Hip pain can be confusing, frustrating, and often slow to settle — particularly when it affects everyday activities like walking, sitting, training, or sport. One commonly discussed cause of hip pain is hip impingement, also known as femoroacetabular impingement (FAI).
This article provides a clear overview of hip impingement: what it is, how it presents, what assessment involves, how physiotherapy helps, and when further investigation or referral may be needed.
Why Hip Impingement Matters
Hip impingement is frequently seen in active individuals, but it can affect anyone – from teenagers and young adults through to older populations. It is common in runners, gym-goers, footballers, dancers, and cyclists, but also in people who spend long periods sitting or performing repetitive movements.
If left unaddressed, ongoing hip pain can lead to reduced activity levels, compensatory movement patterns, and – in some cases – progression toward joint degeneration. Early recognition and appropriate management can significantly improve symptoms and long-term outcomes.
What Is Hip Impingement?
Hip impingement describes a situation where abnormal contact occurs between the femoral head (ball) and the acetabulum (socket) during hip movement. This repeated contact can irritate surrounding structures such as the labrum, cartilage, and joint capsule, leading to pain and stiffness.
There are commonly described patterns (e.g. cam-type, pincer-type), but in clinical practice these labels are less important than how the hip is functioning, how symptoms behave, and how load is tolerated. Importantly, structural features associated with impingement are also found in people without pain, meaning that imaging findings alone do not equal a diagnosis (Griffin et al., 2016).
Common Symptoms of Hip Impingement
People with hip impingement may report:
- Deep hip or groin pain
- Pain with sitting, squatting, running, or pivoting
- Reduced hip range of motion (especially flexion and rotation)
- Catching, pinching, or stiffness in the hip
- Symptoms that worsen with prolonged activity or loading
Pain may develop gradually rather than following a single injury, which is why it’s often ignored or misattributed early on.
How Physiotherapists Assess Hip Impingement
A physiotherapy assessment aims to understand why the hip is painful and how it is being loaded, rather than focusing purely on structural findings.
Assessment typically includes:
1. Subjective History
This explores symptom behaviour, activity levels, training load, work demands, previous injuries, and goals. Understanding what aggravates and relieves symptoms is key.
2. Movement & Functional Assessment
Hip range of motion, control, strength, and movement patterns are assessed — often alongside adjacent areas such as the lumbar spine, pelvis, and lower limb.
3. Strength & Load Tolerance Testing
Weakness or poor control in the hip abductors, extensors, and trunk is common and can increase joint stress. We can use Hand Held dynamometers and VALD Forcedecks to detect asymmetries and monitor your progress as well.
4. Sport- or Activity-Specific Testing
Where relevant, this may include running, gym-based movements, or functional tasks that reproduce symptoms.
Imaging (such as X-ray or MRI) is not always required initially, particularly when symptoms are manageable and respond to conservative care.
How Physiotherapy Helps Hip Impingement
Physiotherapy is considered first-line management for hip impingement and related hip pain (Griffin et al., 2016).
Treatment typically focuses on:
Improving Strength and Control
Targeted strengthening of the hip, pelvis, and trunk improves load distribution and reduces joint irritation.
Optimising Movement Patterns
Subtle changes in how you squat, run, cycle, or lift can significantly reduce hip stress.
Load Management
Gradual progression of activity allows the hip to adapt without repeated flare-ups.
Manual Therapy (Where Appropriate)
Used to support movement, reduce stiffness, and improve confidence with motion — not as a standalone treatment.
Education and Self-Management
Understanding pain, pacing, and progression is central to long-term success.
Many people experience meaningful improvements without surgery, even when imaging shows structural features associated with impingement (Kemp et al., 2020).
What Does Recovery Usually Look Like?
Recovery timelines vary depending on symptom duration, activity demands, and individual response to load. Most rehabilitation programmes span 8-12 weeks, with ongoing progression beyond this for higher-level sport.
The goal is not just pain reduction, but restoring confidence, capacity, and performance – whether that’s returning to running, gym training, or simply daily life without restriction.
Red Flags and When Referral Is Needed
While most cases of hip impingement respond well to physiotherapy, onward referral may be required if:
- Pain is severe, worsening, or constant at rest
- There is night pain or unexplained weight loss
- There is a history of trauma or suspected fracture
- Neurological symptoms are present
- Symptoms fail to improve despite appropriate conservative care
In these cases, imaging or specialist review may be appropriate to rule out alternative pathology.
Who Is This Relevant For?
Hip impingement affects a wide range of people, including:
- Runners and endurance athletes
- Gym-goers and strength athletes
- Football, court, and pivoting sport athletes
- Active adults and “weekend warriors”
- Teenagers and young adults with persistent hip pain
Regardless of age or activity level, the principles of assessment and management remain consistent.
Key Takeaway
Hip impingement is common, manageable, and often responds well to structured physiotherapy. A clear diagnosis, individualised loading strategy, and movement-based rehabilitation can help restore function and reduce long-term joint stress.
Early assessment and appropriate management give the best chance of a strong, confident return to activity.
If you’re ready for evidence-based, structured, and personalised care, our physiotherapy team can help you understand your hip pain and guide you back to confident movement. Book an appointment or get in touch — your hip deserves the right plan, not guesswork.
Written By Stuart Williams | Physiotherapist | Vestibular Specialist | Running Analysis
References
Griffin, D.R., Dickenson, E.J., O’Donnell, J., Agricola, R., Awan, T., Beck, M., Clohisy, J.C., Dijkstra, H.P., Falvey, É., Gimpel, M., Hinman, R.S., Hölmich, P., Kassarjian, A., Martin, H.D., Martin, R., Mather, R.C., Philippon, M.J., Reiman, M.P., Takla, A., Thorborg, K., Walker, S. & Weir, A. (2016) ‘The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement’, British Journal of Sports Medicine, 50(19), pp. 1169–1176. doi:10.1136/bjsports-2016-096743.
Kemp, J.L., Mosler, A.B., Hart, H.F., Semciw, A.I., Barton, C.J., Schache, A.G., Crossley, K.M. (2020) ‘Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions’, British Journal of Sports Medicine, 54(23), pp. 1382–1394. doi:10.1136/bjsports-2019-101690.
Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H. & Siebenrock, K.A. (2003) ‘Femoroacetabular impingement: a cause for osteoarthritis of the hip’, Clinical Orthopaedics and Related Research, 417, pp. 112–120. doi:10.1097/01.blo.0000096804.78689.c2.
Lewis, C.L., Khuu, A. & Marinko, L. (2015) ‘Postural and biomechanical factors associated with hip pain in athletes’, Sports Health, 7(5), pp. 435–441. doi:10.1177/1941738115592013.