Pinching hips

Pinching hips

Tommy Conway, Director and Lead Physiotherapist at OneHEALTH

Do you have a pinching sensation at the front of your hip? Does it start when you're driving or getting out of the chair? Is it starting to feel tight when you're going for a walk?These are all symptoms of a hip impingement. This condition starts off with a light pinch at the front of the hip to eventually becoming painful to put on socks, walk up stairs or sit up in bed. The light pinch will start to radiate pain down the front/back of the thigh and can often be confused with sciatica. The hip impingement is caused by a lack of movement and space in the hip joint and this light pinch is a warning shot that there is less space for the major nerves of the legs to move, the frontal nerve and the sciatic nerve. Also over time this lack of space will cause changes to the joint and this is where arthritis will set in unless treated. Some of my clients present with both pain travelling down the front of the leg and back of the leg. I have seen so many cases of people getting injections, MRI scans of the spine when really it is a hip impingement all along. If it started with a light pinch in the hips, that's a clear give away. Let’s now jump into the details about a hip impingement.

What is a hip impingement?

Hip impingement occurs when the ball and socket of the hip joint don't have enough space to move freely. The restricted motion will damage cartilage and can cause pain and arthritis. The Femur (Leg bone) and Hip (Acetabulum) have to maintain full range of motion in the joint or the body will make changes to the joint. These changes are represented in three different types of hip impingement

1: Cam impingement: Excessive bone growth at the femoral head

• The femoral head forms a bump that no longer fits easily into the acetabulum
• Results in a lack of range of motion

2: Pincer impingement: Excessive bone growth of the acetabulum

• The acetabulum forms an overhang which will not allow the femoral head to move freely in the joint
• Results in a lack of range of motion

3: Combined: Both cam and pincer impingements are present

• Two impingements combined: Worst case scenario and will represent as an extreme restriction in range of motion.

How does the hip get pinched?

The hip gets pinched in two distinct directions. Your body is orientated forward, and you are stuck in a twist. Now let me explain what that looks like.

1: Forward orientation: When we look at the human body and movement we are propelled forward, not backwards. Combine this forward momentum with gravity and we can see changes to human posture and movement. How many people do you see walking with their head down? looking like they are about to fall forward?This is best represented when we get older, walking with the hands clasped together at the back is an effort to fight against gravity and stay upright (Pic 2). This is someone who is orientated forward and this means there's less space for the femur to move in the joint. This lack of space will result in you getting a pinch when you have to perform hip flexion, sitting or climbing a stairs, putting on your socks. This pinch overtime will result in either a pincer, cam deformity of the bone or both.

2: Stuck in a twist: If you are spending more time on one leg than the other you are twisting your pelvis to that side. Stand up, get into your most comfortable standing position. Which leg is holding the most weight? Now look down and see which way the zipper of your jeans is pointing. If you put most of your weight on your right leg and your zipper is pointing towards the right big toe, your hip is rotated to the right. You are twisted to the right, this is ok as long as you spend an equal amount of time twisted to the left, Do you? This twisting motion will restrict the available space in the joint. This lack of space will result in you getting a pinch when you have to perform hip flexion, sitting or climbing a stairs, putting on your socks. This pinch overtime will result in either a pincer, cam deformity of the bone or both.

How do I get rid of the pinch?

With all injuries and diseases, it is about timing. If you can identify today that you have a pinching sensation at the front of your hip? Pinches when driving or getting out of the chair? Starts to feel tight when you're going for a walk? I would get it seen too asap. How do you get rid of it? by restoring the movement in the hip. You have 100 degrees available movement at the hip joint and it’s important to identify how much movement you have lost. How you restore the movement is by fighting against the anterior orientation, This is a constant fight because gravity isn’t going anywhere. Secondly you need to train yourself to untwist the hip. Remember this pinch is again a warning shot. Catch this at the right time and it will stop you getting the bony damage that is irreversible. I hope this helps.