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Are your Gears Grinding: Hip Flexor Pain or Hip Impingement?

Are your Gears Grinding: Hip Flexor Pain or Hip Impingement? Barefoot Rehabilitation Clinic

09 Jun Are your Gears Grinding: Hip Flexor Pain or Hip Impingement?

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Do you have hip flexor pain or a hip impingement?

Let’s figure it out together.

What is a hip impingement?

Impingement occurs when two bones are not sliding on their normal axes and pinch together.

Picture two gears that are spinning nicely without friction.

good gearsThis is the way your hip joint should work.

Now, imagine that one gear is nudged the slightest bit closer to the other gear.  Can you see how the gears will have more friction between them, moving less smoothly, potentially clunking, as one gear passes the other?


jammed gears

This is what occurs in a hip impingement.

Due to prolonged sitting over years and excess training overusing the quads and underusing the gluteal tissue and hamstring, the posterior hip capsular and adductor magnus become overworked and develop adhesion.

When these tissues are tight, they pull the head of the femur forward in the socket, causing a “pinching” sensation in the front of the joint.

How do you know if you have a hip impingement?

Your pain or stretching will only be present at the end range of hip flexion, either in a squat or passively when lying face up.  If you’re not sure, you can stand up and squat now or have someone check your thigh to chest test.

What is hip flexor pain?

The hip flexors are:

  1. psoas
  2. iliacus
  3. rectus femoris


If those muscles are in pain (for the sake of today’s discussion, we’ll ignore the tendons), you either have:

  1. adhesion
  2. a strain
  3. a tear

How do you know which hip flexor pathology you have?

The key differentiator in hip flexor pain vs. hip impingement is at what range the symptoms are provoked.

  • Impingement: felt at end range hip flexion i.e. squat or the thigh to chest test.
  • Hip Flexor Adhesion: felt at end range hip extension or the lunge stretch test.
  • Hip Flexor Strain or Tear: can be felt at any range, but differentiated by the above two by being symptomatic at neutral i.e. standing and lifting the hip a little as you would when walking.

What about a hernia?

A hernia occurs when your intestines come out through a wall of muscle, usually your abdominal/core muscles.

Hernias can be painful.

How do you know if you have a hernia?

You will be a soft mass in the location of the pain.  The lump can go away when you press on it or lie down.

The hip flexor pathologies or hip impingements will not have a mass present.

If you think you have a hernia, surgery is your primary solution and exercise/strengthening is your secondary solution only after surgery is performed.

How do you fix hip flexor pain or an impingement?

As always, all of the above conditions are caused by overload, or too much water in the damaged tissue’s bucket.

In order of severity, hip flexor pain starts as tight muscles that the body conserves energy from by laying down adhesion (A).  Adhesion is present over months to years before there ever is a more significant pathology.  Eventually, an individual does something that uses the hip flexors more (i.e. sprinting after not doing so in months/years) and either strains (small overload – B) or tears (larger overload – C) the tissue.


Notice the distance of the canyon in B.  The body can cross small chasms and repair them.

Notice the distance of the canyon in C. Only if the tear is significant and the body cannot traverse the canyon-sized ravine is surgery required for a tear.

In all of the above cases, removing the adhesion from the psoas, iliacus, or rectus femoris with manual adhesion release is the sweet-spot solution.  If there is a strain or acute tear, then inflammation is present and time is required in addition to deloading (not using) the muscles.

In hip impingements, the adhesion needs to be removed in the adductor magnus and posterior hip capsule.  If an individual has been active from adolescent years, especially hockey, basketball, or soccer,  or has been involved in significant loading of the hip joint over years, then a CAM/Pincer malformation is a possibility to contribute to the symptoms.  In these instances, extra bone has been laid down as a protective mechanism (this is a form of Osteoarthritis) and pinches the labrum and articular cartilage.

Clinical relevance of a CAM/Pincer malformation can only be determined after adhesion has been removed from the adductor magnus and hip capsule.

See this case study to learn how we resolved Sari’s hip impingements 95%.

Does Impingement Lead to Fast Progression of Hip Osteoarthritis?

Yes, it does.

Especially if you have a CAM malformation or reduced hip internal rotation.

Therefore, as soon as hip flexor pain presents itself, it is best to address it early.

speechbubblesTell us about your hip flexor pain? Who have you seen? Did it work?  How long have you had this problem?  What causes it to get worse or better?

If you know of a friend or family member with hip flexor pain or a hip impingement, please forward this information to them so they can get the help they need.  Fixing your adhesion matters because it improves flexibility, improves function, reduces pain, and restores normal movement to the body so you can enjoy the things you love. Call us at 862.205.4847.

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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, is a Sports Therapy & Chronic Pain Resolution Specialist with Barefoot Rehab in Parsippany, NJ.  When you’re in pain that hasn’t gone away and you’ve been to at least 3 other doctors, Dr. Chris wants to help you. And when you’re sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.

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