Hip impingement, formally called femoroacetabular impingement syndrome (FAIS), is treatable through a combination of targeted physical therapy, activity modification, and in some cases arthroscopic surgery. Most people start with conservative treatment for several months before considering surgery, and many improve enough to avoid the operating room entirely.
The condition involves extra bone along the femoral head (called a cam lesion), the hip socket rim (a pincer lesion), or both. This extra bone narrows the joint space, causing the bones to make contact during certain movements and gradually damaging the cartilage ring (labrum) that cushions the joint. Treatment aims to reduce that contact, strengthen the muscles that stabilize the hip, and when necessary, reshape the bone surgically.
Physical Therapy: The First-Line Treatment
A structured physical therapy program is the starting point for nearly everyone with hip impingement. The goal isn’t just stretching or general strengthening. It targets specific muscle weaknesses and movement patterns that increase stress on the joint. A well-designed program typically progresses through three stages, each building on the last.
The first phase focuses on posture and pelvic awareness. You’ll work on finding a neutral pelvic position through exercises like pelvic tilts, first lying on your back, then on all fours, and eventually while seated and standing. This matters because the angle of your pelvis directly affects how much space exists between the femoral head and the socket. Even a slight forward tilt can increase bony contact.
The second phase builds core stability and hip strength. Core work here means more than sit-ups. The deep stabilizing muscles of your abdomen, lower back, and pelvic floor all contribute to controlling how your hip moves under load. Exercises like bird-dogs, planks, dead bugs, and their variations train these muscles to fire properly. For the hip itself, the primary targets are the three gluteal muscles (gluteus maximus, medius, and minimus), which are often weak in people with impingement. When these muscles are underactive, a smaller muscle on the outer hip called the tensor fascia lata compensates, pulling the joint into less favorable positions. Side-lying leg raises, clamshells, bridging, and resisted side-stepping with a band are standard exercises in this phase.
The third phase introduces more demanding, functional movements: single-leg step-downs, multiplanar lunges, and dynamic mobility drills like pendulum leg swings and rotational exercises. This phase prepares you for the specific demands of your sport or daily activities. A full conservative program typically runs 12 to 16 weeks, though some people continue longer.
Exercises to Avoid
While staying active is important, certain movements push the hip into the exact positions that cause impingement. Deep squats, plyometric exercises (box jumps, bounding), and any movement that combines deep hip flexion with rotation are the main offenders. These compress the femoral head against the socket rim and can aggravate the labrum. If you do squats, limiting depth to keep your hip angle above 90 degrees and keeping your knees tracking over your toes generally reduces joint stress. Your physical therapist can help you identify which specific movements trigger your symptoms and find alternatives that keep you training.
Sitting and Everyday Adjustments
Deep-seated positions, where your knees sit level with or below your hips, are a common pain trigger. A standard chair puts the hip at roughly 63 degrees of flexion, and a car seat pushes it further to about 78 degrees. At those angles, the femoral head is more likely to contact the acetabular rim. A kneeling chair, by contrast, holds the hip at about 51 degrees and cuts the force on the joint by roughly 50% compared to a car seat.
If a kneeling chair isn’t practical, raising your seat height so your hips sit slightly above your knees achieves a similar effect. A wedge cushion angled forward works on most office chairs. In the car, sliding the seat back and reclining slightly can reduce hip flexion. For long periods of sitting, standing up and walking briefly every 30 to 45 minutes helps prevent stiffness and pain buildup.
Injections for Pain Relief
When physical therapy alone isn’t controlling symptoms, corticosteroid injections into the hip joint can provide temporary relief. These injections are effective for reducing pain for up to about four weeks, though results vary. Roughly 20% of people get no meaningful response, less than half experience relief lasting two weeks or less, and the remainder get more sustained benefit. These injections serve two purposes: they reduce inflammation enough to let you participate more fully in physical therapy, and they help confirm the diagnosis. If an injection into the joint eliminates your pain, it strongly suggests the hip joint itself is the source.
Hyaluronic acid injections, which aim to improve joint lubrication, have shown some promise in hip osteoarthritis. One formulation combining hyaluronic acid with mannitol reduced pain by 50% in half of patients at 90 days. Platelet-rich plasma (PRP), despite growing popularity, has not shown clear benefits for hip impingement. A systematic review found no improvement in outcomes when PRP was used alongside surgery, in either short-term or long-term follow-up.
When Surgery Makes Sense
Surgery becomes a reasonable option when several months of dedicated physical therapy and activity modification haven’t adequately reduced your symptoms, or when imaging shows significant labral damage or large bony deformities. An alpha angle of 60 degrees or greater on imaging indicates cam morphology, though this measurement alone doesn’t determine whether you need surgery. The decision depends on the combination of your symptoms, physical exam findings, and imaging.
The UK FASHIoN trial, a major randomized study published in The Lancet comparing hip arthroscopy to a structured physiotherapy program, found that both groups improved at 12 months, with surgery providing a modest additional benefit in hip-related quality of life. This suggests that while surgery offers an edge for many patients, conservative care produces meaningful improvement on its own, and the decision isn’t always clear-cut.
What Happens During Hip Arthroscopy
Hip arthroscopy is a minimally invasive procedure performed through small incisions using a camera and specialized instruments. The surgeon addresses each structural problem individually. For a cam lesion, they shave down the extra bone on the femoral head-neck junction to restore the normal rounded shape and allow the hip to move without catching. For a pincer lesion, they trim the overhanging rim of the socket. If the labrum is torn, they either repair it with suture anchors or, in severe cases, debride (trim) the damaged tissue.
The distinction between labral repair and labral debridement matters significantly for long-term outcomes. A study tracking patients for 10 years found that only 5% of those who had labral repair eventually needed a hip replacement, compared to nearly 22% of those who had debridement. The repair group had roughly four times lower risk of needing a replacement. For patients who didn’t progress to replacement, both groups reported similar satisfaction and functional scores at final follow-up. This reinforces why most surgeons now prioritize preserving and repairing the labrum whenever possible, as the labrum plays a critical role in sealing the joint and distributing forces evenly across the cartilage.
Recovery After Surgery
Rehabilitation after hip arthroscopy follows a structured protocol that typically spans about 24 weeks. In the first one to two weeks, you’ll avoid actively lifting your leg (hip flexion) to protect the surgical repair, and you’ll likely use crutches for weight-bearing restrictions. The five-phase program gradually reintroduces range of motion, strengthening, and cardiovascular activity, with each phase building on specific milestones rather than fixed timelines.
For athletes, the return-to-sport rate is encouraging. A study of NCAA Division I athletes found that 89.7% returned to their sport after hip arthroscopy, though the average time to clearance was just under two years. For recreational athletes and non-athletes, the timeline is generally shorter because the physical demands of daily life and moderate exercise are lower than competitive sport. Most people return to desk work within two to four weeks and resume low-impact exercise like swimming or cycling within two to three months.
The early months of recovery can feel slow, particularly if you’re used to being active. Hip flexor tendinitis is a common complaint after surgery and is one reason protocols restrict certain movements early on. Sticking closely to the rehabilitation plan, even when you feel ready to do more, protects the surgical repair and gives you the best chance of a lasting result.