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Hip Impingement (FAI): Why the Front-of-Hip “Pinch” Happens, What Usually Aggravates It, and What Rehab Focuses On

By Emma Glynn - The Hip & Knee Physio - Camberwell



a woman with hip impingement in camberwell doing pilates

Quick Summary

Hip impingement, or femoroacetabular impingement (FAI), refers to a common movement-related condition where abnormal contact between the ball and socket of the hip joint causes pinching or irritation in the front of the hip. It is not simply a bony deformity or a guaranteed path to arthritis, and it can often be managed conservatively with targeted rehab.


This article offers general education only and does not replace a personalised assessment or diagnosis. If you're experiencing hip or groin pain, seek advice from an experienced physiotherapist or doctor.




Common Symptom Pattern

  • Front-of-hip/groin pain, clicking/catching: Especially during or after squatting, lunging, or sitting for long periods.

  • Worse with sitting, deep squats, lunges, car rides: These positions place the hip in flexion, which can provoke impingement symptoms.

  • Hip pain + back/knee pain can co-exist: This is common, particularly if compensation strategies are involved. Don’t assume one joint is the full story.


What Causes the Pinch Feeling

  • Bony shape + joint irritability: Some people have slightly different hip joint shapes (cam or pincer morphology). However, many with this shape have no pain – symptoms arise when there's joint irritability or load intolerance (Griffin et al., 2016).

  • Muscle/tendon overload can mimic it: Sometimes, anterior hip pain is due to hip flexor or adductor overload, not bony impingement itself (Reiman et al., 2013).


Hip Impingement vs Other Common Lookalikes

  • Hip osteoarthritis: OA tends to involve stiffness, especially in the morning, and reduced motion over time.

  • Hip flexor/adductor strain: These present as more localised muscular pain, often with a clearer injury event.

  • Gluteal tendinopathy: More commonly causes pain on the outer hip and with lying on the side.

  • Sciatica/referral: Radiating symptoms down the leg or into the buttock may suggest a spinal or nerve component.


Do I Need a Scan? (When Imaging Is Useful)

  • When X-ray or MRI may be considered: Imaging may help rule in/out structural contributors like labral tears or assess bone morphology.

  • Often doesn’t change early management: Regardless of scan results, initial rehab principles remain similar (Griffin et al., 2016).

  • Red flags that require urgent review: Sudden loss of motion, trauma, systemic symptoms, or night pain.


What Physio Rehab Typically Focuses On

  • Settle irritability: This often involves short-term modification of aggravating movements, not full rest.

  • Strength & control: Focus on glutes, rotators, hamstrings, and trunk to support the hip in movement (Casartelli et al., 2021).

  • Mobility: Mobility work is directed and strategic – not all stretches are helpful.

  • Return to sport/gym: Guided by functional criteria, not fixed timelines.


What You Can Do This Week

  • Reduce deep squats or sitting with hips flexed past 90 degrees.

  • Trial elevated squats or supported split squats.

  • Monitor irritability after activity (24-hour rule).

  • Start gentle glute activation (e.g. side bridge, band walks).


When to Book an Assessment

  • If symptoms persist >4 weeks or impact function.

  • If you’re unsure whether it’s impingement or another condition.

  • If you’re planning return to sport and want guidance.




FAQs

  1. What are hip impingement symptoms?

    Groin/front hip pain with sitting, squatting, or lunging.

  2. Can hip impingement cause back pain or knee pain?

    Yes, related compensations can affect other joints.

  3. Can it get better?

    Many people improve with rehab that targets strength and load tolerance.

  4. Can it be seen on X-ray?

    Bone morphology can be seen, but not all findings are painful.

  5. Is surgery always needed?

    Not at all. Most cases begin with conservative rehab.


Next steps in Camberwell

If your hip is still problematic and symptoms have lasted beyond the expected timeframe, or if pain keeps returning with normal activity, an individual assessment can clarify what’s driving it and how to adjust your rehab plan.


You can:




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Disclaimer

The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan.

Always seek the advice of a qualified healthcare provider before starting any exercise program, particularly if you are experiencing pain, injury, or a pre-existing medical condition.

Use of this website does not create a physiotherapist–patient relationship. The Hip and Knee Physio accepts no responsibility for any injury or loss arising from reliance on or use of this information.

By using this website, you agree to these terms.


References

  • Griffin, D. R., Dickenson, E. J., O'Donnell, J., et al. (2016). The Warwick Agreement on FAI syndrome: an international consensus statement. British Journal of Sports Medicine, 50(19), 1169-1176.

  • Reiman, M. P., Thorborg, K., & Hölmich, P. (2013). Clinical examination of femoroacetabular impingement: a systematic review of the literature. British Journal of Sports Medicine, 47(6), 349-355.

  • Casartelli, N. C., Leunig, M., & Maffiuletti, N. A. (2021). Rehabilitation and return to sport after hip arthroscopy. Journal of Hip Preservation Surgery, 8(3), 212-221.


 
 
 

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