What is a hip impingement?
First let’s go over what it is. The definition according to the Hospital for Special Surgery in NYC (HSS), a hip impingement, also known as femoroacetabular impingement (FAI), is a condition in which there is abnormal and wearing contact between the ball and socket of the hip joint. The result is increased friction during hip movements that may damage the joint.
What does a hip impingement feel like?
Once again, according to the HSS, patients often complain of pain in the groin. Many athletes often describe pain in the groin with deep flexion or rotation of the hip during activity. Occasionally, a popping or clicking in the front of the hip is described.
Symptoms that my own patients have described:
Sciatic nerve pain
Lower back pain
Radiating pain along the side and/or back or even front of the thigh
SI joint pain
Buttock pain
Because of the wear and tear at the joint, you may have lost some of range of motion. Maybe you struggle with putting socks on, bending over to tie your sneakers, maybe going upstairs is ok but going downstairs feels unstable and painful or vice versa.
My personal experience with hip impingements
Six years ago, I slipped and fell on some ice while walking my dog. I seriously injured my right knee and while I give all credit to orthopedic acupuncture in helping me heal from that incident, I made a mistake of not doing any strength training once it was healed.
Because of how hard I slammed my knee into the concrete, for five years that knee no longer fully bent and I always had some sort of instability on my right leg so my left leg took the brunt of all my weight when I walked. Acupuncture helped me remain pain free so I’m guessing I didn’t realize that I was using my left leg as a crutch. I’d get some lower back pain, then get my acupuncture and voila, no more back pain.
It was like this for years, I felt relatively pain free and I tried many things to keep active- yoga, indoor cycling, some light weight lifting and as the knee injury pain completely dissipated, I pushed myself a little and started taking Krav Maga classes. It didn’t matter what kind of workout, I always got slightly injured no matter how slow I took it and I couldn’t figure out why.
One day, I started to feel a brand new pain in my groin, butt and lower back that felt different from what I had experienced before. I thought, oh no, what is this now? I opted to not see an orthopedic doctor and instead skipped over and went straight to physical therapy where I was diagnosed with a hip impingement.
The physical therapist used a strap to basically pull my leg out of the hip socket. A really simple way of explaining what a hip impingement is, imagine if someone turned you upside down, took a giant mallet and hammered away at the bottom of your foot until your leg got jammed into the hip socket. It’s an oversimplification, but that’s essentially what it is. You can see in the picture above, the fascia (connective tissue) is connecting the femur to the hip. That fascia gets so bound up your leg is kinda stuck in that joint so you can’t quite turn your leg out as easily as you used to, or it hurts every time it bends.
Now, onto How to Fix a Hip Impingement without Surgery
I’m going to assume that you stumbled across this blog post because you have already been diagnosed with FAI. You're probably wondering if acupuncture or dry needling can help you and the short answer is yes.
If you have FAI, you will most definitely have developed trigger points and/or have muscles of the buttocks, hips, groin, thigh and lower leg that are under-functioning. Trigger points and muscles that aren’t firing as strongly as they should, can lead to pain. I guarantee there is some combination of both happening if you have FAI. Because of this, it is absolutely necessary to get orthopedic acupuncture in order to heal. However this only holds true for people who don't actually need surgery.
I have worked on plenty of people who have a slightly torn hip labrum or have fraying in the joint. With my style of acupuncture, these people lead full, happy, active lives. Many people are so impressed with how well releasing trigger points and firing up muscle function works for FAI. I’m often asked if they can stop or just not go to PT all together. My answer is no, you got the hip impingement because of some lack of strength to begin with. All athletes of all ages, genders and sizes, must put in some work to build foundational functional strength once all the muscles and soft tissue have been treated, so you can avoid this happening again.
I am one of those people. I enjoy strength training, I can sumo squat, I can lunge and its keeping my hips healthy. I occasionally have to see my acupuncturist to treat any trigger points that show up, but yours truly is one of those cases that healed without surgery.
WHO TO SEE FOR HIP IMPINGEMENT
Because of my knowledge in orthopedics, I knew to see a physical therapist first but if you’re reading this, you may have already seen a doctor.
In NYS, I believe you don’t need a referral to see one so if you suspect you have one, go get assessed by a physical therapist first.
See an orthopedic/Sports Medicine acupuncturist like myself, to treat the muscle and soft tissue.
Once that is done, go back to your physical therapist or qualified personal trainer to rebuild your strength
Pick some form of exercise that you like and can continue to do so that you can avoid this from happening again.
I’m happy to report that I’ve helped others heal from FAI with a combination of massage and orthopedic acupuncture. If you are told that you must have surgery, it may still be worth coming in for treatment before making that decision. I can’t gaurantee that you will get out of needling surgery but at least you can put that out of your mind and say you did everything you could to avoid it.
If you have a labral tear in your hip and are getting surgery, I strongly recommend coming in for treatment once the incisions have healed up enough. Your surgeon will tell you when it’s ok to start getting acupuncture.
““When I was told by my doctor that I had a hip impingement, the worst thoughts went through my head. I was in so much pain, all they offered was some physical therapy and some pain medication. I had already been a patient of Lorraine’s for a while and decided to see what she could do for me in this case. In just two sessions, she accomplished more than in five weeks of physical therapy. My range of motion improved by leaps and bounds and the pain subsided. She’s my go to when anything hurts and she should be yours too.”