Effective Hip Impingement Exercises

Dealing with hip impingement? Exercises may help to reduce pain and keep symptoms at bay. Also known as femoroacetabular impingement (FAI), this type of hip pain is caused by a deformity or abnormalities of the hip joint itself; typically of the femoral head or labrum causing pinching within the hip joint or upper femur with hip flexion. Keep reading to learn the best hip impingement exercises and how to perform them. 

Best Hip Impingement Exercises

When it comes to exercise for hip impingement, strengthening exercises typically focus on restoring muscle balance between a few key muscle groups. Hip strengthening should address the hip flexors, hip rotators (internal rotation and external rotation), hip abductors, and hip adductors.

Core strengthening is also a vital part in reducing hip pain since it helps control the coordination of the pelvis, where the socket of the hip is located. All of the best exercises below address these areas without aggravating symptoms by avoiding flexion biased movement.

This basic exercise primarily addresses the glutes and hamstrings while also encouraging appropriate core activation. Since the movement involves hip extension (the opposite of the painful flexion direction), it can also provide some secondary hip pain relief too. 

• Lie on your back with the knees bent and feet flat on the floor at hip width apart 
• Tighten the core and squeeze your glutes as you push through your heels and lift your butt off the floor
• Lift as high as you can comfortably and hold for 1-2 seconds 
• Return slowly and in control to the starting position
• Repeat 10-15 times for 2-3 sets
• When you’re ready, you can progress to a single leg bridge as well

Fire Hydrants

This is another great combination move that addresses core strength and glute strength (more specifically the hip abductors and rotators) at the same time. 

• Start by getting on your hands and knees
• Make sure the spine is neutral (relatively flat) and your abs are engaged
• Lift one knee off the ground and out to the side while keeping it bent
• Raise it to the side as high as you can, as if you are a dog peeing on a fire hydrant, without letting the back rotate
• Return your leg to the ground and repeat 10-15 times
• Switch to the other side when you’re ready
• Complete 2-3 sets on each side
• Additionally, you can add hip extension raises, known donkey kicks, where you lift the leg straight behind you as well

This is another exercise that addresses the hip abductor muscles. Having strong hip muscles, particularly the abductors, that can coordinate well with daily activities is essential for reducing overall strain on the hip. Weakness of these muscles is common with hip pain and impingement.

• Lie on your side with the hip you want to work facing up toward the ceiling
• Bend your bottom hip and knee to provide some stability
• Keep the upper leg straight and in line with your trunk as you tighten your abs
• Lift your straight leg sideways up toward the ceiling without letting the hips or trunk rotate
• Make sure your knee continues to point straight forward and doesn’t rotate up toward the ceiling with each leg lift
• Repeat this movement with control for 10-15 repetitions for 2-3 sets on each leg
• You can also work your lower leg in this position to address the hip adductors by straightening the bottom leg and lifting it straight up toward the ceiling as well (you just need to get your bend upper leg out of the way)
• Additionally, while you’re lying on the floor, you can also roll onto your back and practice lifting your straight leg up toward the ceiling (known as a straight leg raise) in a pain free range of motion

Loop Band Side Leg Lifts

This more functional move addresses the hip abductor muscles in a standing position. It is a great movement when you’re ready since weight bearing positions will help better preserve your hip integrity.

• Grab a loop band and wrap it around your legs at about mid-shin
• Stand with your feet hip width apart
• Shift your weight into one leg as you lift the opposite foot off the ground so that it can move freely
• Then, keeping the leg straight and trunk upright (no leaning), lift your leg straight out the side to approximately 45 degrees if tolerated
• Return your leg to the starting position and repeat on the opposite side
• Alternate and repeat for 10 repetitions on each side for 2-3 sets
• You can try other functional moves with the band as well such as forward, backward, and sideways walking

Hip Hike

This movement helps improve coordination of the pelvis by activating muscles in the lower back and hips all at once (including the large iliopsoas and quadratus lumborum stabilizing muscles). Oftentimes, hip pain and weakness can lead to poor pelvic stability that further aggravates the underlying issues. Learning to control and minimize unnecessary pelvic movement with weight bearing activities can help.

• Find a step or elevated surface and stand on it with the edge of one foot near the side
• Let the foot near the edge clear the step and fall down toward the floor by dropping the pelvis (movement comes from the hip- not from leaning the entire trunk)
• Then, practice lifting the foot back up to the level of the step and beyond in the opposite direction
• All of the movement should be coming from the hip that is staying up on the step throughout
• This movement can feel awkward to coordinate all at once- it can help to stand in front of a mirror to start if needed
• Repeat 10 times on each side for 2-3 sets

The exercise we just discussed above involves being able to coordinate the pelvis in a frontal plane (side to side). Now, this exercise will focus on pelvic stability in the lateral plane (front to back). Being able to “tilt” the pelvis is important for optimal core activation and trunk stability. If this exercise is too hard to start with, you can always start by lying down with your knees bent or sitting in a chair.

