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Andcol

Hip impingement/femoroacetabular impingement questions

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Hello,

I first experienced some pain in my right hip last year, thought it was something temporary and went on with exercising. Capoeira, skateboarding, GST training and some running. Sometimes after exercise I could feel a sharp pain in the right groin area of my hip, the pain was often there for just a couple of hours after working out and then went away.

After some time I decided to visit a Physiotherapist and took an MRI on both of my hips. The difference was clearly between my left and right hip. The physio suspected hip impingement on my right side. He gave me a couple of exercises in order to build up strength in the glutes and around the hips and told me that surgery was the last option. After some months with these rehab exercises I could barely feel any difference at all, the groin pain was still there, especially when rotating the hip inward. It's really frustrating because of the limits in range of motion I have on my right hip. Sometimes I can hear a snapping sound coming from the femur and it doesn't sound god. I'm in the thoughts of having surgery because I feel there is not much that I can do to make it better myself. Tried foam rolling, stretching and different mobility exercises for the hips. When i'm for example stretching for middle splits, specially the frog stretch, I can feel a sharp pain in the right groin area.

So now to my questions: Can impingement in the hips be treated with stretching over a long period of time?

Anyone else here on the forum dealing with the same or similar problem?

Have anyone done surgery? If so, how long was the recovery time and how did you feel afterwards?

Thank you.

Best regards

Andreas

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Andcol wrote:

Can impingement in the hips be treated with stretching over a long period of time?

Not if the impingement is bony—but some is not (it can be the labrum, or a combination of labrum and muscular causes, like extremely tight hip flexors, possibly). It it were me, I'd back off on all movements that cause the sharp pain, and pursue all stretches that loosen the hips generally, and see what happens. Bone spurs in some cases can be resorbed, but if the hips joints themselves are different L-R, then less likely. But bone can adapt over time—the question is only, 'how much time'. If you can move and stretch without further hurting this joint, that would be my preferred option over surgery.

In my body's case, I have a bony leg length difference of about 20mm—and this caused me a huge amount of pain as an athlete (middle distance running). But now that I am much more flexible (and ROM is not the key here; it's much-reduced whole body tension) I have no problems at all. Moving from a high-tension state to low took 20 years, though.

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Hey, Andi - This topic is near and dear to my heart! This is something I struggled with as well. As kit said, if it truly is a bony issue you can't do much...but there is a lot you can do if may be muscular / flexibility / motor control related.

This is my story about dealing with the issue:

Check out www.TheFAIFix.com

Let me know if you have any questions (email is best...dowd1sm@gmail.com)

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i was diagnosed with FAI (cam type) about eighteen months ago - have opted to try and manage it rather than surgery (the osteo that diagnosed it didn't recommend surgery if I could avoid it, my physio is in agreement with that as is my reformer pilates instructor who also has FAI and is doing the same himself) so far seems to be going okay but have had to accept not being able to do a couple of things I would like to, however there are still plenty of things I can do.

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Sorry to hear Mintathea. I´m also a bit skeptical to surgery and really want to try out other things before to see if I can improve. I practice a lot of capoeira (brazilian martial art/dance) and really need flexibility in the hips, especially for kicks. Hope you get better.

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I cannot say this strongly enough: massive adaptation is possible, providing you do not injure yourself along the way. All the relevant hip muscles can be worked on up to the limit of the impingement—and that will result in anyone with this limitation being a lot more flexible than they are at present. Perfect hamstring flexibility allows so much more movement than you have at the moment, for example. Full HF ROM then allows perfect front splits which leads to perfect backbends, and so on.

And I know that some kinds of impingement can change over time, and only time can tell is this kind is one of those. And you have lost nothing in the process, and gained much. If I had this problem, I know I'd be persevering for years before surgery became an option, if, indeed, it ever did. Take your time, and pay very close attention to all the sensations, and see what happens. This thing you live in is way more plastic than your present experience of it indicates.

