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Hip · Femoroacetabular Impingement (FAI) Syndrome

Hip Impingement

The ball and socket of your hip pinch together when you move it in deep — a slightly snug fit between the bones and the cushiony rim around the socket. It comes from the shape and movement of the joint itself, is common in younger active people, and the first thing to try is movement and strengthening, not surgery.

The shape of the joint means the bones contact sooner than usual at deep flexion and rotation — so squatting deep, folding the hip while sitting, or pivoting pinches it. The fix is to take the squeeze off (modify the deep end-range that provokes it), then build the muscles around the hip — glutes and deep core — and retrain how you hinge and control the hip so the joint is supported and you stay out of the painful corner. The strongest evidence (a 25-society agreement, and a large randomised trial) puts physiotherapy-led care first: in that trial both exercise and surgery improved people, so a proper exercise program comes before any operation.

How it typically shows up

Deep front-of-hip / groin pain in a younger, active adult — the kind you'd cup with a C-shaped hand — that is brought on by deep hip bending (long sitting, squatting, getting in/out of a car, pivoting) and reproduced by drawing the knee up and across toward the opposite shoulder (a self-FADIR), often with clicking or catching. Once lateral GTPS, an older-adult osteoarthritic hip, an acute hip-flexor strain, and a stress fracture are excluded, and provided there's no true locking/giving way (which routes out to an unstable labral assessment).

How long recovery takes

Expect a step-by-step comeback over weeks to a few months: first calm it down by easing off the deep-bend-and-twist positions that set it off and getting comfortable movement back, then build strength in your hip and core and work on controlling the movement, then work back up to harder loading and your sport — moving on when you're staying basically pain-free, not by the calendar.

Clicking on its own isn't damage. But if the hip truly locks or gives way, or a solid program hasn't helped, that's the sign to get it checked.

The phased recovery approach

  1. Phase 1 · 1–3 weeks

    Calm

    Take the squeeze off by easing the provocative deep-flexion/rotation positions, restore comfortable pain-free range, and start gentle glute + deep-core activation.

    What you get back: sitting and bending without the pinch.

    • Pain-Free Hip Rocking (quadruped) — 2–3 sets × 10–20s hold · On hands and knees, gently rock the hips back toward the heels and forward again, staying inside the range that stays pain-free
    • Side-Lying Clam (neutral hip) — 2–3 sets × 10–20s hold · Lie on your side, knees bent in front, feet together; lift the top knee like a clam without rolling the pelvis back
    • Double-Leg Bridge — 2–3 sets × 8–12 reps · On your back, knees bent, lift the hips
    • Dead Bug (core control) — 2–3 sets × 8–12 reps · On your back, knees and arms up; slowly lower one arm and the opposite leg, keeping the low back flat to the floor

  2. Phase 2 · 3–8 weeks

    Rebuild

    Strengthen the glutes and deep core and retrain the hip hinge and rotational control so the joint is supported and stays out of the painful corner.

    What you get back: a deeper squat without the pinch.

    • Hip Hinge — 2–3 sets × 8–12 reps · Push the hips back, keep a long flat back
    • Low Step-Up — 2–3 sets × 8–12 reps · Step up onto a low step, drive through the heel
    • Offset (Single-Leg-Biased) Bridge — 2–3 sets × 8–12 reps · Bridge with most weight through one leg
    • Double-Leg Squat — 2–3 sets × 8–12 reps · Feet hip-width, sit back and down only as far as comfortable

  3. Phase 3 · 2–4 weeks

    Back to daily life

    Lock in hip and core strength for pain-free sitting, stairs, getting in and out of chairs and cars, and comfortable squatting to a useful depth without chasing sport-specific end range.

    What you get back: daily bending, stairs, and sitting without the pinch.

    • Graded Walking — 1 sets × 900–1800s hold · Build up walking time gradually
    • Hip Hinge — 2–3 sets × 8–12 reps · Push the hips back, keep a long flat back
    • Low Step-Up — 2–3 sets × 8–12 reps · Step up onto a low step, drive through the heel
    • Double-Leg Squat — 2–3 sets × 8–12 reps · Feet hip-width, sit back and down only as far as comfortable

  4. Phase 4 · 3–8 weeks

    Back to the gym

    Build graded external load — goblet/loaded squat and hip-hinge/RDL — on top of deeper single-leg control, then prove a loaded-squat tolerance, to return to gym, lifting, and pivoting sport.

    What you get back: gym, lifting, and pivoting sport.

    • Leg Press — 3–4 sets × 8–12 reps · Use a comfortable hip range; do not chase deep flexion
    • Loaded Box Squat — 3–4 sets × 8–12 reps · Hold a backpack or household load close to the chest
    • Double-Leg Squat — 3–4 sets × 8–12 reps · Feet hip-width, sit back and down only as far as comfortable
    • Offset (Single-Leg-Biased) Squat — 3–4 sets × 8–12 reps · Squat with most weight through one leg, fingertips on a support

  5. Phase 5 · 3–8 weeks

    Back to running

    Functional single-leg loading carried into a pain-free run-walk progression — rebuild speed and running volume in stages so the hip tolerates impact without dropping into the deep-flexion pinch.

    What you get back: running and sport again.

    • Offset (Single-Leg-Biased) Squat — 2–3 sets × 8–12 reps · Squat with most weight through one leg, fingertips on a support
    • Low Step-Up — 2–3 sets × 8–12 reps · Step up onto a low step, drive through the heel
    • Controlled Split-Squat / Lunge — 2–3 sets × 8–12 reps · Step into a slow controlled lunge, front knee over the foot, feeling the back hip lengthen
    • Hip Hinge — 2–3 sets × 8–12 reps · Push the hips back, keep a long flat back

Exact exercises, sets and progression depend on your severity, equipment and goal — this is the shape of the program, not a one-size prescription.

What matters while you recover

  • Stay out of the pinch

    The biggest early win is avoiding the deep end-range that pinches the joint: don't sit folded up for long stretches (raise the seat, get up and move, don't slump the hip into deep flexion), go easy on deep squats and aggressive knee-to-chest stretches, and be mindful getting in and out of low seats and cars. You're not avoiding movement — you're avoiding the one provocative corner while you build strength around it.

  • Exercise comes before surgery

    Hip impingement at this stage is treated with movement and strengthening first. The international agreement on FAI and a large randomised trial both put physiotherapy-led care ahead of the operating table — and in that trial, people improved with exercise much like they did with surgery. Clicking on its own isn't damage. Give it weeks; expect ups and downs.

  • How much pain is okay — and when to get checked

    Some discomfort during the exercises is fine, up to about 5/10, as long as it eases afterwards and isn't worse that night or the next morning; if it is, ease the load and stay further out of the deep range. Work strength hard but keep range inside the pain-free arc. If the hip truly LOCKS or gives way, or a good program hasn't moved the needle, that's the signal to get it assessed for an unstable labral tear.

Common questions

Do I need surgery?
Usually not first. The international agreement and a large randomised trial put physiotherapy-led care ahead of the operating table — in that trial both exercise and surgery improved people. Surgery is considered only if a structured program hasn't helped enough.
Should I stretch into the pinch to loosen it?
No — forcing the deep end-range (knee-to-chest-and-across, deep squats) is exactly the position that pinches the joint, so it tends to flare it. Work range within the pain-free arc and build strength and control instead.
What's the clicking?
Clicking or catching that settles is common with impingement and on its own isn't harmful. True locking or the hip giving way is different — that's worth getting checked for an unstable labral tear.

Go deeper

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