You have been treating your back for months. You have stretched it, rested it, maybe had it imaged, and it keeps coming back. Somewhere in there, nobody asked about your groin.
That is the gap where hip impingement lives. It is common and it responds well to treatment. It also spends a remarkable amount of time being mistaken for a lumbar problem.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
What hip impingement actually is
The hip is a ball sitting in a socket. Femoroacetabular impingement means the two do not clear each other cleanly through their full range, so they collide at the edges instead of gliding.
It comes in two shapes. In a cam lesion the ball is misshapen. Orthopedic surgeon Dr. Zach McVicker, who joined Dr. Dave Kashuba on our Pain 2 Power podcast, puts it this way: “instead of being round, it's more like an oval peg in a round hole.” In a pincer lesion the shape problem is on the socket side, which covers more of the ball than it should. Cam lesions turn up more often in men, pincer lesions more often in women, and pincer cases are the more technically demanding to repair.
Around the rim of the socket sits the labrum. Dr. McVicker compares it to a gasket between two pipes. It creates a suction seal that spreads your body weight across the whole dome of the joint with every step. When that seal fails, load stops being shared and starts concentrating on cartilage that was not designed for it.
The symptoms people miss
Groin pain is the one to know. It is the most common first symptom, and it is the detail that separates a hip problem from a back problem, because a disc tends to send pain down the leg rather than into the groin.
Around it cluster the symptoms that get attributed elsewhere: low back pain, pain over the SI joint, aching toward the buttock, soreness on the outside of the hip, and for some people pelvic floor dysfunction. Pain shows up with anything that torques or pivots under load, which in Palm Beach County means golf, tennis and pickleball. Dave has seen this diagnosed for the first time in seventy-year-olds who are still on the court several days a week.
One more clue Dave uses in the clinic: watch where a man's belt buckle points. If it tips downward rather than sitting flat, the pelvis is already tilted, and hip pain is usually not far behind.
Physical therapy for hip pain in North Palm Beach
Most painful hips we evaluate have one thing in common, and it is not the joint surface. It is a weak gluteus medius, the muscle on the side of the hip that keeps your pelvis level while you stand on one leg. Every step you take is briefly a single leg stance, so when that muscle gives up, the joint absorbs what the muscle should have.
The exercise Dave starts nearly everyone on is a sit to stand with a resistance band looped just above the knees. The band matters. A sore hip makes you quietly shift your weight onto the good leg, and you will do it for weeks without noticing. The band pushes both knees outward and forces the two sides to share the work, so the movement retrains the pattern instead of reinforcing it.
From there the program builds: standing leg abductions holding the back of a chair, kicking away from the midline; clams to strengthen the external rotators, which are weak in almost everybody because nothing in daily life asks for them; a side lying leg raise; and a prone cobra with the pelvis staying down on the floor to open the front of the hip. One piece of practical advice from Dave that belongs with any floor exercise: make sure you can get back up before you get down there.
Load management does the rest. Stop sitting with your legs crossed. Break up repetitive bending. And rather than giving up golf, change the swing so it stops driving torque through the hip.
When it is time for a surgeon
Therapy is where this should start, and for many people it is where it ends. The reason we do not wait indefinitely is that a torn labral seal keeps letting the joint grind at itself.
Hip dysplasia raises the stakes. There the socket is underdeveloped, so the load concentrates at the edge of the cartilage rather than spreading across it. Dr. McVicker's assessment was direct: that edge loading “ends up in arthritis 100% of the time.” Labral tears come early, and the surrounding soft tissue takes a beating. Gymnasts, dancers and long distance runners are the classic histories.
Modern hip arthroscopy is small work, done through a few poke holes with a camera, and it preserves the joint you were born with. That is the argument for looking early rather than waiting for the conversation to become about replacement. As Dr. McVicker noted, a replacement can feel close to normal, “but it's not your own hip. You don't have the proprioception” that your native joint provides. That positional sense is what keeps you from missteps, and missteps are what turn into falls.
Dr. McVicker practices with the Paley Orthopedic and Spine Institute in Jupiter, and he is one of the surgeons Dave sends hip patients to when a joint needs more than therapy can give it.
Start with an evaluation
If your back pain has never fully explained itself, or the ache sits in your groin when you get up from a chair, an evaluation is the fastest way to find out which joint is actually responsible. We will look at how your hip moves, how your pelvis behaves under load, and how much work that gluteus medius is really doing, then build the program from what we find.
Call 561-624-4263 or request an appointment. You can read more about our approach to hip pain and back pain, see how we structure physical therapy, browse the physical therapy questions in our FAQ, or hear the full conversation on the Pain 2 Power podcast.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.