Physiotherapy
Since hip impingement is due to a malposition or unevenness of the bones involved, causal treatment in physiotherapy is not possible. The goals of physiotherapy are on the one hand to relieve pain, improve mobility and strengthen certain muscles surrounding the hip, and on the other hand to achieve a better posture and a more favorable gait pattern. On the other hand, purely passive mobilization of the hip joint can even worsen the symptoms in some cases, which is why the treatment plan has to be adapted individually.
For pain relief, heat therapy can be used, e.g. with fango, and massages and electrotherapy can be applied additionally. It is important not to overload the hip joint and, if necessary, to restrict sporting activities. Therapy can then begin by building up the gluteal muscles, while the adductor group and the hip flexors can be stretched carefully. Smooth postures or possible gait disorders can be corrected under the guidance of the therapist so that the hip joint is not put under one-sided strain.
Sports
Sports that are associated with high forces acting on the joint, or in which movement is often slowed down, are considered risk factors for hip impingement. These include tennis, running, martial arts, ice hockey, soccer, and almost every type of competitive sport.Especially competitive sports in childhood are suspected to impair the maturation of the acetabulum and the femoral head. Patients with acute complaints should avoid the pain-inducing movements as far as possible.
In most cases, it is necessary to refrain from sports at first until an improvement occurs. Exercises from physiotherapy or joint-sparing sports such as swimming (especially backstroke) can and should continue to be performed so that the musculature is largely preserved. After successful therapy, when the joint cartilage has not been damaged, it is often possible to resume sports habits.
OP
To treat the cause of a hip impingement, in most cases surgery is necessary to restore the symmetry of the femoral head and acetabulum and allow unrestricted mobility. The aim is also to prevent destruction of the cartilage and thus make early arthrosis less likely. There are basically two different types of hip impingement: pincer impingement or biting forceps impingement, where the hip is too large and covers too much of the femoral head.
On the other hand the Cam- Impingement, which is accompanied by a deformation of the femoral head and the femoral neck. In this case, the ossifications repeatedly hit the edge of the acetabulum. In the case of pincer impingement, the acetabulum must be reduced in size.
For this purpose, the hip joint lip (the labrum) is detached, the edge of the acetabulum is slightly removed and then the labrum is reattached to it. In the case of cam impingement, the shape of the femoral head and neck is corrected by removing the excess bone. Both operations can be performed as open surgery on the exposed joint or, more and more often, minimally invasive as arthroscopy.
