil: Yeah, it's like basically a pain in the front part of your hip. And it's primarily you know, you feel weak in there as well, weak and painful. And it's interesting because I had a fellow who was an avid rock climber recently who had been doing a bit more driving, I guess, just you know, driving around sort of getting to different rock climbing gyms now that there's the winter season and also he's a skier too. And he noticed that he was getting some more hip pain. And he was driving a standard, so he was using that left side. He was getting an impingement on that left side. And that was getting even more trouble as he was like sleeping. And then he was noticing that it was referring down to his knee.

That's when he finally thought he had to get checked out by me. It was when he started getting the increasing in symptoms and it just wasn't going away. So basically that's the biggest symptom right there. It's really that sort of like, you can put your palm of your hand or just your fist on the front part of your hip and that's the area of pain. And especially trying to bring your knee towards your chest and you start to elicit a sharp pain and then if you try and rotate it out, the knee coming outwards, and then that can also elicit a painful response into that interior part of your hip.

Mark: So that's how it shows up. You can't maybe put your socks on as easy without pain. So when you're diagnosing it, what are you looking at? You talked about muscle imbalances and all kinds of other things. How are you diagnosing it exactly to find what's going on? 

Wil: Yeah. So quite honestly, there's marked weakness in that hip. So weakness marked with pain. And then also just in terms of the movement of the joint. So when we get in there and looking at the joint, there's like the kinesiological movement or the anatomical movement of how it's supposed to move. And there's usually a restriction and extension, but then with that extension restriction, you have that accompanying weakness with the fluxion, which is bringing the knee to the chest. With pain. And there's always like, sort of this pinching sensation. And also coming out into the, what we call like an abduction fluxion motion, where you bringing the knee outwards and upwards kind of thing because that puts more sort of a closing in aspect of that hip joint. And then that brings in more of that impingement.

So that's sort of the primary part of it, like, Oh yeah, that's the hip impingement. And then we really look for well what's causing that. And aside from like, you know, the structural and the congenital parts of what I talked about before, you know, then you're really starting to look at, okay, so is this now really like an issue with the sacroiliac joint that's driving this. And then also quite often, in addition to that, you know, we talked about the weakness. You also want to just really work on strengthening specific muscles in that hip flexor area. 

Because strengthening that area helps to support the normal moving patterns in that hip again. Because when it's really weak, then it basically, you know, all the other muscles that are really tight started to take over and then you get all this imbalance and it basically spits it to the front. Spits that joint to the front. And then you can imagine as it does that, then you go to like, bring the need of the chest. If you've got to bend over and you have that motion of fluxion pinching even more when you're having all that imbalance happening. So those are the things that we're looking at addressing is those imbalances, but then primarily, you know, what's driving it. Is it, you know, the sacroiliac joint.

So with this specific client who actually had a sacroiliac joint injury, it was definitely driving that hip impingement. And then now we're also in the process of looking at helping them strengthen his core. Now it's hard to tell, was his core already weak, and then it caused the sacroiliac joint to shift. It's hard to say, but we definitely know that he had this issue with his mobility and his SI joint or a sacroiliac joint. So now we're in the process of trying to help him with his core strengthening and also his hip flexor strength. And I've only really seen him three times. He comes in like he's still really active, still climbs.

And in those three sessions, you know, the first time he came in, he was getting constant pain. You know, it was like nine to 10 on the pain. And it went from nine to 10 out of the pain to like a three to four out of pain out of the second session. And that was like a month later. And, you know, we gave him some exercises, reinforced the stuff that I did manually and doing the releases that we did and all the things that we worked on to try and really restore a more normal movement pattern in that hip.

And then I saw him for the third time, like a month after that. So this has been a span of like almost three months. And he's like at times where he's pain free almost, and he feels it mostly with climbing. And then when he's still driving a little bit, when he's clutching with that left foot.

Mark: Anything else you wanted to say about hip impingement? 

Wil: Well, I think you know, the big thing is that if you're trying to stretch it out, it's not just about trying to stretch things out in there. Like it's, I think the biggest misconception is that I got this really sharp hip pain, you think, Oh, I just stretch it and it's okay.

Sometimes it may be, sometimes it might help, but like if you're stretching and you're noticing very little returns and gains in that, then you want to get it checked out because then you want to get at the root cause of what's actually driving that. And you know, something as simple as like, you know, figuring out that alignment issue and what's causing that and addressing that, you know, can really make the difference of like, like you know, from experiencing a constant nine to 10 out of the pain to making life a little bit more enjoyable. Making your sports and activities a little more enjoyable. And finally being able to pursue the things that you really want to be able to do again. 

Mark: Bottom line. If you want to feel better, if you're tired of being in pain, the guys to call in Vancouver are Insync Physio. If you're in the King Ed, Cambie area, Mount Pleasant, et cetera, et cetera, they get people coming from all over the place actually. They're that good. The Vancouver office is (604) 566-9716 to book your appointment, you got to call and book ahead. They're busy. Or in North Burnaby, there's another office (604) 298-4878. Give Insync Physio a call they will help you out. 

If you want to check out the website, Insyncphysio.com. You can book online there as well. And you'll see there's lots of videos on there for all kinds of types of exercises and stuff that will help. Whatever, if you've got a minor issue that you need to work on, maybe that'll help, but if you want expert help and getting better and moving freer, give them a call. Thanks Wil. 

Wil: Thanks Mark.