Femoral Acetabular Impingement (intro)
Het heupgewricht bestaat uit twee botten het bovenbeen (het femur) en het heupbeen (het art. coxae). Het heupbeen is een deel van het bekken welke daar direct aan verbonden zijn. Het heupbeen bevat aan beide zijde een kom, dit wordt het acetabulum genoemd. De kom is over het algemeen groter dan de kop van het bovenbeen, dit zodat de kop niet (snel) uit de kom kan schieten. Een onderdruk zorgt ervoor dat de heup een soort vacuüm zuigt en beter in de kom blijft zitten, dit noemen we onderdruk. Er komt over het algemeen behoorlijk veel belasting op de heup te staan, door de onderdruk blijft de kop van het bovenbeen stabiel in de heupkom.
Phase 1 of recovery
During this phase, the goal is to improve the mobility of the hip
1. Lateral traction trunk flexion
Get onto your hands and knees on a mat. Place a resistance band around your thigh, as high up as possible. Extend your arms and place your hands in front of you, then move your buttocks towards your heels. Finally, return to the starting position.
2. Dorsal traction with pelvic rotation
Assume a half-kneeling position, with one knee on the ground and the other leg in front of you. Place a resistance band around your thigh, as high up as possible. Shift your weight onto your front leg and rotate your upper body toward your front knee.
3. Dorsal traction squat
Place a resistance band around your upper thigh as high up as possible and position your feet hip-width apart. Perform a squat, hold the position steadily, and slowly return to a standing position.
4. Traction with external rotation
Sit on a mat or towel. Place an elastic band around your upper thigh, as high up as possible. Bring your knee toward your chest and turn your foot inward. Hold your ankle with one hand and your knee with the other, then pull your knee even closer to your chest. Hold this position steadily, then relax your hip.
5. Lateral traction mobilization
Assume a kneeling lunge position, one knee on the ground, the other in front of you. Place a resistance band around your thigh, as high up as possible. Place one hand on your front knee and the other on the ground. Use your hand to move the knee outward and then back inward.
Phase 2 of recovery
During this phase, the goal is to reduce the muscle tension by stretching exercises.
1. Heupbuigers rek
Ga op één knie zitten, plaats het andere been voor je op de grond, kantel het bekken naar voren (maak de rug bol), strek je vervolgens helemaal op en gooi de heupen een klein beetje naar voren.
2. Rekking bovenbeenspier (quadriceps)
Ga achter de stoel staan, houdt met een arm de stoel vast, pak met de andere hand de schoen vast en breng de hak van de schoen richting de bil. Hierbij wordt een lichte rek aan de voorkant van het bovenbeen gevoeld.
3. Stretching glutes while seated
Sit on a bench and place your foot on your other knee. Lean forward slightly and apply light pressure to your knee. Hold this for 3 seconds and relax.
4. Adductor stretching in butterfly position
Sit on the floor, then bring the soles of your feet together and let your knees slowly fall outward. Next, slowly move your knees outward a little further, alternating sides, so that your pelvis moves along with the movement.
Phase 3 of recovery
During this phase the goal is to strenghten the muscles around the hip joint.
1. Gluteus medius walk
Ga op heup breedte staan. Doe het elastiek om, net boven de enkels. Houdt de knieën gestrekt. Verplaats de verste voet opzij, zet het standbeen een klein beetje bij. Verplaats over ongeveer 10 meter op en neer.
2. Hamstring curl
Ga op de rug liggen, plaats beide benen op de bal. Kom met de billen van de grond. Trek vervolgens de hakken naar de bil toe en beweeg weer langzaam terug.
3. Tensor static abduction
Stand with your feet together. Then, lift one leg out to the side, keeping your toes pointing forward. Hold this position, then slowly lower your leg back down.
Resistance band
Hard. Compact. Qualitatively.
Resistance band
Hard. Compact. Qualitatively.
The meaning of a hip impingement
The hip joint is made up of two bones, the thigh bone (femur) and the hip bone (os coxae). The os coxae is connected to 3 different hip bones (pubic, ilium and ischium) that make up the pelvis. The hip bones on both sides of the pelvis contain the hip socket called acetabulum. The socket is larger than the ball (head of femur) and ensures the ball can not dislocate easily. There is a slight vacuum in the hip joint producing suction further helping the ball stay in the socket. There can be a lot of load over the hip joint and this suction helps to keep the ball stable in the socket. A change in shape of the ball or socket can cause a painful compression where the bones (femur and acetabulum) come in contact with each other. This is known as femoral (thigh bone) acetabular (hip socket) impingement (FAI).
The causes of a hip impingement
Femoral acetabular impingement can occur due to a change in shape of the hip joint (often idiopathic). Listed below are the three different types:
Pincer lesion, the acetabulum has excess bone growth causing a limitation in movement in the hip joint. Labral (cartilage ring attached to the edge of the socket) damage can occur and it can be painful at the end of the range of movement.
Cam lesion, a thickening on the femoral head (the ball) limits smooth movement of the ball in the socket. This can damage the socket over time.
Combined, both a pincer and cam lesion are present.
Hip impingement is more common in people between the ages of 15 and 50 and in athletes that play sports requiring a lot of hip rotation (soccer, hockey, gymnastics, basketball etc.)
The symptoms of a hip impingement
Pain, stiffness, limited range of motion and locking of the hip can all be symptoms of FAI. The pain is usually felt in the hip radiating to the groin.
The treatment of a hip impingement
Early diagnosis is important, so care can be taken to reduce load through the hip from a young age to prevent hip damage. When the specialist refers you for physiotherapy treatment it will be aimed at improving the joint movement, stretching the muscles surrounding the hip joint and eventually strengthening the hip muscles. Recovery from FAI ranges from 1 to 6 months.
Synonyms
Femoral acetabular impingement, hip impingement, hip dysplasia, hip deformity, hip stiffness, pain in hip
Advice
If you have any questions regarding the exercises, doubt if you are doing them correctly or aren’t sure they are suited for your condition, please contact your physiotherapist for support.
Attention:
Yourbody.coach offers a range of exercises. Yourbody.coach can not be held responsible if you develop injuries. Always consult your physiotherapist or specialist.