If you get a sharp catch deep at the front of your hip when you lift your knee, turn it inward, or bring it across your body, that is usually not tightness. It is more likely a pinch, and the two need opposite treatment. Here is how to tell, and what actually helps.
Hip anatomy, briefly
Your hip joint is a ball and socket. The ball sits atop your femur, or thigh bone, and that rounded portion is called the head of the femur. The head fits into the socket in your pelvis, which grips it tightly like a baseball glove, and the whole thing is wrapped in a joint capsule of strong connective tissue. The capsule keeps the ball in the socket while your muscles guide the femur around it smoothly through full range.
At least, that is what is supposed to happen.
What can go wrong
If you feel hip pain or catching deep in the front of your hip, you could have femoroacetabular impingement. A pinchy hip.
The movements most often associated with it are pulling your knee up, turning it inward, or bringing it across your body — especially when all of those happen at once, as the picture above shows.
What it feels like
The pain typically occurs deep within your groin or the front of your hip, though in rare cases it can affect the outer hip or buttock. The joint usually feels stiff and sharply restricted in those directions.
It may affect only one side, so it can feel very different to your other hip by comparison. It may come on suddenly after an injury, or build up gradually over time with age and wear.
The giveaway is the sharpness. A tight muscle gives you a stretchy, dragging discomfort. A pinch gives you a catch, and it stops the movement.
Why it happens
The shape of the bones in the joint may be that way from birth, or it may develop in response to overuse or trauma. Some patterns affect younger people, especially athletes.
If the muscles surrounding the socket — typically the hip flexors and internal rotators — are overused and become tight, the ball gets pulled forward in the socket. That shrinks the space at the back of the joint capsule, and as the head of the femur is pushed toward the front of the hip and down, the bone responds by growing where it is being loaded.
These same factors build up gradually over long periods, which is why it also shows up in older people.
This is why tight hip flexors are one of its causes. But the fix is not simply to stretch harder, and that distinction matters. Stretching a pinching hip aggressively usually makes it worse, because you are forcing the very movement that causes the catch.
What makes it worse
If you have hip impingement, you will most likely notice it while:
- sitting for a long period
- walking or running
- crossing your legs
- during or after leg exercise
Sitting is often the worst of these, because it holds the hip in the exact flexed and inward-rotated position that closes the space.
What physiotherapy does about it
If you think this is what you have, see a physiotherapist for proper testing and diagnosis. It is worth confirming rather than assuming, because several things feel similar from the outside and they are treated differently.
Once we have confirmed it, treatment usually includes:
- Mobilising the joint capsule. Applying pressure through the hip joint to stretch out a stiff capsule and buy back some range.
- Releasing the tight muscles. Massage to loosen the muscles around the hip, particularly at the back of the hip and in the buttock, which is often where the restriction is.
- Retraining movement. A range of exercises to improve the control you have over the affected hip, so you draw the ball back and down as you move into triggering positions and avoid bone-on-bone catching.
That last one is the important part. The aim is not to force more range into the joint. It is to get the range you already have, used better.
In some cases a doctor can advise on pain and anti-inflammatory medicine, and in severe cases a surgical consult may be needed. If surgery is the route, your physio plays a vital role afterwards to make sure you recover fully.
Exercises that help
Push the head of the femur back. Lie on your back and lift the knee of your affected leg directly above your hip. Clasp your hands over your knee and push directly down through the line of your thighbone toward the floor. Two sets of ten, with firm pressure.
Push the head down, socket out. Stand with your feet wide apart. Keeping your affected leg straight, bend your other knee and fold through the hips, pushing your bottom out as you go. Once you feel the inner thigh of your affected leg stretch, use your hand to press firmly down on your upper thigh, as high up as you can near the groin. Two sets of ten.
Stretch the front of your hip. Kneel on the knee of your affected leg with your other leg bent up in front. Rest your hands either side of your front foot and press your hips forward and down toward the ground. You should feel a stretch across the front of the affected hip. Hold 30 seconds and repeat.
Go gently with that last one. If it produces the pinch rather than a stretch, stop — you are loading the wrong direction.
These mobilising and alignment exercises work best alongside a proper strengthening program for hip and pelvic stability, which is where our Pilates and hip stability class comes in. The goal is good strength, support and movement control around the whole hip, not just the joint itself.
Where this sits with tightness
A pinch and tightness often travel together, because tight hip flexors are one of the things that causes a pinch. But they are not the same problem and they need different work.
If your main complaint is stiffness rather than a catch, start with where your hip flexors are and why they grip. If you are a runner trying to open up your stride, the full release routine is in hip flexors and your running stride.
For the wider picture on how we assess and treat hips, our hip pain page covers it in more detail.
Join an online class from the comfort of your home — Katrina, the principal physio at The Fix Program, has designed a series of Pilates exercise programs that will help you immensely.
