Hip Impingement Syndrome: How Do I Know I Have It | Femoral Acetabular Impingement Syndrome:

By Dr Ken Nakamura+

Hip Impingement Syndrome: Why Do I Have Hip Pain: Downtown Toronto Chiropractor

Do you have groin or hip pain while tying your shoes, or going up the stairs?


Does sitting for long periods make your pain worse?


Does your pain sometimes become sharp or “catch” with activity?


If you answered yes to these questions you might have hip impingement syndrome. The technical name for this condition is femoralacetabular impingment sydrome.

Hip Impingement Syndrome: Why Do I Have Hip Pain: Downtown Toronto Chiropractor


You also might be walking with a swing of your torso over the bad side, and feeling pain right over your hip. Keep in mind most people will feel the pain as in the diagram above not near the belt-line.


Symptoms of Hip Impingement

  • Pain in the groin area sometimes radiating to the thigh or knee.
  • Hip pain like in the picture above aggravated by activity
  • Buttock pain
  • Clicking of the hip
  • You are a teenager to forty years of age


Most of you would have had physiotherapy or chiropractic without any positive results. X-rays reports came back negative for the hip, and groin ultrasounds don’t show anything wrong. (Just because pain is near the groin doesn’t mean it’s a groin pull)


Your doctor, your physiotherapist and mostly you are frustrated that you can’t do much activity before you start getting hip pain.


The Cause of Hip Impingement Syndrome


Hip impingement sydrome is related to abnormalities of the hip or using the hip in extreme ranges of motion.


Abnormalities Of The Hip


Abnormalities of the the hip joint can occur at one of two places. Your hip joint is a ball and socket joint. The abnormal shape can be at the ball part of the joint or the socket end.

Ball & Socket Hip Joint: Hip Impingement Test: Why Do I Have Hip Pain: Downtown Toronto Chiropractor

The socket is called the acetabulum, while the ball is called the femur head.[7-9]


Here I go over some of the abnormalities not visible on X-ray followed by those abnormalties visible on X-ray.


  • Acetabular (acetabulum) retroversion. This means the socket portion of the joint is angled backwards more than normally. Most people have their socket pointing slightly forward. If it points more backwards than this then you have acetabular retroversion. This is something you are born with. Most people with this have their one foot pointing out, or both feet pointing out, if they have retroversion on both sides.[10]
  • Acetabular Retroversion is actually visible on X-rays but it’s missed quite often so I put acetabular retroversion in the non-visible on X-ray category. Many radiologists miss this sign as they are unfamiliar with hip impingement or are not looking for it. The sign that is visible when it’s actually found is  called “cross over sign“. I won’t go over the details of what to look for as you would need training to see this sign.

Cam and Pincer | Hip Impingement Syndrome: Why Do I Have Hip Pain: Downtown Toronto Chiropractor

  • Camshaft (Cam) Deformity: Excess growth of bone on the upper surface of the femur. [11] If you have a Cam deformity you will have pain with hip flexion together with hip rotation inwards.
  • Pincer Deformity: Excess growth of the upper lip of the acetabulum. If you have a pincer deformity you have very limited hip flexion together with rotating of your hip inwards.
  • Combination: Many times people have a combination of camshaft and pincer deformity.


You can see the camshaft and pincer deformity above. The camshaft deformity is seen in red while the pincer deformity is seen in green.


  • Previous fracture to the femur (thigh bone). Breaking the femur can change the angle of the ball fitting into the socket.


Causes Of Hip ImpingementVisible On X-ray


  • Slipped Femoral Epiphysis: Backward slipping of the very end of the femur ball due to a weakness in the growth plate. This is painful during adolescent ages.


  • Legg-Calvé-Perthes disease: When the blood supply to the ball of the femur is interrupted or stops causing the bone to die. This is a disease of childhood.



The main problem is that since the X-rays are normal or insignificant such as a small spur on the acetabular rim. On X-ray it doesn’t seem to be a big deal.


Here’s the problem. When you move your hip the pincer will jab into the joint like a fork jabbing cartilage of your joint. Eventually this cause damage and tearing to the cartilage that is found on the surface of the ball of the femur.


Tears will cause abnormal movements and eventually wear and tear of your hip. You will be left with premature osteoarthritis of the hip before most people your age.


Impingement Test


Hip Impingement Test: Why Do I Have Hip Pain: Downtown Toronto Chiropractor



One test will be positive for 90% of you that have this condition. It’s called the impingement test. Make sure your health care practitioner does this test.


Your health care provider will have you laying down on your back.

  • Flex your hip to 90 degrees.
  • Knee is then adducted (pushed past the midline), while internally rotating the hip


When the test is positive you will know as you will feel a pain that is sharp in the area of your hip or recreates the pain they usually have.


Tell us what you think in the comments below and like us on Facebook. I will answer all questions in the comments section here at this downtown Toronto Chiropractic clinic.




1 . Ganz R , Parvizi J , Beck M , Leunig M , Notzli H , Siebenrock KH . Femoroacetabular impingement: a cause for osteoarthritis of the hip . Clin Orthop Rel Res . 2003 ; 417 : 112 – 20 . [PubMed]

2 . Kassarjian A , Yoon LS , Belzile E , Connolly SA , Millis MB , Palmer WE . Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement . Radiology . 2005 ; 236 : 588 – 92 .[PubMed]

3 . Ito K , Minka MA , Leunig M , Werlen S , Ganz R . Femoroacetabular impingement and the cam effect: a MRI based quantitative anatomical study of the femoral head neck offset . J Bone Joint Surg Br . 2001 ;83 : 171 – 6 . [PubMed]

4 . Ito K , Leunig M , Ganz R . Histopathologic features of the acetabular labrum in femoroacetabular impingement . Clin Orthop Rel Res . 2004 ; 429 : 262 – 71 . [PubMed]

5 . Beck M , Leunig M , Parvizi J , Boutier V , Wyss D , Ganz R . Anterior femoroacetabular impingement: part 2. Midterm results of surgical treatment . Clin Orthop . 2004 ; 418 : 67 – 73 . [PubMed]

6 . Goodman DA , Feighan JE , Smith AD , Latimer B , Buly RL , Cooperman DR . Subclinical slipped capital femoral epiphysis . J Bone Joint Surg . 1997 ; 79 : 1489 – 97 . [PubMed]

7 . Lavigne M , Parvizi J , Beck M , Siebenrock KA , Ganz R , Leunig M . Anterior femoroacetabular impingement: part 1. Techniques of joint preserving surgery . Clin Orthop Rel Res . 2004 ; 418 : 61 – 6 .[PubMed]

8 . Tanzer M , Noiseux N . Osseous abnormalities and early osteoarthritis: the role of hip impingement .Clin Orthop Rel Res . 2004 ; 429 : 170 – 7 . [PubMed]

9 . Wagner S , Hofstetter W , Chiquet M , Mainil-Varlet P , Stauffer E , Ganz R , et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoroacetabular impingement . Osteoarthritis Cartilage . 2003 ; 11 ( 7 ): 508 – 18 . [PubMed]

10. D. Reynolds, J. Lucas, K. Klaue. Retroversion of the acetabulum: A CAUSE OF HIP PAIN. J Bone Joint Surg. 1999

11 . Peters CL , Erickson JA . Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults . J Bone Joint Surg . 2006 ; 88A : 1735 – 41 . [PubMed]



Dr Ken Nakamura

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