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Olympus Lifestyle Co

Condition

Hip Impingement

Pinching or deep ache at the front of the hip when squatting, sitting low or pivoting? Accurate assessment of femoroacetabular impingement and a structured, strength-based program with clear guidance on surgery.

Hip impingement, formally femoroacetabular impingement (FAI) syndrome, is a common cause of hip and groin pain in active young and middle-aged adults. It usually shows up as a pinching or deep ache at the front of the hip, particularly when you squat, sit low, drive for a long time, or twist and pivot in sport. It’s easy to confuse with a groin strain or hip flexor problem, so an accurate diagnosis matters.

Understanding hip impingement

The hip is a ball-and-socket joint. In FAI, the shape of the ball (cam), the socket (pincer), or both, means the bones contact earlier than normal as the hip moves into deep flexion and rotation. Over time this can irritate the labrum, the rim of cartilage around the socket, and the surrounding tissues.

Importantly, these bony shapes are very common in people with no pain. An international consensus statement (the Warwick Agreement) introduced the term FAI syndrome to reflect that the condition needs three things: the right symptoms, positive clinical signs and appropriate imaging findings. A scan alone isn’t enough to make the diagnosis.

Symptoms we commonly see

  • Pain or a pinching feeling at the front of the hip or groin, sometimes the outer hip or thigh
  • Pain with deep squatting, getting out of a car or sitting for long periods
  • Pain with pivoting, kicking or sprinting
  • Catching, clicking or a feeling of the hip locking
  • Stiffness, particularly turning the hip inwards
  • A dull ache after activity

Our evidence-based approach

International consensus lists conservative care and rehabilitation, as well as arthroscopic or open surgery, as suitable treatments. The evidence is balanced. In the UK FASHIoN trial of 348 people with FAI syndrome, both hip arthroscopy and a personalised, supervised physiotherapy program improved hip-related quality of life at 12 months, and arthroscopy led to a greater improvement that exceeded the minimum clinically important difference. That’s why we offer structured rehab as a sensible first step for many people while being open that surgery is a legitimate option for some. Our approach includes:

  1. Assessment of the hip, pelvis, lower back and movement, to confirm FAI syndrome and rule out groin strains, hip arthritis, labral tears and referred pain
  2. Education about what your scan does and doesn’t mean, and what’s pinching
  3. Activity modification, adjusting the deep positions and movements that provoke pain while keeping you active
  4. Progressive strengthening of the glutes, hip rotators, core and legs, which improves hip control and load tolerance
  5. Movement and control work for squatting, hinging, landing and change of direction
  6. Hands-on treatment where it eases pain and improves comfort for exercise
  7. A graded return to sport, with strength testing where relevant
  8. A clear pathway to a surgical opinion if you don’t progress with a well-delivered program

See our hip and groin pain page for other causes of hip and groin pain.

What to expect: recovery timeline

  • First six to twelve weeks: many people see their pain and function improve with consistent strengthening and modified loading
  • Beyond three months: strength, control and sport-specific work continue to build
  • If progress stalls: we’d discuss imaging and a surgical opinion with you

When to seek help urgently

Get assessed promptly if your hip pain follows a fall or injury, you can’t put weight through the leg, or you have hip pain with fever, redness, warmth or feeling unwell. Constant severe night pain also needs review.

References

How We Treat This

PhysiotherapySports PhysiotherapyStrength and ConditioningPerformance Testing

Q & A

Questions about Hip Impingement

What is hip impingement?

Femoroacetabular impingement (FAI) syndrome is a hip condition where the shape of the ball and socket means the bones come close together or contact each other earlier than they should as the hip moves, especially in deep bending. It causes pain at the front of the hip or groin, often with squatting, sitting for a long time, pivoting or kicking.

My scan shows cam or pincer changes. Does that mean I have FAI?

Not necessarily. Cam and pincer shapes are common on the scans of people with no hip pain at all. International consensus says FAI syndrome is diagnosed when you have the right symptoms, positive findings on examination and a compatible shape on imaging, not from the scan alone. That's why a careful assessment matters.

Do I need hip arthroscopy?

Sometimes. In a large UK trial, people who had hip arthroscopy improved more at 12 months than those who had a personalised physiotherapy program, and the difference was clinically meaningful, but both groups improved. Surgery also carries risks. For many people a well-delivered structured rehab program is a sensible first step, with a surgical opinion if it doesn't give you enough relief.

Should I avoid squatting and deep hip positions?

We usually modify rather than avoid. For a while we'd reduce the movements that pinch, such as very deep squats and prolonged low sitting, while building strength around the hip and trunk. Often you can return to deeper positions comfortably once the hip is stronger and better controlled.

Is impingement the same as hip arthritis?

No, though they can coexist and some people with FAI shapes go on to develop arthritis. Hip arthritis usually causes stiffness and pain that are worse after rest, more common over 50. See our osteoarthritis page. We'd work out which you're dealing with at your assessment.

Let's get this sorted

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