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I had a similar problem as well, it first showed up as an injury from capoeira, maybe a tear at the origin of rectus femoris, but it kept getting re-torn every week or two and didn't get better. Turned into chronic anterior hip pain that lasted close to a decade. The basic thing that fixed it was strengthening my glutes and making them work, and really waking up all of the many muscles around the hips.

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I whole-heartedly agree with Kit. Massive adaptation of this very malleable, very plastic matter we call "body" is totally possible. It's just very gradual. :-)

 

I have a whole playlist of videos for free on my YouTube channel about this subject if anyone is dealing with this issue:

 

Exercises for FAI:

 

https://www.youtube.com/playlist?list=PLBek8msGJAxNtxFFhEBWrc9RBblottHyJ

 

I've found that very deep, very targeted, sustained tissue work was necessary to complement my stretching and ultimately overcome the issue.

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SDowd

 

I was diagnosed with FAI (CAM) and labral tears in both hip joints a couple of years ago (probably from years of Taekwondo and Wushu training). Got surgery in the right hip which actually increased the pain, personally I wouldn't do it again.

 

It took more than two years when I finally found that a combination of loads and loads of glute activation via single leg hip bridges and the resets from the Original Strength system did wonders for me. I still get pain from time to time and I'm not as comfortable with the side splits as I want and used to be. Also, I didn't get back to kicking.

 

Seeing that you worked with Ido and looking at your videos I'm really interested in your system. Being a student of physiotherapy and having read and tried a lot (Ido, Kurz, Starret, pt,...) I would be interested how your systems differs from those.

 

thanks

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ChenZhen - I stand on the shoulders of giants for sure (Ido, Kurz, Starrett, etc)...and other who the world will never know about (my chiropractor / deep tissue therapy "yoda" named Phil...a quiet spiritual guy with 30+ years experience who has less than zero interest in publicity.)

 

I like to think I've added a few unique elements as well....particularly around the tissue work side of the equation :-)

 

I'd be happy to discuss more in-depth! If you have any questions - fire away!

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Rolling out the glute / lateral hip / TFL area is a game changer for this issue. Try SDowd's barbell TFL torture thing. Very intense, but effective.

 

And yeah, move in the new ranges afterwards as much as possible.

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Zollie - Agreed! The barbell was a game changer for me when I first found it. I particularly like to get in that position and then "shake" or "vibrate" the barbell - very gnarly!

 

Also - if you can find a friend to stand over you as you lie on your side and press thumbs or fingers straight down into the TFL, it gets into the crevice's in a super effective way as well.

 

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I've had that before a few times. First time I got a podiatrist I was seeing adjust the hip (I got luck with that one, go see a gonstead chiro). I've been able to hit it myself via movement quite a few times. Once my chiro adjusted the hip and it went away (just luck and timing).

The first time it was out was the most painful. Took about 2-3 weeks for the swelling to be fully pushed out (nutrition is spread in joints by movement, not blood flow)

How I hit it... Loosen: Hip flexor, hamstring, abductors. Between either a bent knee hip flexor/quad lunge stretch and butterfly it would slide back it (nothing forced). Focus SI articulation and bracing muslces around the femur/fip to pull it back to normal and Femur head/labrum to massage swelling and prevent scarring. Personally lunges (normal, with rotations so 1 arm on the floor other in the sky, front foot the side, and front foot out front more) and butterfly was all I needed, donno about you. Sometimes rolling my hip flexor on a med ball was enough.

You may want to med ball your quads and upper hammies to clear adhesions.

At first I'd say go see a gonstread chiro so you can feel what popping it back in feels like. Note that when you do it yourself you use leverage of the limbs instead of impact. There may be super-duper slight discomfort when you work on yourself but nothing should be painful. Self adjustment are super gentle and if you get it right it will feel like no effort and it just slides back in.

Since I've been working on my front splits, it's never come back

This is a good way to massage the joint

This also works to pop it back in, maybe stretch to loosen yourself first then go for it.

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