ULTIMATE GUIDE TO HIP IMPINGEMENT: PART 2

In part 1 of this blog post I explained all about what hip impingement (FAI) is and options for treatment. Be sure to read Part 1 first, so this post will make sense! Now it's on to part 2 and I'm sharing the fun stuff-- how to correct it and a few of my favorite exercises.


LEARNING HOW TO MOVE

In order to understand how to properly do these exercises, we first need to take a look at how a healthy hip should move. Keep in mind, that there is no "one size fits all," but this will provide you with a general idea of what needs to happen mechanically at the joint during movement to avoid impingement symptoms.


In part 1, I explained how the head of the femur must stay centered in the socket. If there are muscle imbalances between mobility and/or stability, it will cause the femur to not stay centered during movement and press too far forward, causing symptoms of impingement.


To recap, there are a few common movement patterns that can result in this excessive forward pressure. Here's 2 possibilities:

  1. Imbalance between the Iliopsoas (hip flexor) and the tensor fascia latea (TFL)

  2. Excessive posterior pelvic tilt (butt tucking under)

Our goal with exercise is to help restore these imbalances in order to keep the joint centered throughout our functional movements.



MOBILITY

Before working on strength, you need to make sure you have sufficient hip mobility. Otherwise, it's near impossible to maintain proper movement patterns during the exercises, which can end up leading to compensations. Typically with FAI, the greatest mobility limitations are with hip flexion and internal rotation. Here's a few of my favorite mobility drills to address it:


90/90 Hip Rotations

This exercise helps you work on internal rotation (the back leg) AND external rotation (the front leg) at the same time. While going through the movement, you really want to strive to keep your trunk as upright as possible, and drive that back hip down into the ground to get a better stretch.


Quadruped Rockbacks

Pinching at the bottom of a squat? This exercise will help you restore deep hip flexion in a functional, weight bearing position. The key to getting this one right is maintaining a neutral spine/pelvic position while you hinge from the hips. No butt tucking allowed, otherwise, you will likely start to feel the pinching again.


Hip Flexion stretch with banded mobilization

For this one, you'll need a yoga strap or super band. Anchor it to something sturdy and place right at the crease of the hip. Now, when you stretch your knee towards your chest, you will be getting a slight inferior glide at the joint. Which hopefully equals more range of motion and less pinching.


STRENGTH

Most people focus far too much on stretching and not enough on strengthening. Even if you feel tight, strengthening will often help more than stretching will. Add these strength exercises in and they will be a game changer for your pain & pinching hips.


Marching Progressions

It' time to learn how to keep the head of the femur centered in the socket while flexing the hip. This means you have to use the hip flexor, and not compensate with the TFL. It can be tricky to learn, so sometimes using a yoga strap or towel to assist you can really help. Just be sure you really focus on alignment and imagine the head of the femur driving towards the floor while you flex the hip. Here's how to do it:


Once you master that, you can slowly practice taking the band assistance away. Then, it's time to start challenging yourself. Here are a few ideas for progressions to help strengthen the hip flexor, while learning to maintain proper alignment and control:


Hip Hinges

This is one of the most foundational exercise you can learn, and it helps with SO many things. The hip hinge is the beginning to both your squat and deadlift, so learning to do it right will not only reduce symptoms of impingement, but it will improve your lifts!



WANT TO LEARN EVEN MORE??

Check out my FREE online workshop: Hip impingement 101


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       Owner- Jenna Siracuse Loewer, DPT   
       jenna@onpointewellness.com 
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