Exercises for Hip Impingement. What TO do and what NOT to do.

Hip Impingement. A frustrating diagnosis that can leave you more confused than before. Doctors tell you that surgery is the only true “cure” to fix this bony pathology. But try physical therapy first you’re told...

So you try physical therapy. Correction: you try physical therapists. Doesn’t work. You go to a chiropractor. Doesn’t work. Yoga. Nope. Pilates. Nothing. So what’s the deal? Is exercise useless for hip impingement? And is surgery the only treatment?

The truth is that exercise is not the magic fix either. That doesn't mean it can’t be an incredibly powerful tool in your path to pain-free hips. It’s part of the puzzle, but it’s not the antidote.

Desperately clinging to exercise as some panacea for all your body’s pain problems will just keep you on the perpetual pain-relief hamster wheel.

This was me many years ago when I first received my FAI, hip impingement diagnosis. At first it was injections and doctors appointments and then it was foam rolling and “activation” drills.

I didn’t feel better until I understood how my psychology, behavior and mindset affected my chronic hip pain. Until I fully digested this, all of the exercises I did were useless.

In this article, I’ll help break this down for you so you put your attention on the physical and psychological strategies that will actually help you move and feel better.

My Hip Impingement Story 

In 2014, I wanted an answer to my chronic hip pain. I went to a highly-respected Manhattan orthopedic surgeon and got the infamous X-Ray and MRI. I was told I had femoral acetabular impingement (“FAI”) aka hip impingement.

I got all the tests. The cortisone shot in the hip socket. The FADIR test. I was apparently a good candidate for surgery. So I scheduled the surgery a few weeks out. I was sick of this pain and ready to move on with my life.

But leading up to surgery, something didn’t sit right with me. I did some research online and quickly realized I was rushing into surgery. Did I really do everything I can to avoid surgery? Am I just looking for a “quick fix” to a more complicated problem?

I was only 25 years old. Were my hips really so damaged I needed them shaved? There were too many doubts so I decided to cancel the surgery. The bone-on-bone explanation did not make sense to me. I needed to take a step back and truly understand why I was in pain.

This was one of the best decisions of my life. Not only am I no longer in hip pain but I’ve learned more about my body than I ever imagined. I’ve been where you are. I understand what you’re feeling. And there is a better future for your hips. But the path may not be what you expected. 

What is hip impingement?

Most people reading this know the medical definition of hip impingement aka FAI. I won’t spend too much time on this but for the sake of due diligence, here is a definition from the reputable Cleveland Clinic:

Source: Cleveland Clinic's review of FAI.

Scary stuff. But also misleading. The key word in this definition is CAN. It shows up three times but is crucial to emphasize.

FAI can limit motion and cause pain but it also might NOT. FAI can damage the cartilage but it might NOT. And cartilage damage can lead to arthritis but it also MIGHT NOT.

Many people are walking around with hip impingement without any pain. Numerous studies demonstrate that there is no connection between hip pain and hip impingement. Here are a couple of my favorite:

• 72% of 110 asymptomatic hips had signs of FAI. Thier et al.
• Metareview analyzing 2,114 hips found FAI in 67% of asymptomatic hips. Frank et al.
• Out of 244 young men with no history of hip pain, 67 or approximately 25% of them had signs of hip impingement. Reichenbach et al.

So what is hip impingement? A common anatomical feature of the human hip bone that may or may not be associated with hip pain. Let me ask you this: if you were not in pain, would you care that you have hip impingement? 

Reframe Hip Impingement as Hip Pain 

Hip impingement is not the problem, your hip pain is. The first step to resolve your problem is to understand what it is. 

Chronic pain, whether in the hip, back, shoulder or wherever else, comes from the brain. If you want to live a life of resilience and move without restriction, you need to understand how the pain-brain works. 

In western society, we are indoctrinated from a young age to separate the physical from the psychological. Physical pain comes from physical problems. Psychological pain comes from psychological problems. 

This is true in some instances, of course, but not all. For chronic conditions, the barrier between mind and body is not so clear. This is understood much more fully in eastern traditions. There is a recognition and respect for the mind-body connection.

How you think affects how you feel. How you move impacts your mood. Our bodies and brains are dynamic and influence each other in ways we are only starting to understand through modern science. 

It took me years to fully give into the power of the brain. But once I did, I finally started to reap all the amazing benefits exercise had to offer.

Not just for my hips, but for my whole body. For some people, it takes years or decades to embrace the brain's role in their pain patterns.

For others, it probably never happens and the endless search for pain-relief through physical treatments lasts their entire lives. 

I used to think I was some type of healer in the work I do, but this is far from the influence I want to have. Instead, I simply want to help people move their bodies with more ease and joy. But the only way I can do this is if they first honor the power of their brains. 

How to Exercise for Hip Impingement 

The key principle to understand is that exercise will not fix your hip impingement. Nor does it have to in order for you to feel better. 

Exercise is a way for you to connect your body to your mind. It is a tool to quiet down all the noise of a busy adult life and listen to what is happening inside.  

What type of movement does your body crave? Where are you weak and tight? Where are your limitations? 

Every body will need something different through exercise. This is not because you have cam impingement and another person has pincer. It is because you are not like anyone else. 

You move in particular way because of who you are. All of your life's experiences, injuries, unfelt emotions and thousands of other factors influence how your body moves through the world. 

This can sound confusing and overwhelming but I promise you it doesn't have to be.  What made the biggest difference for me is not by doing more but by doing less. 

The goal is not to fix or optimize. It is to listen. Once you can pay attention to what your body is telling you, the path forward becomes much more clear.  

Are there any exercises to avoid if you have hip impingement? 

A common question I get is whether there are exercises or activities to avoid if you have hip impingement. I get this question often and it’s a commonly searched question on search engines so this is clearly a topic of interest. 

The major theme of this article is that a hip impingement diagnosis should not dictate your decision-making. You can have hip impingement and have no pain.

Conversely, you can have hip pain but no hip impingement. So the way I would restructure this question is whether there are any activities or exercises to avoid if you have hip pain.

In other words, the question would be something like the following: “Should I avoid running if I have hip pain?” instead of “Should I avoid running if I have hip impingement?” This shift alone makes it easier for people to answer the question.

Another helpful strategy is to perform the exercise but do so mindfully. If the pain gets above a 6 or 7 during the activity or exercise, then slow it down and see if you can reduce the intensity.

The reason for this encouragement is because avoidance is a slippery slope. I see many people in a pattern of avoidance and fear which can make the pain even worse.

This reinforces a feeling that you are broken or damaged because of hip impingement. And nothing can be further from the truth. 

Conclusion 

My advice for those starting their movement journey is to focus on the things you can control. You cannot “fix" hip impingement. And you don’t need to.

Focus on the actual problem - your hip pain. And the first step in addressing any chronic pain problem is by understanding the brain's role. 

This is not only the way to build a foundation for resilience in the body but it is also a way to get the most out of exercise. Otherwise, you'll just keep changing which exercises you do anytime you get a flare up.