Pinching type pain generally felt at the front of the hip joint or into the groin when coming over the top of the pedal stroke (maximum hip bend position). It is rarely tender to touch the area as the pain will mostly feel deeper in the front of the hip joint.
What causes Hip impingement?
This problem is thought to develop from pinching of either soft tissue pressure or bony compression at the front of the hip joint itself. It is more technically known as Femoroacetabular Impingement (FAI).
Repetitive activities into deep hip flexion e.g. in cycling
A saddle height that is set too low or cranks that are too long
Childhood hip problems
Repetitive sports involving hip flexion / rotation as an adolescent – may change the anatomy of the developing hip joint.
Below are some of the anatomical features that can lead to FAI
Pincer - a deeper hip socket can increase the likelihood of compression
CAM - bump or wider area of the femoral neck, increases the chances of bony contact in deeper hip flexion positions.
Mixed - this is where there is both CAM and Pincer changes in the hip
Labral Tear – it is not clear how this may contribute to hip impingement, but what is known is that the labrum helps with joint mobility, stability, force dissipation and shock absorption. As such damage to this could contribute to hip impingement symptoms.
What are the symptoms?
The cyclist will complain of a deeper pain at the front of the hip and groin when coming over the top of the pedal stroke (top dead centre). This will often start as a dull ache but can become quite sharp.
In the early stages most riders will continue to ride through this, also noting that the hip can be quite achy following longer rides.
Pain when hugging the hip and knee into the chest or opposite shoulder is also a common clinical finding.
Clinical examination by an expert physiotherapist (ideally experienced in working with cyclists) or a hip specialist orthopedic surgeon in combination with an MRI scan (if indicated) will allow a clear diagnosis.
How can I manage Hip impingement?
As with most injuries brought on by cycling it is important to reduce training volume or intensity to allow a chance for the symptoms to settle if possible.
Consider alternative forms of cardio exercise such as swimming or a cross-trainer which both put much less pressure and stress on the front of the hip joint as they don’t involve deep hip flexion.
This is a crucial step in helping to alleviate hip impingement problems and there are three key issues that often need to be addressed:
Saddle to Bar Drop
Getting a full assessment of the contributing factors in your individual case is key to building a clear rehab and recovery plan.
Mobility exercises are useful if there are non-painful movement restrictions around the hip contributing to pressure at the front.
Commonly the adductor and abductor muscle are seen to have strength deficiencies in those suffering with hip impingement.
Sports Massage Gluteal muscle spasm is often found in hip impingement which can lead to increased pressure and overload at the front of the hip joint - so some sports massage, or even using a foam roller or trigger point ball can help
In cases where pain has been resistant to a combination of rest, bike fit, physiotherapy, and rehabilitation then a steroid injection may assist in alleviating symptoms of pain and inflammation.
Cases that fail conservative management and injection therapy should be considered for arthroscopic surgery if appropriate
What else could it be?
Hip joint arthritis
Referred pain (spinal)
If you are having issues with you hip and want to get in touch about booking a consultation or a bike fit then please email us: firstname.lastname@example.org.