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What is Ischiofemoral Impingement?: How It Presents and What Treatment Usually Involves - Camberwell


By Emma Glynn - The Hip & Knee Physio


Struggling with deep buttock pain or a pinch when you move your leg backwards? It could be ischiofemoral impingement - a rare but increasingly recognised cause of hip and gluteal pain.







Quick Summary: What is Ischiofemoral Impingement?

Ischiofemoral impingement (IFI) refers to compression or irritation of the quadratus femoris muscle between the ischial tuberosity (sitting bone) and the lesser trochanter of the femur (inner part of the thigh bone). In plain English? It’s a soft tissue “pinch” in the deep buttock area, often aggravated by hip extension or external rotation.

Although rare, it’s gaining attention as a source of pain in active adults, particularly women, due to increased MRI usage and greater clinical awareness.


Who Typically Gets It?

Ischiofemoral impingement is more commonly seen in:

  • Women over 40

  • Athletes involved in dance, pilates, running, or yoga

  • People with previous hip surgery or hip trauma

  • Those with altered pelvic/hip anatomy (e.g., excessive femoral anteversion)

It may also occur post-total hip replacement due to altered bony spacing (Kassarjian et al., 2011; Torriani et al., 2009).


Common Symptoms of IFI

The typical presentation of IFI includes:

  • Deep buttock pain, often hard to localise

  • Pain with long-stride walking, lunges, or hip extension

  • Aggravation with external rotation or adduction

  • Tenderness over the ischial tuberosity or deep gluteal area

  • In some cases, referred pain to the groin or hamstring origin

Pain is usually mechanical meaning it increases with certain movements and may be unilateral or bilateral (Johnson, 2017).


Diagnosing Ischiofemoral Impingement

IFI is primarily a clinical diagnosis, supported by imaging. The key features on assessment include:

  • Reproduction of pain with long-stride walking or prone hip extension

  • Positive IFI test: pain reproduced with hip extension, adduction, and external rotation

MRI findings may show narrowing of the ischiofemoral space (<15 mm) or quadratus femoris space (<10 mm), as well as muscle edema or atrophy (Kassarjian et al., 2011).

However, imaging must be correlated with symptoms, many asymptomatic individuals show similar MRI findings (Mayes et al., 2013).


Differential Diagnosis: What Else Could It Be?

Because of its vague presentation, IFI is often misdiagnosed. Other causes of similar symptoms include:

  • Proximal hamstring tendinopathy

  • Deep gluteal syndrome or piriformis syndrome

  • Lumbar radiculopathy (especially L4–S1)

  • Sacroiliac joint dysfunction

  • Ischial bursitis

A thorough clinical exam is crucial to differentiate these conditions (Gollwitzer et al., 2017).


Management: What Usually Helps?

Most cases of ischiofemoral impingement improve with conservative (non-surgical) management. Key components of rehab include:

1. Activity Modification

  • Avoid provocative positions (e.g., long-stride walking, deep lunges)

  • Modify sitting postures if prolonged hip flexion causes symptoms

2. Targeted Strengthening

  • Focus on hip abductors, external rotators, and deep stabilisers

  • Reduce excessive anterior pelvic tilt and hip adduction moments

  • Gluteal strengthening is essential, particularly glute max and medius (Selkowitz et al., 2013)

3. Movement Re-Education

  • Teach efficient gait and stair mechanics

  • Reduce overstriding and improve pelvic control

4. Manual Therapy and Dry Needling

  • May help settle surrounding tissue irritability (although effects are short term)

5. Imaging-Guided Injections

In some cases, an image-guided corticosteroid injection into the ischiofemoral space may reduce inflammation and confirm the diagnosis (Johnson, 2017).


When is Surgery Considered?

Surgical decompression (e.g., resection of the lesser trochanter) is rare and only considered for cases that fail conservative treatment after 6–12 months. Risks and benefits should be thoroughly discussed with a hip specialist (Safran & Ryu, 2014).


What to Expect from Physio Rehab

With a structured program, most people experience significant improvements in pain and function. Rehab is often progressive over 6–12 weeks, but timelines vary. Your physiotherapist may use outcome measures like the Hip Outcome Score (HOS) or Lower Extremity Functional Scale (LEFS) to track progress.


Take Action: When Should You Seek Help?

If your buttock pain:

  • Lingers for more than 6 weeks

  • Worsens with walking or lunges

  • Doesn’t respond to general hip stretches

  • Interferes with running or training

…it’s worth getting assessed by a physiotherapist experienced in hip biomechanics and differential diagnosis.

📍If you're based in Camberwell or surrounding suburbs, book a consult today with The Hip & Knee Physio for tailored hip care.



Frequently Asked Questions

  1. Can ischiofemoral impingement go away on its own?

    Mild cases may improve with load management, but structured rehab is usually needed for sustained relief.

  2. Is stretching helpful for IFI?

    Overstretching the hip flexors or adductors can actually worsen symptoms. Strength + control is more effective.

  3. Is IFI the same as piriformis syndrome?

    No, but they can present similarly. Piriformis syndrome typically involves sciatic nerve irritation, while IFI involves muscle compression between bony structures.


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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.

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References

Gollwitzer, H., Banke, I. J., Schauwecker, J., Schöttle, P. B., & Jansson, V. (2017). Ischiofemoral impingement: Clinical and radiographic midterm results after surgical decompression of the lesser trochanter. Journal of Hip Preservation Surgery, 4(3), 231–237. https://doi.org/10.1093/jhps/hnx010


Johnson, K. A. (2017). Ischiofemoral impingement syndrome: Insights and treatment strategies. Orthopaedic Journal of Sports Medicine, 5(8), 2325967117724582. https://doi.org/10.1177/2325967117724582


Kassarjian, A., Tomas, X., Cerezal, L., Llopis, E., & Canga, A. (2011). MRI of the quadratus femoris muscle: Normal anatomy, pathologic conditions, and postsurgical findings. AJR.

American Journal of Roentgenology, 197(1), 170–174. https://doi.org/10.2214/AJR.10.5912


Mayes, S., Ferris, L., Smith, P., Cook, J., & Buckeridge, D. (2013). The prevalence of ischiofemoral impingement in the asymptomatic population: A magnetic resonance imaging study. Hip International, 23(5), 451–456. https://doi.org/10.5301/hipint.5000100


Safran, M. R., & Ryu, J. H. (2014). Ischiofemoral impingement: A rare cause of hip pain. Sports Health, 6(6), 471–476. https://doi.org/10.1177/1941738114525253


Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Journal of Orthopaedic & Sports Physical Therapy, 43(2), 54–64. https://doi.org/10.2519/jospt.2013.4116

 
 
 
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