Hip Joint Jam

Hip joint impingement or Femoroacetabular impingement is a common malady affecting millions of people. If left untreated, this condition will result in osteoarthritis, hip replacement, severe groin and buttock pain, and limited and painful range of motion. FAI can result from playing sports or sitting too much. A student of mine brought his client to me who was suffering for years from severe buttock pain. She had had several MRIs as the doctors suspected she had sciatica resulting from some impingement in her lower lumbar spine. The MRIs were of course negative. She also received anti-inflammatory injections in her lumbar spine which did nothing. After getting her history I put her through some range of motion testing which included her hip joint. I found her hip joint to be very jammed. After balancing the muscles around her hip joint, I applied light traction to her leg, and voila, there was an audible pop, and while weeping, she reported that her pain was completely gone.

Let’s go over the important muscular components of FAI. First and foremost are the obturator internus and externus. These two muscles suspend the femur in the hip joint. If they become too tight the femur jams into the acetabulum. The question then becomes why are they tight? A very common compensation pattern that I see is the obturator muscles inhibiting the gluteus maximus. This is something that happens from sitting too much. The obturator muscles can also inhibit the psoas. Again, this is due to sitting and sometimes athletics. The obturator muscles, just like the rotator cuff muscles, are not meant to do motions that require load bearing. So when there is a dysfunctional movement pattern, and they are required to compensate, naturally they tighten up. The result of all of this is a painful hip joint. I know about this from personal experience. From doing a lot of mountain biking, my hip joint became increasingly painful, to the point where when I sat with the soles of my feet together, my one knee was much higher than the other. I tried stretching my  adductors to no avail. Finally I learned about the obturator muscles, and was able to resolve my problem.

I use the standard range of motion tests to determine if FAI exists. I have the client perform internal and external rotation of the hip via the foot, knee to chest, cross one leg over the other, put the soles of the feet together, and do a circular range of motion. Often times many of these are restricted, and depending on the severity, sometimes only one is restricted. After balancing the obturators, the next thing I check is strength in the rectus femoris. With FAI, this is often inhibited. This muscle is also inhibited after hip joint replacement, and it’s facilitation is crucial in postsurgical recovery. What I find commonly facilitated is the iliacus. Naturally, the adductors can be facilitated and inhibit the rectus femoris. Dysfunction of the hip joint commonly can lead to lower back pain via antagonistic relationships, neck pain due to kinetic chain compensation, and knee pain also due to kinetic chain compensation. Only after all of these relationships have been resolved, will I gently traction the leg to facilitate a release of the hip joint.

Of course, if there has been too much degeneration in the joint, I will recommend a hip replacement. Optimally, if there hasn’t been too much damage, a hip resurfacing procedure can be done. Let’s remember that hip joint replacement is amongst the most successful of surgeries. I have seen people’s lives changed dramatically from such a procedure. Remember to be a pragmatist not a fanatic. Conservative management of FAI is very successful if you understand its components and how to resolve the specific dysfunctional movement patterns.