Cycling related hip impingement

Hip Impingement also known as femoral acetabular impingement (FAI) is a condition which affects a large population of cyclists, however the majority of this population remain asymptomatic and pain free. FAI is characterised by the formation of extra bone around the head and neck of the femur bone. This is caused when the head and neck of the femur are forcefully jammed up against the acetabulum (hip socket). This mechanism causes and inflammatory response to the bone causing it to become thicker and deposit extra layers of bone. Predisposing factors: There are a number of factors that predispose to the formation of this condition.
  • History of kicking sports
  • Hip Dysplagia is a condition in which there is developmental issues of the hip joint causing it to have poor coverage of the hip joint and extra movement inside the hip joint. This is commonly diagnosed during early childhood.
  • Poor Gluteal Strength at both top and bottom of your pedal stroke causes your knees to track in towards the top tube therefore giving you rotation at the hip as shown in the picture.
  • Incorrect Bike Set-up is the main driver to this condition. Having your seat lower than recommended guidelines will cause your hips to bend higher at the top of your pedal stroke.
  • Lack of core strength will cause you to fatigue quicker therefore forcing you to use extra muscles than required. This can cause stiffening up of certain joints and lead to poor technique
  • Cycling technique is important when it comes to prevention. A push/pull technique will cause you to work more with your hip flexor muscles which will cause the hip to be pulled up excessively. Ensure you have a nice smooth pedal stroke and only focus on the push phase.
How do you know if you have a FAI? You will generally have pain around the front of your groin area which is commonly followed by a period of aching after cycling or exercise. Diagnosis is best made with MRI and CT scan but X-ray can be successful if the right person is looking at them. Treatment In mild cases Physiotherapy intervention can be beneficial in preventing any further damage as this condition is not reversible after the damage is there. Physiotherapy can offer a range of joint mobilisation techniques, soft tissue management, a cycling specific core program and most importantly a bike screening and assessment of riding technique. FAI can be a predisposing condition to other conditions such internal damage to the hip joint. In cases like these a surgical opinion is warranted
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