• Grab a stability ball and sit on it 
• Focus on keeping an upright posture with the shoulders pulled back and spine in neutral to start
• Imagine you have a tail and you want to tuck it between your legs as you bring the top of your glutes closer to the ball (with minimal upper back movement) and tighten your lower abdominals
• Then, reserve directions and tilt your pelvis forward while gently arching the low back 
• Try alternating between these two movements in coordination with your breath
• Repeat 10 times for 2-3 sets 
• This movement can feel awkward to coordinate at first but will get easier with practice

This full body core strengthening move is great when your hip pain is well managed and you want to optimize your overall coordination and strength with this classic move.

• Get on your hands and knees to start
• You can support your upper body weight either through your forearms or hands- simply ensure your elbows are directly below your shoulders
• Tighten your lower abs (belly button toward the spine) as you create a straight line with your spine from your head to your knees
• Decide if you will stabilize your lower body on your knees or toes, whichever you can keep adequate control with
• Hold for 30+ seconds for 2-3 sets total 
• Progress your hold time as tolerated with good form

Exercises to Avoid

While no exercise is explicitly off the table for completing with hip impingement, there are definitely some specific movements to be wary of. In general, they all involve hip flexion, especially when weighted or near end range of motion because of the pressure these moves put on the acetabulum (aka the hip socket and local cartilage). Deep hip flexion can further compromise the affected tissues if done repeatedly. Below are some moves to consider avoiding, at least in the short term if not longer.

• Deep squats; particularly sumo squats
• High impact moves like plyometrics with hip flexion; such as squat jacks or jump squats
• Box jumps
• Leg press
• Lunges
• High knees
• Repetitive kicking
• Prolonged periods of sitting

The Goal of Exercising

Keep the entire lower body strong and coordinated to prevent unnecessary strain to the hip. With the exercises listed above, they all help to promote optimal muscle balance and hip alignment. When utilized correctly, this can help with improving the mechanics of your daily activities like walking, squatting, running, and more. Plus, it can reduce discomfort with more aggravating passive activities like prolonged sitting. Overall, there is a lot to gain with consistent hip exercise.

Tips for Effective Exercises

Now that you know what exercises to focus on with hip impingement, there are a few key factors to keep in mind that can help maximize your efforts. Keep these tips in mind.

• Always use your symptoms as a monitor

  Exercises should not exacerbate hip pain and other symptoms. If symptoms like groin pain occur, it's a sign that you need to modify your exercises. You may be able to progress to it later or simply avoid it until further notice.

• Focus on your body alignment to reduce hip strain

  There are a lot of moving parts in the lower trunk that can feel overwhelming to coordinate at first. This is why many of the starting exercises above initially focus on one or two primary muscle groups at a time. Always focus on keeping a neutral spine and level pelvis as much as possible.

  Learn About Good Posture

• Before completing your strengthening routine, start with some gentle hip and trunk stretches

  Warm Up Stretches

  This can help warm up the muscles, boost hip mobility, and alleviate pain. You can also stretch after your strengthening exercises, or any other time of the day, if you notice any onset of muscle soreness or stiffness.

• Utilize tools to maximize your outcomes

  There are plenty of great options for pain management and treatment at home, such as heating pads, ice packs, massage tools, and more. Plus, use tools like bands, weights, balance pads, and exercise balls to progress your exercises and challenge your muscles.

  Treatment for Hip Impingement Pain

• Seek professional guidance

  If you aren’t sure whether you’re keeping good form or what exercises you should even be doing in the first place, it’s always best to get medical advice. A physical therapist is your best option for getting personalized exercise recommendations in addition to other potential beneficial treatment options. 

Getting Started

With hip pain, getting started with an exercise program is an important first step in recovering and feeling your best. After a proper warm up, start here with these exercises and combine with conservative treatments for even more effectiveness. You’ll find that you are able to better manage and prevent symptoms including the onset of issues like osteoarthritis. If your symptoms aren’t improving, keep in mind it’s always best to get in touch with your physical therapist or orthopedic doctor for further medical advice and recommendations such as arthroscopic hip surgery.

Resources:

https://www.verywellhealth.com/physical-therapy-exercises-for-fai-and-hip-impingement-4135968

https://www.beaconortho.com/blog/exercising-fai/

http://www.geelongperformancephysio.com/top-4-exercises-help-hip-impingement/

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