Medically Reviewed by Dr Wang Lushun
Senior Consultant Orthopaedic Surgeon
MBBS (S’pore), MRCS (Edinburgh), MMed (Ortho), FRCS (Ortho) (Edinburgh)
Hip pain in active adults is often attributed to muscle strain or overuse. However, in some cases, the underlying cause may be hip impingement — a structural condition affecting the hip joint. Also known as femoroacetabular impingement (FAI), hip impingement occurs when there is abnormal contact between the ball and socket of the hip joint. Over time, this can lead to cartilage damage, labral tears, and even early arthritis if left untreated.
The hip is a ball-and-socket joint. The ball (femoral head) sits within the socket (acetabulum). In a healthy hip, these structures move smoothly against each other.
In hip impingement, the shape of the ball, the socket, or both is slightly abnormal. This causes the bones to rub against each other during movement, particularly with bending or twisting motions. Repeated friction can damage the cartilage and the labrum — a ring of cartilage that stabilises the hip joint.
Hip impingement is common in active individuals and athletes, especially those involved in sports that require repetitive hip flexion such as football, hockey, martial arts, dance and running.
Hip impingement can arise from different structural changes in the hip joint, which doctors classify into three main types:
This occurs when the femoral head is not perfectly round. The irregular shape causes abnormal contact with the socket during movement. Cam impingement is more common in young, active individuals.
This happens when there is extra bone growth along the rim of the acetabulum. The socket covers too much of the femoral head, leading to pinching of the labrum. Pincer impingement is more commonly seen in middle-aged adults.
Many patients do not have just one structural abnormality. When both cam and pincer deformities are present, the hip joint is subjected to abnormal contact from multiple angles. This often results in earlier cartilage wear and labral injury if left untreated.
Symptoms of hip impingement can develop gradually and may initially feel like a minor strain. Common symptoms include:
Symptoms often worsen with high-impact activities or sports that involve repetitive hip bending. Furthermore, because the pain is usually felt in the groin, hip impingement may sometimes be mistaken for a muscle strain or hernia.
Hip impingement is caused by structural differences in the shape of the hip bones. These differences usually develop during adolescence, especially in active individuals involved in intensive sports training. Other contributing factors may include repetitive stress on the hip joint, genetic predisposition, and high-impact or pivoting sports.
To diagnose hip impingement, your doctor will first ask about your symptoms and activity level. During the evaluation, your hip will also be gently moved into certain positions to see if these movements trigger your pain. This helps to determine whether the discomfort is coming from inside the joint.
Besides that, imaging studies are usually also required to confirm the diagnosis. This includes:
The findings from your examination and scans will determine the severity of the condition and guide the most appropriate treatment approach.
Treatment for hip impingement generally falls into two categories: conservative management to control pain and improve movement, and surgical treatment to reshape the joint when symptoms persist or if the joint damage is severe.
Many patients with mild to moderate symptoms can initially be managed without surgery. Non-surgical treatment may include:
While conservative treatment may relieve symptoms, it does not correct the underlying structural abnormality of the joint.
Surgery for hip impingement may be considered if:
When these factors are present, surgery may be recommended to address the underlying bony impingement and prevent further joint damage.
Hip arthroscopy is a minimally invasive procedure commonly performed to treat hip impingement that has not responded to conservative care. The surgery is carried out through small keyhole incisions using a specialised camera and instruments, allowing the surgeon to visualise the inside of the joint in detail without the need for a large open incision.
During the procedure, the areas of excess bone responsible for the impingement are carefully reshaped to improve the way the ball and socket move against each other. If a labral tear is present, the damaged tissue may be repaired or stabilised, and any cartilage injuries are addressed at the same time. By correcting the structural cause of the pinching, a hip arthroscopy aims to restore smoother joint mechanics, reduce pain, and help protect the hip from further degeneration.
Because the procedure is minimally invasive, it is generally associated with smaller scars and less soft tissue disruption. Combined with physiotherapy following the procedure, eligible patients can usually achieve good long-term outcomes.
When hip impingement is not addressed, repeated pinching between the ball and socket can gradually damage the structures inside the joint. Over time, this may lead to labral tears and progressive cartilage wear, as the abnormal contact continues with everyday movement and sports activities.
As cartilage damage accumulates, the hip may become increasingly stiff and painful. In some cases, longstanding impingement can contribute to the development of early hip osteoarthritis, particularly in active individuals. Seeking timely evaluation allows appropriate management before more significant joint damage occurs.
Ongoing hip pain is not always “just a strain.” If symptoms persist or interfere with movement, a proper evaluation can help determine whether hip impingement is the underlying cause. Consider seeing an orthopaedic specialist if you experience:
An early assessment allows for accurate diagnosis and timely management before irreversible joint damage occurs.
Ongoing hip or groin pain can interfere with your daily life, and in some cases, may signal an underlying structural issue such as hip impingement. With appropriate evaluation and treatment, many patients are able to relieve pain, restore mobility, and protect their long-term joint health. For a detailed check-up and personalised advice about your hip pain, please contact us to make an appointment with Dr Wang Lushun today.
MBBS (S’pore), MRCS (Edin), MMed (Ortho), FRCS (Ortho) (Edin)
With over 20 years of experience, Dr Wang Lushun is an orthopaedic surgeon who specialises in treating a wide range of sports injuries and musculoskeletal conditions. He has in-depth experience in minimally invasive surgery and advanced robotic surgery. Dr Wang provides orthopaedic care to athletes and everyday individuals throughout their journey to recovery.
