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Hip and Groin Pain

Hip Impingement

Hip Impingement

Hip and groin pain can be multifactorial in nature. Femoroacetabular impingement is a painful condition in the groin due to underlying morphological abnormalities of the hip joint. However, underlying abnormalities may be present on radiological examination (CAM and Pincer) but without pain and it is common in the majority of population. A non-symptomatic femoroacetabular impingement is more likely to become symptomatic with athletes or due to changes in activities or training that involve high hip flexion. Skiing causes the skier to be in a position of hip flexion for prolonged time and with high loading. This type of training may also predispose a person to changes in the bone morphology. The grading of the pathology depends upon your clinical presentation and not on radiological imaging.

Symptoms include intermittent catching pain in the groin region with specific positions of the hip, such as flexion when the knee approximates the chest or rotation, as so in skiing. This condition rarely affects sleeping and it is normally pain-free soon after cessation of aggravating activity or position. If the pathology has been present for a while, inflammation will result in more generalised pain that can become a constant ache and can affect other structures. It can also lead to morning stiffness or stiffness after a period of rest which will ease off with a few minutes of walking. Pain medication and especially anti-inflammatories can temporarily relieve the symptoms but it is important to understand that it will not cure the underlying condition. Signs of bruising or inflammation are rarely seen with a naked eye but examination will reproduce the symptoms. If there is a need for confirmation, further imaging may accompany the clinical examination.  

Management:

The management of the above includes a combination of activity modification to protect the affected area from further irritation. Evaluation of skiing technique will allow the clinician to advise you on changes that can be made according to your pain. This will be followed by exercise rehabilitation beginning with simple exercises which are the basis for then progressing and loading the joint to allow for necessary adaptations in posture and structures in order for you to return to skiing. In addition, in the initial stages, ice or pain medication may be advised to allow for progression with exercise rehabilitation. Manual techniques may be used to decrease your pain and improve function. Other treatment modalities may be considered depending on your symptoms and rehabilitation is tailored towards each individual.

In severe cases where the labrum is affected, surgery may be considered. Following your operation, the rehabilitation will begin with a combination of ice and pain medication as well as using crutches in the initial days. This will be combined with simple lying down or standing exercises to re-activate muscles that are now malfunctioning due to the operation. As you progress, the pain from the operation will decrease and you will be able to tolerate walking and more exercises. Static cycling without resistance starts after you are able to normally walk unsupported. Then progressive exercise rehabilitation and manual techniques may be used as in the non-operative approach.

Strand House, 169 Richmond Rd, Kingston upon Thames KT2 5DA 020 8546 6464